Appendix Q – ACGME Program Requirements for GME in Dermatology (Effective 7/1/2023)

ACGME Program Requirements for
Graduate Medical Education
in Dermatology
Revision Information
ACGME-approved focused revision: June 12, 2022; effective July 1, 2022
Updated to include revised Common Program Requirements, effective July 1, 2023
Definitions
For more information, see the ACGME Glossary of Terms.
Core Requirements: Statements that define structure, resource, or process elements
essential to every graduate medical educational program.
Detail Requirements: Statements that describe a specific structure, resource, or
process, for achieving compliance with a Core Requirement. Programs and
sponsoring institutions in substantial compliance with the Outcome Requirements may
utilize alternative or innovative approaches to meet Core Requirements.
Outcome Requirements: Statements that specify expected measurable or observable
attributes (knowledge, abilities, skills, or attitudes) of residents or fellows at key stages
of their graduate medical education.
Osteopathic Recognition
For programs with or applying for Osteopathic Recognition, the Osteopathic Recognition
Requirements also apply (www.acgme.org/OsteopathicRecognition).

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I.
Oversight..
I.A.
Sponsoring Institution
I.B.
Participating Sites..
I.C
Workforce Recruitment and Retention
I.D.
Resources
L.E.
Other Learners and Health Care Personnel
Il. Personnel
II.A.
II.B.
Program Director
Faculty.
II.C.
Program Coordinator.
II.D.
Other Program Personnel
IlI. Resident Appointments…
III.A.
III.B.
Eligibility Requirements
Resident Complement…
III.C.
Resident Transfers…
IV. Educational Program…
IV.A.
Educational Components..
IV.B.
ACGME Competencies
Curriculum Organization and Resident Experiences
IV.D.
Scholarship
V. Evaluation..
V.A.
Resident Evaluation
V.B.
V.C.
Faculty Evaluation.
Program Evaluation and Improvement
VI. The Learning and Working Environment..
VI.A.
Patient Safety, Quality Improvement, Supervision, and Accountability
VI.B
Professionalism
VI.C.
Well-Being
VI.D.
Fatigue Mitigation
VI.E.
Clinical Responsibilities, Teamwork, and Transitions of Care
VI.F.
Clinical Experience and Education
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common rogram neyuremens (nesiuency/ are li DuLu
Where applicable, text in italics describes the underlying philosophy of the requirements in that
section. These philosophic statements are not program requirements and are therefore not
citable.
Introduction
Int.A.
Definition of Graduate Medical Education
Graduate medical education is the crucial step of professional
development between medical school and autonomous clinical practice. It
is in this vital phase of the continuum of medical education that residents
learn to provide optimal patient care under the supervision of faculty
members who not only instruct, but serve as role models of excellence,
compassion, cultural sensitivity, professionalism, and scholarship.
Graduate medical education transforms medical students into physician
scholars who care for the patient, patient’s family, and a diverse
community; create and integrate new knowledge into practice; and educate
future generations of physicians to serve the public. Practice patterns
established during graduate medical education persist many years later.
Graduate medical education has as a core tenet the graded authority and
responsibility for patient care. The care of patients is undertaken with
appropriate faculty supervision and conditional independence, allowing
residents to attain the knowledge, skills, attitudes, judgment, and empathy
required for autonomous practice. Graduate medical education develops
physicians who focus on excellence in delivery of safe, equitable,
affordable, quality care; and the health of the populations they serve.
Graduate medical education values the strength that a diverse group of
physicians brings to medical care, and the importance of inclusive and
psychologically safe learning environments.
Graduate medical education occurs in clinical settings that establish the
foundation for practice-based and lifelong learning. The professional
development of the physician, begun in medical school, continues through
environment that emphasizes joy in curiosity, problem-solving, academic
rigor, and discovery. This transformation is often physically, emotionally,
and intellectually demanding and occurs in a variety of clinical learning
environments committed to graduate medical education and the well-being
of patients. residents. fellows. facult members. students. and all members

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The educational program in dermatology must be 36 months in length.
(Core)
I.
Oversight
I.A.
Sponsoring Institution
The Sponsoring Institution is the organization or entity that assumes the
ultimate financial and academic responsibility for a program of graduate
medical education, consistent with the ACGME Institutional Requirements.
When the Sponsoring Institution is not a rotation site for the program, the
most commonly utilized site of clinical activity for the program is the
primary clinical site.
Background and Intent: Participating sites will reflect the health care needs of the
community and the educational needs of the residents. A wide variety of organizations
may provide a robust educational experience and, thus, Sponsoring Institutions and
participating sites may encompass inpatient and outpatient settings including, but not
limited to a university, a medical school, a teaching hospital, a nursing home, a school
of public health, a health department, a public health agency, an organized health care
delivery system, a medical examiner’s office, an educational consortium, a teaching
health center, a physician group practice, federally qualified health center, or an
educational foundation.
I.A.1.
The program must be sponsored by one ACME-accredited
Sponsoring Institution. (Core)
I.B.
I.B.1.
1.B.2.
Participating Sites
A participating site is an organization providing educational experiences or
educational assignments/rotations for residents.
The program, with approval of its Sponsoring Institution, must
lesignate a primary clinical site. (Core)
There must be a program letter of agreement (PLA) between the
program and each participating site that governs the relationship
etween the program and the participating site providing a requires
ssianment. (Core
Tha PI A mist.

