ACGME Response to COVID-19: Clarification regarding Telemedicine and ACGME Surveys

On Wednesday, March 18, 2020, ACGME President and CEO Thomas J. Nasca, MD, MACP issued a letter to the graduate medical education (GME) community addressing ACGME activities and graduate medical education (GME), including expectations regarding ACGME requirements.

“I and the ACGME recognize and thank the entire GME community for taking a critical role in the nation’s response to the COVID-19 pandemic,” he said. “By engaging the GME programs in your health system’s planning and execution of this response, you have demonstrated the value of GME in fulfilling your organization’s mission. By having faculty members, residents, and fellows engage in the care of COVID-19 patients, the GME community serves as an example of professionalism at the highest level, and one that will serve as a model to be emulated by future faculty members, residents, and fellows.

“The ACGME is fully aware of the tremendous burden of work each GME program faces as you prepare for this national emergency and care for these patients. During this challenging time, we want to remove as many external burdens to your programs that we can. Accordingly, we will suspend some of our activities to allow you to focus on patient care and institutional issues.”

In response to the crisis and more specifically following this letter, the ACGME has been receiving a high volume of questions through email, by phone, and on social media. Our leadership and staff are meeting frequently, and where appropriate, collaborating (electronically) with other organizations, to develop answers and guidance as quickly as possible. Since the release of Dr. Nasca’s letter, two areas where the community is clearly seeking additional guidance and clarification are on telemedicine and the ACGME Resident/Fellow and Faculty Surveys. Below we are providing further explanation on these two topics. As we develop responses to other questions, we’ll provide those to the community through the appropriate means (via email and our website, as well as on social media [Twitter and LinkedIn]).

Telemedicine
As stated in Dr. Nasca’s letter:

Many institutions are deploying telemedicine to continue to care for patients but avoid having them leave home and be at risk for infection. The ACGME has accelerated the use of the Common Program Requirements for supervision of telemedicine visits carried out by residents and fellows, originally scheduled to go into effect July 1, 2020. Instead, effective immediately, the ACGME will permit residents/fellows to participate in the use of telemedicine to care for patients affected by the pandemic.

The definition of Direct Supervision as part of these new telemedicine requirements includes the following classification: “the supervising physician and/or patient is not physically present with the resident and the supervising physician is concurrently monitoring the patient care through appropriate telecommunication technology.”

Ultimately each specialty Review Committee will choose whether to continue to allow for this type of direct supervision with telemedicine in other situations. In no situation will a program be penalized retroactively for appropriate engagement of residents and fellows with appropriate supervision in the use of telemedicine during this crisis.

Additional clarification:
We want to be clear that those residents and fellows who are capable of providing this service (telemedicine) with indirect supervision available or immediately available are covered under the indirect supervision requirements.

Under the circumstances, however, where direct supervision is required in the context of provision of telemedicine care, new Common Program Requirement VI.A.2.c).(1).(b) permits faculty members to provide direct supervision through telecommunications technology. Decisions regarding how this is implemented must be made at the program level, and must be appropriate for the clinical setting and the needs of the individual patient, as well as the health and safety of the resident(s)/fellow(s) and faculty member(s) involved. In some situations, it may be appropriate for a resident/fellow to conduct a patient encounter remotely and then discuss the case with the supervising faculty member, also through remote means. In other situations, the program may determine that the resident/fellow and supervising faculty member should both participate in the patient encounter.

This type of program-level decision making is already in place for other clinical settings, and is addressed in Common Program Requirement VI.A.2.b.(1), which states that the program must demonstrate that the appropriate level of supervision is in place for all residents/fellows based on each resident’s/fellow’s level of education/training and ability, as well as patient complexity and acuity.

ACGME Surveys
As stated in Dr. Nasca’s letter, among other ACGME activities, the annual Resident/Fellow and Faculty Surveys are suspended until future notice to allow the GME community to prioritize patient care duties in line with COVID-19 responsibilities.

Additional clarification:
Surveys will remain available to scheduled participants and the survey closing date has been extended to May 15, 2020, but participation is optional. Currently, programs scheduled to complete the surveys and that choose to continue administering them can still remind survey takers using the reminder tool in the Accreditation Data System (ADS), but the ACGME will stop sending reminders.

For programs that have already reported, and those that choose to continue participating, we will work to create program-specific reports when there is a large enough response rate to protect the confidentiality of the participants. We appreciate the response we have received so far and will provide future updates on the availability of program reports.

A Few Other Notes
The ACGME’s weekly e-Communication will go out on Tuesday, March 24 next week instead of Monday due to an ACGME work holiday. Additionally, out of respect for the demands on and work of the GME community, we are adjusting the current focus of ACGME communication on essential information needed to enable the community to do its job caring for patients and the health of the public. As time moves forward and needs evolve, the regular e-Communication will resume accordingly. This adjustment echoes the focus Dr. Nasca’s letter. The ACGME thanks the GME community for its outstanding, professional response to this crisis.

Finally, in addition to thanking our staff members and the GME community at large, we’d like to acknowledge our volunteers, in particular the members of the Review and Recognition Committees, who will not only continue to serve the community in their ACGME volunteer roles, but who, as your colleagues and peers, are also on the front lines managing this crisis at their own institutions and care settings. They understand your priorities to care for patients first. For those institutions and programs submitting materials and information to the Review and Recognition Committees, we know you understand their need to prioritize those professional responsibilities over their volunteer roles.

This is an extraordinary and unprecedented international health crisis. The ACGME is so proud of the remarkable professional strength of the field to manage it in the face of such uncertainty. We will continue to share information, guidance, and clarification as it is developed. Please continue to take care of your patients, your family and friends, and yourselves.

Email questions about the ACGME’s guidance regarding COVID-19 to ACGMECommunications@acgme.org.