Opinion ID: 1773893
Heading Depth: 2
Heading Rank: 1

Heading: Accredited Residency Programs

Text: After completing medical school, medical students receive an M.D. degree and are eligible to continue their training in a graduate medical education program, commonly referred to as a residency program. [15] Residency programs focus on developing clinical skills and professional competencies and preparing the physicians in the programs (residents) to practice in a medical specialty. Residency training takes place primarily through the residents' provision of patient care while under the supervision of more experienced physicians. During the course of a residency, the resident takes on progressively greater responsibility for patient care. [16] Medical residency programs are accredited under the general authority of the Accreditation Council for Graduate Medical Education (ACGME). [17] St. Joseph's general surgery residency program was accredited by ACGME, which has rigorous, detailed requirements for residency programs. Among other things, ACGME requires that [a] residency program must [operate under the authority and control of] a sponsoring institution. [18] However, general surgery residency programs are sometimes multi-institutional. Sponsoring institutions that cannot provide sufficient resources and clinical experience within their own facilities may make arrangements with other entities, called participating institutions, [19] to provide additional resources and experience. [20] A participating institution may be integrated with the parent or sponsoring institution through an agreement that must specify, among other things: [T]hat the program director of the parent institution: 1) appoints the members of the teaching staff at the integrated institution; 2) appoints the chief or director of the teaching service in the integrated institution; 3) appoints all residents in the program; and, [sic] 4) determines all rotations and assignments of both residents and members of the teaching staff. [21] Although the general rule is that the sponsoring and participating institutions providing a general surgery residency program should be in close geographic proximity, this is not an absolute requirement. [22] Thus, general surgery residents may treat patients at a participating institution some distance away from the sponsoring institution. [23] A sponsoring institution assumes the final responsibility for a program of graduate medical education [24] and must assume responsibility for the educational quality of its sponsored program(s). [25] However, in general surgery residency programs, the ACGME recognizes that the patient's attending physician is responsible for that patient's care and requires the attending physician to supervise any residents involved in providing that care: The attending physician has both an ethical and a legal responsibility for the overall care of the individual patient and for the supervision of the resident involved in the care of that patient. Although [senior residents] require less direction than junior residents, even the most senior resident must be supervised. A chain of command that emphasizes graded authority and increasing responsibility as experience is gained must be established. Judgments on this delegation of responsibility must be made by the attending surgeon who is ultimately responsible for the patient's care; [such judgments shall be] based on [the attending surgeon's] direct observation and knowledge of each resident's skills and ability. [26]