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I.B.3.a)
At each participating site there must be one faculty member,
designated by the program director as the site director, who
is accountable for resident education at that site, in
collaboration with the program director. (Core)
Background and Intent: While all residency programs must be sponsored by a single
ACGME-accredited Sponsoring Institution, many programs will utilize other clinical
settings to provide required or elective training experiences. At times it is appropriate
to utilize community sites that are not owned by or affiliated with the Sponsoring
Institution. Some of these sites may be remote for geographic, transportation, or
communication issues. When utilizing such sites, the program must ensure the quality
of the educational experience.
Suggested elements to be considered in PLAs will be found in the Guide to the
Common Program Requirements. These include:
Identifying the faculty members who will assume educational and supervisory
•
responsibility for residents
Specifying the responsibilities for teaching, supervision, and formal evaluation
of residents
••
Specifying the duration and content of the educational experience
Stating the policies and procedures that will govern resident education during
the assignment
I.B.4.
The program director must submit any additions or deletions of
participating sites routinely providing an educational experience,
required for all residents, of one month full time equivalent (FTE) or
more through the ACGME’s Accreditation Data System (ADS). (Core)
I.B.5.
Required rotations to participating sites that are geographically distant
from the Sponsoring Institution must offer educational opportunities not
available locally that significantly augment residents’ overall educational
experience. (Detail)
I.B.6.
Rotational experiences occurring outside of the Sponsoring Institution
should occur with a clear educational rationale that does not place
learning or resident well-being at risk as a result of significant or
burdensome daily travel or transit time to reach the clinical education site.
(Detail)
I.C.
Workforce Recruitment and Retention

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individuals underrepresented in medicine and medical leadership in accordance with
[the Sponsoring Institution’s mission and aims.
I.D.
I.D.1.
I.D.1.a)
Resources
The program, in partnership with its Sponsoring Institution, must
ensure the availability of adequate resources for resident education.
(Core)
The program must provide equipment for taking and reviewing
I.D.1.b)
I.D.1.c)
laptop computer and digital projector, and a viewing room with a
projection screen. (Detail)
There must be adequate space available for didactic conferences.
(Detail)
There must be a sufficient number of adult and pediatric patients
to ensure adequate exposure to and education in medical,
pediatric, surgical, and procedural dermatology as evidenced by
residents reaching graduate-level milestones by the end of the
I.D. 1.d)
I.D.2.
I.D.2.a)
I.D.2.b)
There must be a sufficient number of dermatopathology
specimens available to and reviewed by residents to ensure
adequate exposure to and education in dermatopathology. (Core)
ensure neat, y and sate learning as Sponsore visitents that.
promote resident well-being and provide for:
access to food while on duty; (Core)
safe, quiet, clean, and private sleep/rest facilities available
and accessible for residents with proximity appropriate for
safe patient care; (Core)
Background and Intent: Care of patients within a hospital or health system occurs
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capapites, win proximity appropriate tor sate patient care;
(Core)
Background and Intent: Sites must provide private and clean locations where residents
may lactate and store the milk within a refrigerator. These locations should be in close
proximity to clinical responsibilities. It would be helpful to have additional support
within these locations that may assist the resident with the continued care of patients,
such as a computer and a phone. While space is important, the time required for
lactation is also critical for the well-being of the resident and the resident’s family, as
outlined in VI.C.1.c) (1).
I.D.2.d)
security and safety measures appropriate to the participating
site; and, (Core)
I.D.2.e)
accommodations for residents with disabilities consistent
with the Sponsoring Institution’s policy. (Core)
I.D.3.
Residents must have ready access to specialty-specific and other
appropriate reference material in print or electronic format. This
must include access to electronic medical literature databases with
full text capabilities.
I.E.
Other Learners and Health Care Personnel
The presence of other learners and other health care personnel, including
but not limited to residents from other programs, subspecialty fellows, and
advanced practice providers, must not negatively impact the appointe
esidents’ education. (Core
Background and Intent: The clinical learning environment has become increasingly
complex and often includes care providers, students, and post-graduate residents and
II.
II.A.
II.A.1.
Personnel
Program Director
There must be one faculty member appointed as program director
with authority and accountability for the overall program, including

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Dackgrouna ana intent: vynue ine Moome recognizes ine value or input trom
numerous individuals in the management of a residency, a single individual must be
designated as program director and have overall responsibility for the program. The
program director’s nomination is reviewed and approved by the GMEC.
II.A.1.b)
The program must demonstrate retention of the program
director for a length of time adequate to maintain continuity
of leadership and program stability. (Core)
Background and Intent: The success of residency programs is generally enhanced by
continuity in the program director position. The professional activities required of a
II.A.2.
II.A.2.a)
Program leadership, in aggregate, must be provided with the
dedicated minimum time specified below for administration of the
program. This may be time spent by the program director only or
divided between the program director and one or more associate
(or assistant) program directors. (Core)
Number of Approved
Minimum FTE
Resident Positions
Required
12 or fewer
0.2
13-18
0.3
19 or more
0.4
Specialty-Specific Background and Intent: Successful administration of a dermatology
II.A.2.a).(1)
II.A.2.a). (2)
The appointed term of an interim director should not
exceed six months.
(Core)
If the temporary absence is eight weeks or longer, the
Review Committee must be notified via ADS. (Core)

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serving as eaucauon ana aamınıstrauve leaders or residency programs, as well as
those significantly engaged in the education, supervision, evaluation, and mentoring of
residents, must have sufficient dedicated professional time to perform the vital
activities required to sustain an accredited program.
The ultimate outcome of graduate medical education is excellence in resident
education and patient care.
The program director and, as applicable, the program leadership team, devote a
portion of their professional effort to the oversight and management of the residency
program, as defined in II.A.4.-Il.A.4.a).(12). Both provision of support for the time
required for the leadership effort and flexibility regarding how this support is provided
are important. Programs, in partnership with their Sponsoring Institutions, may provide
support for this time in a variety of ways. Examples of support may include, but are not
limited to, salary support, supplemental compensation, educational value units, or
relief of time from other professional duties.
Program directors and, as applicable, members of the program leadership team, who
are new to the role may need to devote additional time to program oversight and
management initially as they learn and become proficient in administering the
program. It is suggested that during this initial period the support described above be
increased as needed.
In addition, it is important to remember that the dedicated time and support
requirement for ACGME activities is a minimum, recognizing that, depending on the
unique needs of the program, additional support may be warranted. The need to
ensure adequate resources, including adequate support and dedicated time for the
program director, is also addressed in Institutional Requirement II.B.1. The amount of
support and dedicated time needed for individual programs will vary based on a
number of factors and may exceed the minimum specified in the applicable
specialty/subspecialty-specific Program Requirements. It is expected that the
Sponsoring Institution, in partnership with its accredited programs, will ensure support
for program directors to fulfill their program responsibilities effectively.
II.A.3.
Qualifications of the program director:
II.A.3.a)
must include specialty expertise and at least three years of
locumented educational and/or administrative experience, o
ualifications acceptable to the Review Committee: (Core

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In certain circumstances, the program and Sponsoring Institution may propose and the
Review Committee may accept a candidate for program director who fulfills these
goals but does not meet the three-year minimum.
II.A.3.b)
II.A.3.c)
must include current certification in the specialty for which
they are the program director by the American Board of
Dermatology or by the American Osteopathic Board of
Dermatology, or specialty qualifications that are acceptable to
the Review Committee; (Core)
must include ongoing clinical activity; and, (Core)
Background and Intent: A program director is a role model for faculty members and
residents. The program director must participate in clinical activity consistent with the
specialty. This activity will allow the program director to role model the Core
Competencies for the faculty members and residents.
II.A.3.d)
must include a minimum of one year of documented experience
serving as a core faculty member for an ACGME-accredited
dermatology program, or specialty qualifications that are
acceptable to the Review Committee. (Core)
II.A.4.
Program Director Responsibilities
The program director must have responsibility, autority, and
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Il.A.4.a)
II.A.4.a).(1)
The program director must:
be a role model of professionalism; (Core)
Background and Intent: The program director, as the leader of the program, must serve
as a role model to residents in addition to fulfilling the technical aspects of the role. As
residents are expected to demonstrate compassion, integrity, and respect for others,
they must be able to look to the program director as an exemplar. It is of utmost
importance, therefore, that the program director model outstanding professionalism,
high quality patient care, educational excellence, and a scholarly approach to work.
The program director creates an environment where respectful discussion is welcome,
lith the anal af mantinuad imnrausmant af tha Arlastianal sunArianns

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eaucaton is to improve ine near or te pusic. can communiy nas near neeas inar
vary based upon location and demographics. Programs must understand the structural
and social determinants of health of the populations they serve and incorporate them
in the design and implementation of the program curriculum, with the ultimate goal of
addressing these needs and eliminating health disparities.
II.A.4.a).(3)
administer and maintain a learning environment
conducive to educating the residents in each of the
ACGME Competency domains; (Core)
Background and Intent: The program director may establish a leadership team to
assist in the accomplishment of program goals. Residency programs can be highly
complex. In a complex organization, the leader typically has the ability to delegate
authority to others, yet remains accountable. The leadership team may include
physician and non-physician personnel with varying levels of education, training, and
experience.
II.A.4.a).(4)
have the authority to approve or remove physicians
and non-physicians as faculty members at all
participating sites, including the designation of core
faculty members, and must develop and oversee a
process to evaluate candidates prior to approval; (Core)
Background and Intent: The provision of optimal and safe patient care requires a team
approach. The education of residents by non-physician educators may enable the
resident to better manage patient care and provides valuable advancement of the
residents’ knowledge. Furthermore, other individuals contribute to the education of
residents in the basic science of the specialty or in research methodology. If the
program director determines that the contribution of a non-physician individual is
significant to the education of the residents, the program director may designate the
individual as a program faculty member or a program core faculty member.
II.A.4.a).(5)
have the authority to remove residents from
supervising interactions and/or learning environments
that do not meet the standards of the program; (Core)

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brequeste p te Momo and optaining requisite sign-on py ne uiu.
II.A.4.a).(7)
II.A.4.a).(8)
provide a learning and working environment in which
residents have the opportunity to raise concerns,
report mistreatment, and provide feedback in a
confidential manner as appropriate, without fear of
intimidation or retaliation; (Core)
ensure the program’s compliance with the Sponsoring
Institution’s policies and procedures related to
grievances and due process, including when action is
Background and Intent: A program does not operate independently of its Sponsoring
royan arie facing memora por parame, and rede moring
II.A.4.a).(9)
ensure the program’s compliance with the Sponsoring
Institution’s policies and procedures on employment
and non-discrimination; (Core)
II.A.4.a).(9).(a)
II.A.4.a).(10)
II.A.4.a).(11)
Residents must not be required to sign a non-
competition guarantee or restrictive covenant.
(Core)
document verification of education for all residents
within 30 days of completion of or departure from the
program; and, (Core)
provide verification of an individual resident’s
(crucation upon the resident’s request, within 30 days.
Background and Intent: Primary verification of graduate medical education is
important to credentialing of physicians for further training and practice. Such
verification must be accurate and timely. Sponsoring Institution and program policies

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members experience the pride and joy of fostering the growth and
development of future colleagues. The care they provide is enhanced by
the opportunity to teach and model exemplary behavior. By employing a
scholarly approach to patient care, faculty members, through the graduate
medical education system, improve the health of the individual and the
population.
Faculty members ensure that patients receive the level of care expected
from a specialist in the field. They recognize and respond to the needs of
the patients, residents, community, and institution. Faculty members
provide appropriate levels of supervision to promote patient safety. Faculty
members create an effective learning environment by acting in a
profesional manner and attending to the well-being of the residents and
themselves.
Background and Intent: “Faculty” refers to the entire teaching force responsible for
educating residents. The term “faculty,” including “core faculty,” does not imply or
require an academic appointment.
II.B.1.
There must be a sufficient number of faculty members with
competence to instruct and supervise all residents. (Core)
II.B.2.
II.B.2.a)
II.B.2.b)
Faculty members must:
be role models of profesionalism; (Core)
digh-gustiay cost effective, pate delivente oe sare guitable,
Background and Intent: Patients have the right to expect quality, cost-effective care
with patient safety at its core. The foundation for meeting this expectation is formec
luring residency and fellowship. Faculty members model these goals and continuall
strive for improvement in care and cost, embracing a commitment to the patient and
II.B.2.c)
demonstrate a strong interest in the education of residents,
including devoting sufficient time to the educational program
to fulfill their supervisory and teaching responsibilities; (Core)
II.B.2.d)
administer and maintain an educational environment
conducive to educating residents; (Core)
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programming developea tor ine purpose or ennancing transterence or knowieage, sKill,
and behavior from the educator to the learner. Faculty development may occur in a
variety of configurations (lecture, workshop, etc.) using internal and/or external
resources. Programming is typically needs-based (individual or group) and may be
specific to the institution or the program. Faculty development programming is to be
reported for the residency program faculty in the aggregate.
as educators and evaluators; (Detail)
II.B.2.f).(1)
II.B.2.f).(2)
II.B.2.f).(3)
in quality improvement, eliminating health inequities,
and patient safety; (Detail)
in fostering their own and their residents’ well-being;
and, (Detail)
II.B.2.f).(4)
n patient care based on their practice-based learnin
and improvement efforts, (Detail
Background and Intent: Practice-based learning serves as the foundation for the
practice of medicine. Through a systematic analysis of one’s practice and review of the
literature, one is able to make adjustments that improve patient outcomes and care.
Thoughtful consideration to practice-based analysis improves quality of care, as well
as patient safety. This allows faculty members to serve as role models for residents in
practice-based learning.
II.B.3.
Faculty Qualifications
II.B.3.a)
Faculty members must have appropriate qualifications in
foreir field and hold appropriate institutional appointments.
II.B.3.b)
II.B.3.b).(1)
Physician faculty members must:
have current certification in the specialty by the
American Board of Dermatology or the American
Osteopathic Board of Dermatology, or possess
qualifications judged acceptable to the Review
Committee. (Core)
II.B.3.b). (1). (a)
Physician faculty members directing resident
education in dermatopathology should have
subspecialty certification in dermatopathology by
tho Amorican Board of Dormatolony ortho

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conference educators, workshop leaders, and as clinical team members
II.B.4.
Core Faculty
Core faculty members must have a significant role in the education
and supervision of residents and must devote a significant portion
of their entire effort to resident education and/or administration, and
must, as a component of their activities, teach, evaluate, and
provide formative feedback to residents. (Core)
Background and Intent: Core faculty members are critical to the success of resident
education. They support the program leadership in developing, implementing, and
assessing curriculum, mentoring residents, and assessing residents’ progress toward
achievement of competence in and the autonomous practice of the specialty. Core
faculty members should be selected for their broad knowledge of and involvement in
the program, permitting them to effectively evaluate the program. Core faculty
members may also be selected for their specific expertise and unique contribution to
the program. Core faculty members are engaged in a broad range of activities, which
may vary across programs and specialties. Core faculty members provide clinical
teaching and supervision of residents, and also participate in non-clinical activities
related to resident education and program administration. Examples of these non-
clinical activities include, but are not limited to, interviewing and selecting resident
applicants, providing didactic instruction, mentoring residents, simulation exercises,
completing the annual ACGME Faculty Survey, and participating on the program’s
Clinical Competency Committee, Program Evaluation Committee, and other GME
committees.
II.B.4.a)
II.B.4.b)
II.C.
II.C.1.
II.C.2.
Core faculty members must complete the annual ACGME
Faculty Survey. (Core)
There should be a core faculty member-to-resident ratio of at least
one-to-three. (Core)
Program Coordinator
There must be a program coordinator. (Core)
The program coordinator must be provided with dedicated time and
support adequate for administration of the program based upon its
size and configuration. (Core)
At a minimum the nonram ronrlinator mict ha nravidad with the
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Background and Intent: The requirement does not address the source of funding
required to provide the specified salary support.
Each program requires a lead administrative person, frequently referred to as a
program coordinator, administrator, or as otherwise titled by the institution. This
person will frequently manage the day-to-day operations of the program and serve as
an important liaison and facilitator between the learners, faculty and other staff
members, and the ACGME. Individuals serving in this role are recognized as program
coordinators by the ACGME.
The program coordinator is a key member of the leadership team and is critical to the
success of the program. As such, the program coordinator must possess skills in
leadership and personnel management appropriate to the complexity of the program.
Program coordinators are expected to develop in-depth knowledge of the ACGME and
Program Requirements, including policies and procedures. Program coordinators
assist the program director in meeting accreditation requirements, educational
programming, and support of residents.
Programs, in partnership with their Sponsoring Institutions, should encourage the
professional development of their program coordinators and avail them of
opportunities for both professional and personal growth. Programs with fewer
residents may not require a full-time coordinator; one coordinator may support more
than one program.
The minimum required dedicated time and support specified in II.C.2.a) is inclusive of
activities directly related to administration of the accredited program. It is understood
that coordinators often have additional responsibilities, beyond those directly related
to program administration, including, but not limited to, departmental administrative
responsibilities, medical school clerkships, planning lectures that are not solely
intended for the accredited program, and mandatory reporting for entities other than
the ACGME. Assignment of these other responsibilities will necessitate consideration
of allocation of additional support so as not to preclude the coordinator from devotin
he time specified above solely to administrative activities that support the accreditec
program.
In addition, it is important to remember that the dedicated time and support
requirement for ACGME activities is a minimum, recognizing that, depending on the
unique needs of the program, additional support may be warranted. The need to
ensure adequate resources, including adequate support and dedicated time for the
program coordinator, is also addressed in Institutional Requirement II.B.4. The amount
of support and dedicated time needed for individual programs will vary based on a

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ensure me avalauly i necessary persummer lur me enevuve
administration of the program. (Core)
II.D.1.
The Sponsoring Institution must ensure the availability of adequate
clerical, clinical, and nursing personnel to ensure that residents’ duties
principally encompass the diagnosis and treatment of patients, and not
duties which are primarily clerical or nursing in nature. (Core)
Background and Intent: Multiple personnel may be required to effectively administer a
program. These may include staff members with clerical skills, project managers,
education experts, and staff members to maintain electronic communication for the
program. These personnel may support more than one program in more than one
III.
III.A.
III.A.1.
Resident Appointments
Eligibility Requirements
An applicant must meet one of the following qualifications to be
eligible for appointment to an ACGME-accredited program: (Core)
III.A.1.a)
III.A.1.b)
III.A.1.b).(1)
III.A.1.b).(2)
III.A.2.
graduation from a medical school in the United States or
Canada, accredited by the Liaison Committee on Medical
Education (LCME) or graduation from a college of
osteopathic medicine in the United States, accredited by the
American Osteopathic Association Commission on
Osteopathic College Accreditation (AOACOCA); or, (Core)
graduation from a medical school outside of the United
States or Canada, and meeting one of the following additional
qualifications: (Core)
holding a currently valid certificate from the
Educational Commission for Foreign Medical
Graduates (ECFMG) prior to appointment; or, (Core)
holding a full and unrestricted license to practice
medicine in the United States licensing jurisdiction in
which the ACGME-accredited program is located. (Core)
All prerequisite post-graduate clinical education required for initial
entry or transfer into ACGME-accredited residency programs must
he comnlatad in ACGMF-accraditad racidency nronrams ANA.

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resent a lever or competency in me reyunreu cunicar neru
using ACGME, CanMEDS, or ACGME-I Milestones evaluations
from the prior training program upon matriculation. (Core)
III.A.2.a).(1)
Prior to appointment in the program, residents must have
successfully completed a broad-based clinical year (PGY-

1. in an emergency medicine, family medicine, general
   surgery, internal medicine, obstetrics and gynecology,
   pediatrics, or transitional year program accredited by the
   ACGME, or in such a program that satisfies the
   requirements in III.A.2. (Core)
   III.A.2.a). (1).(a)
   During the broad-based clinical year (PGY-1),
   elective rotations in dermatology must not exceed a
   total of two months. (Core)
   Background and Intent: Programs with ACGME-| Foundational Accreditation or from
   institutions with ACGME-| accreditation do not qualify unless the program has also
   achieved ACGME-| Advanced Specialty Accreditation. To ensure entrants into ACGME-
   accredited programs from ACGME-I programs have attained the prerequisite
   milestones for this training, they must be from programs that have ACGME-| Advanced
   Specialty Accreditation.
   III.B.
   Resident Complement
   The program director must not appoint more residents than approved by
   the Review Committee. (Core)
   Background and Intent: Programs are required to request approval of all complement
   changes, whether temporary or permanent, by the Review Committee through ADS.
   applicable specialty section of the ACGME website.
   III.C.
   Resident Transfers
   The program must obtain verification of previous educational experiences
   and a summative competency-based performance evaluation prior to
   acceptance of a transferring resident, and Milestones evaluations upon
   natriculation. (Core)
   Edurational Dronram

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melo rebuynceu mat pruyrams may prace umerem emprasis un rescarel,
leadership, public health, etc. It is expected that the program aims will reflect the
nuanced program-specific goals for it and its graduates; for example, it is
expected that a program aiming to prepare physician-scientists will have a
different curriculum from one focusing on community health.
IV.A.
Educational Components
The curriculum must contain the following educational components:
IV.A.1.
a set of program aims consistent with the Sponsoring Institution’s
nission, the needs of the community it serves, and the desirec
listinctive capabilities of its graduates, which must be made
available to program applicants, residents, and faculty members;
IV.A.2.
competency-based goals and objectives for each educational
experience designed to promote progress on a trajectory to
autonomous practice. These must be distributed, reviewed, and
available to residents and faculty members; (Core)
Background and Intent: The trajectory to autonomous practice is documented by
lilestones evaluations. Milestones are considered formative and should be used t
dentify learning needs. Milestones data may lead to focused or general curricular
revision in any given program or to individualized learning plans for any specific
resident.
IV.A.3.
Background and Intent: These responsibilities may generally be described by PGY
level and specifically by Milestones progress as determined by the Clinical
Competency Committee. This approach encourages the transition to competency-
based education. An advanced learner may be granted more responsibility
independent of PGY level and a learner needing more time to accomplish a certain task
IV.A.4.
a broad range of structured didactic activities; and, (Core)
IV.A.4.a)
Residents must be provided ith protected time to participate
in core didactic activities.
[RsalarAlInd snd Intont. lt ie intandad that racidante will MaMtiAingto in etrIlntiirar
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IV.A.o.
Tormal educational cavities promote parent sarry-related
goals, tools, and techniques.
IV.B.
ACGME Competencies
Background and Intent: The Competencies provide a conceptual framework describing
the required domains for a trusted physician to enter autonomous practice. These
Competencies are core to the practice of all physicians, although the specifics are
further defined by each specialty. The developmental trajectories in each of the
Competencies are articulated through the Milestones for each specialty.
IV.B.1.
The program must integrate the following ACGME Competencies
into the curriculum:
IV.B.1.a)
Professionalism
Residents must demonstrate a commitment to
professionalism and an adherence to ethical principles. (Core)
IV.B.1.a).(1)
IV.B.1.a).(1).(a)
Residents must demonstrate competence in:
Compassion, integrity, and respect for others;
IV.B.1.a).(1).(b)
esponsiveness to patient needs tha
upersedes self-interest: (Cor
IV.B.1.a).(1).(c)
IV.B.1.a).(1).(d)
IV.B.1.a).(1).(e)
cultural humility; (Core)
respect for patient privacy and autonomy; (Core)
accountabilitoreo patients, society, and the
protession:
IV.B.1.a).(1).(f)
respect and responsiveness to diverse patient
populations, including but not limited to
diversity in gender, age, culture, race, religion,
disabilities, national origin, socioeconomic
status, and sexual orientation; (Core)
IV.B.1.a).(1).(g)
ability to recognize and develop a plan for one’s
own personal and professional well-being; and,
(Core)

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situaton pasea on skill set or knowieage pase.
IV.B.1.b)
Patient Care and Procedural Skills
Background and Intent: Quality patient care is safe, effective, timely, efficient, patient-
centered, equitable, and designed to improve population health, while reducing per
capita costs. In addition, there should be a focus on improving the clinician’s well-
being as a means to improve patient care and reduce burnout among residents,
fellows, and practicing physicians.
IV.B.1.b).(1)
IV.B. 1.b). (1).(a)
IV.B.1.b). (1).(a). (i)
IV.B.1.b).(2)
IV.B.1.b). (2).(a)
IV.B.1.b).(2).(b)
Residents must be able to provide patient care that is
patient- and family-centered, compassionate,
equitable, appropriate, and effective for the treatment
of health problems and the promotion of health. (Core)
Residents are expected to demonstrate the ability
to manage patients:
in a variety of roles within a health system,
with progressive responsibility, to include
serving as the principal provider, continuity
provider, the leader or member of a multi-
disciplinary team of providers, a consultant
to other physicians, and a teacher to the
patient and other physicians. (Core)
Residents must be able to perform all medical,
diagnostic, and surgical procedures considered
essential for the area of practice. (Core)
Residents must demonstrate competence in skin
biopsy techniques, including local anesthesia and
regional blocks, destruction of benign and
malignant tumors, excision of benign and malignant
tumors, and closures of surgical defects using
layered repairs, in patients of all ages, with
attention to the chronologic and developmental age
of the patient. (Core)
Residents must gain competence through direct
clinical experiences in the application and
interpretation of patch test procedures, and in
raincelina nationte on the recrilte (Core)

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IV.B.1.b) (2).(e)
IV.B.1.b).(2).(f)
IV.B.1.c)
IV.B.1.c).(1)
IV.B.1.c). (2)
IV.B.1.c).(3)
IV.B.1.c).(4)
IV R 1 c) (5)
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Residents must demonstrate competence in
ordering and interpreting results of dermatology-
relevant serologic testing. (Core)
Residents must demonstrate competence in the
use of and indications/contraindications for
photomedicine, phototherapy, and topical/systemic
pharmacologic therapies in all age groups,
including infants and young children. (Core)
Medical Knowledge
Residents must demonstrate knowledge of established and
evolving biomedical, clinical, epidemiological, and social-
behavioral sciences, including scientific inquiry, as well as
the application of this knowledge to patient care. (Core)
Residents must demonstrate competence in their
knowledge of pathophysiology and diagnosis and
management of complex medical dermatologic conditions
in both adults and children. (Core)
Residents must demonstrate competence in their
knowledge of risks and benefits of commonly used
dermatologic therapies in infants and children compared to
the risks and benefits of those therapies when used in
adults. (Core)
Residents must demonstrate competence in the
knowledge of diseases specific to pediatric patients, to
include neonatal disorders, congenital neoplasms and
hamartomas, cutaneous signs of child abuse, and
cutaneous manifestations of inherited and sporadic
multisystem diseases. (Core)
Residents must demonstrate knowledge of proper
techniques for botulinum toxin injections, soft tissue
augmentation, repairs of cutaneous surgical defects using
flaps and grafts, and the use of light, laser, and other
energy-based modalities for skin conditions. (Core)
Residents must demonstrate knowledae of indications and
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IV.B.1.c).(6)
IV.B.1.d)
IV.B.1.d). (1)
IV.B.1.d).(1).(a)
IV.B.1.d). (1).(b)
IV.B.1.d). (1).(c)
IV.B.1.d). (1).(d)
IV.B.1.dl) (1).(e)
IV.B.1.d). (1).(f)
IV.B.1.e)
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Residents must demonstrate competence in their
knowledge of the interpretation of molecular diagnostic
tests and direct immunofluorescence specimens.
Practice-based Learning and Improvement
Residents must demonstrate the ability to investigate and
evaluate their care of patients, to appraise and assimilate
scientific evidence, and to continuously improve patient care
based on constant self-evaluation and lifelong learning. (Core)
Residents must demonstrate competence in:
identifying strengths, deficiencies, and limits in
one’s knowledge and expertise; (Core)
setting learning and improvement goals; (Core)
identifying and performing appropriate learning
activities; (Core)
systematically analyzing practice using quality
improvement methods, including activities
aimed at reducing health care disparities, and
mplementing changes with the goal of practic
mprovement: (Core
incorporating feedback and formative
evaluation into daily practice; and, (Core)
locating, appraising, and assimilating evidence
heath problems, lies related to their patients:
Interpersonal and Communication Skills
Residents must demonstrate interpersonal and
communication skills that result in the effective exchange of
information and collaboration with patients, their families,
and health professionals.

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IV.B.1.e).(1).(b)
IV.B.1.e).(1) (c)
IV.B.1.e).(1).(d)
IV.B.1.e).(1).(e)
IV.B.1.e).(1).(f)
IV.B.1.e). (1) (g)
IV.B.1.e).(2)
IV.B.1.f)
su caul pavent, “
communicating effectively with physicians,
other health professionals, and health-related
agencies; (Core)
working effectively as a member or leader of a
health care team or other professional group;
(Core)
educating patients, patients’ families, students,
other residents, and other health professionals;
acting in a consultative role to other physicians
and health professionals; (Core)
maintaining comprehensive, timely, and legible
health care records, if applicable; and, (Core)
counseling patients regarding their disease and
treatment options, and providing appropriate
anticipatory guidance to parents and, as age-
appropriate, to children, regarding chronic
disorders, genodermatoses, and congenital
cutaneous anomalies. (Core)
Residents must learn to communicate with patients
and patients’ families to partner with them to assess
their care goals, including, when appropriate, end-of-
life goals. (Core)
Systems-based Practice
Residents must demonstrate an awareness of and
responsiveness to the larger context and system of health
care, including the structural and social determinants of
ealth, as well as the ability to call effectively on othel
esources to provide optimal health care. (Core
Background and Intent: Medical practice occurs in the context of an increasingly
complex clinical care environment where optimal patient care requires attention t
omoliance with external and internal administrative and regulatorv reauirements

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Iv.D.I.I)-[”)-(a)
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courumanny pauent care acruss te neali care
continuum and beyond as relevant to their
clinical specialty; (Core)
Background and Intent: Every patient deserves to be treated as a whole person.
Therefore it is recognized that any one component of the health care system does not
meet the totality of the patient’s needs. An appropriate transition plan requires
coordination and forethought by an interdisciplinary team. The patient benefits from
proper care and the system benefits from proper use of resources.
IV.B.1.f).(1).(b)
advocating for quality patient care and optimal
patient care systems; (Core)
IV.B.1.f).(1).(c)
participating in identifying system errors and
implementing potential systems solutions; (Core)
IV.B.1.f).(1).(d)
incorporating considerations of value, equity,
cost awareness, delivery and payment, and
risk-benefit analysis in patient and/or
population-based care as appropriate; (Core)
IV.B.1.f). (1).(e)
understanding health care finances and its
impact on individual patients’ health decisions;
and, (Core)
IV.B.1.f).(1).(f)
IV.B.1.f).(2)
using tools and techniques that promote patient
safety and disclosure of patient safety events
(real or simulated). (Detail)
Residents must learn to advocate for patients within
the health care system to achieve the patient’s and
patient’s family’s care goals, including, when
appropriate, end-of-life goals. (Core)
IV.C.
IV.C.1.
Curriculum Organization and Resident Experiences
The curriculum must be structured to optimize resident educational
[Rankaraund and Intant. In enma enorialtie frantiant ratational trancitione inadeniato

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IV.C.1.b)
IV.C.2.
IV.C.2.a)
IV.C.3.
IV.C.4.
IV.C.4.a)
IV.C.4.b)
IV.C.5.
IV.C.5.a)
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ele by conn r pen care, nyuiny super vision,
longitudinal relationships with faculty members, and high-quality
assessment and feedback. (Core)
Clinical experiences should be structured to facilitate learning in a
manner that allows residents to function as part of an effective
interprofessional team that works together longitudinally with
shared goals of patient safety and quality improvement. (Core)
The program must provide instruction and experience in pain
ma signs of if stance buse orthrder, claity, including recognition of
Instruction must include pain assessment and management
relevant to dermatology, including appropriate use of local
anesthesia and post-procedural analgesics, and recognition of the
signs of substance use disorder and drug-seeking behavior. (Core)
A resident’s time throughout each year of the program must be related to
the direct care of outpatients and inpatients, to include clinical
conferences and didactic lectures related to patient care, consultations,
inpatient rounds, and other subspecialty rotations concerning
dermatology. (Core)
The clinical experience must include:
consultations, inpatient rounds, dermatologic surgery,
dermatopathology, pediatric dermatology, and other dermatology
elated subspecialty experiences; and, (Core
significant exposure to other procedures, either through direct
observation or as an assistant in Mohs micrographic surgery, and
reconstruction of these defects, to include flaps and grafts, and
the application of a wide range of lasers and other energy
sources. (Core)
Residents must have experiences in medical dermatology, procedural
dermatology, dermatopathology, and pediatric dermatology, including:
following a core group of individual patients throughout the
majority of the program in a minimum of a once-monthly continuity
of care clinic setting as well as in follow-un of innatients and

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IV.C.5.c)
IV.C.5.d)
IV.C.5.e)
IV.C.5.f)
IV.C.5.f).(1)
IV.C.6.
IV.C.7.
IV.C.8.
IV.C.9.
IV.C.9.a)
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therapy; (Core)
pediatric dermatology encounters in diagnosing and managing
infants and children with neonatal skin disorders, atopic dermatitis,
psoriasis, blistering disorders, disorders of hair and nails, skin
infections (fungal, bacterial, and viral), vascular tumors and
malformations, congenital and acquired pigmented lesions and
other hamartomas, cutaneous signs of child abuse, and
cutaneous manifestations of multisystem diseases; (Core)
providing consultations for neonatal and pediatric inpatients; (Core)
exposure to procedures, either through direct observation or as an
assistant at surgery, including Mohs surgery with encounters in
include the use of laps ad grats, the applicatise of a cide range
of lasers and other energy sources, botulinum toxin injections, and
dermatopathology encounters with routinely stained histologic
sections from the full spectrum of dermatologic disease.
A portion of this exposure must occur in an active faculty-
run sign-out setting and with the use of study sets. (Core)
Each resident must record all required procedures and medical/surgical
cases in the ACGME Case Log System, and ensure that the data entered
is accurate and complete for all 36 months of the program. (Core)
There should be a well-organized course of instruction in the basic
sciences related to medical dermatology, surgical and aesthetic
dermatology, dermatopathology, and pediatric dermatology. (Core)
The curriculum should contain instruction dedicated to ethical behavior
and professionalism aspects of medicine. (Core)
Didactic sessions should include lectures, conferences, seminars,
demonstrations, clinical education rounds, book and journal reviews,
patient case reviews, and histologic slide review. (Core)
The majority of conference education for residents, including
didactics should occur within the program with a clear facult

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IV.C.9.c)
therapies, must be included in didactic sessions. (Core)
Interpretation of direct immunofluorescence specimens must be
included in didactic sessions.
IV.D.
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Scholarship
Medicine is both an art and a science. The physician is a humanistic
scientist who cares for patients. This requires the ability to think critically,
evaluate the literature, appropriately assimilate new knowledge, and
practice lifelong learning. The program and faculty must create an
environment that fosters the acquisition of such skills through resident
participation in scholarly activities. Scholarly activities may include
discovery, integration, application, and teaching.
The ACGME recognizes the diversity of residencies and anticipates that
programs prepare physicians for a variety of roles, including clinicians,
scientists, and educators. It is expected that the program’s scholarship will
reflect its mission(s) and aims, and the needs of the community it serves.
For example, some programs may concentrate their scholarly activity on
quality improvement, population health, and/or teaching, while other
programs might choose to utilize more classic forms of biomedical
IV.D.1.
IV.D.1.a)
IV.D.1.b)
IV.D.1.c)
IV.D.2.
IV.D.2.a)
Program Responsibilities
The program must demonstrate evidence of scholarly
ictivities consistent with its mission(s) and aims. (Core
he program, in partnership with its Sponsoring Institution
nust allocate adequate resources to facilitate resident anc
faculty involvement in scholarly activities. (Core)
The program must advance residents’ knowledge and
pare, ce of the scholarly approach to evidence-based patient
Faculty Scholarly Activity
Among their scholarly activity, programs must demonstrate
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IV.D.2.b)
educational activities, or electronic educational
materials
• Contribution to professional committees, educational
organizations, or editorial boards
• Innovations in education
The program must demonstrate dissemination of scholarly
activity within and external to the program by the following
methods:
Background and Intent: For the purposes of education, metrics of scholarly activity
represent one of the surrogates for the program’s effectiveness in the creation of an
environment of inquiry that advances the residents’ scholarly approach to patient care.
The Review Committee will evaluate the dissemination of scholarship for the program
as a whole, not for individual faculty members, for a five-year interval, for both core
and non-core faculty members, with the goal of assessing the effectiveness of the
creation of such an environment. The ACME recognizes that there may be differences
in scholarship requirements between different specialties and between residencies and
fellowships in the same specialty.
IV.D.2.b).(1)
faculty participation in grand rounds, posters,
workshops, quality improvement presentations,
podium presentations, grant leadership, non-peer-
reviewed print/electronic resources, articles or
publications, book chapters, textbooks, webinars,
service on professional committees, or serving as a
journal reviewer, journal editorial board member, or
IV.D.2.b).(2)
IV.D.3.
IV.D.3.a)
peer-reviewed publication. (Outcome)
Resident Scholarly Activity
Residents must participate in scholarship. (Core)
IV.D.3.a).(1)
Basic science and clinical investigation must be included in
the educational experience of residents.
IV.D.3.a). (1).(a)
All residents should participate or have education
regarding basic science and/or clinical research
during the program. (Core)

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V.
EValualUll
V.A.
Resident Evaluation
V.A.1.
Feedback and Evaluation
Background and Intent: Feedback is ongoing information provided regarding aspects
of one’s performance, knowledge, or understanding. The faculty empower residents to
provide much of that feedback themselves in a spirit of continuous learning and self-
reflection. Feedback from faculty members in the context of routine clinical care
should be frequent, and need not always be formally documented.
Formative and summative evaluation have distinct definitions. Formative evaluation is
monitoring resident learning and providing ongoing feedback that can be used by
residents to improve their learning in the context of provision of patient care or other
educational opportunities. More specifically, formative evaluations help:
residents identify their strengths and weaknesses and target areas that need
work
• program directors and faculty members recognize where residents are
struggling and address problems immediately
Summative evaluation is evaluating a resident’s learning by comparing the residents
against the goals and objectives of the rotation and program, respectively. Summative
evaluation is utilized to make decisions about promotion to the next level of training, or
program completion.
End-of-rotation and end-of-year evaluations have both summative and formative
components. Information from a summative evaluation can be used formatively when
residents or faculty members use it to guide their efforts and activities in subsequent
rotations and to successfully complete the residency program.
Feedback, formative evaluation, and summative evaluation compare intentions with
iccomplishments, enabling the transformation of a neophyte physician to one witl
V.A.1.a)
Faculty members must directly observe, evaluate, and
requently provide feedback on resident performance during
ach rotation or similar educational assianment. (Core
Background and Intent: Faculty members should provide feedback frequently

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V.A.1.b).(2)
V.A.1.c)
V.A.1.c).(1)
V.A.1.c).(2)
V.A.1.d)
V.A.1.d). (1)
V.A. 1.d). (1). (a)
V.A. 1.d). (2)
V.A. 1.d).(3)
uuranun, evaluauun must ve uucumenteu alleast
every three months. (Core)
Longitudinal experiences, such as continuity clinic in
the context of other clinical responsibilities, must be
evaluated at least every three months and at
completion. (Core)
The program must provide an objective performance
evaluation based on the Competencies and the specialty-
specific Milestones, and must: (Core)
use multiple evaluators (e.g., faculty members, peers,
patients, self, and other professional staff members);
and, (Core)
provide that information to the Clinical Competency
Committee for its synthesis of progressive resident
performance and improvement toward unsupervised
practice. (Core)
The program director or their designee, with input from the
Clinical Competency Committee, must:
meet with and review with each resident their
documented semi-annual evaluation of performance,
including progress along the specialty-specific
Milestones; (Core)
Review of resident Case Logs must be a part of the
semiannual review. (Detail)
assist residents in developing individualized learning
plans to capitalize on their strengths and identify areas
for growth; and, (Core)
develop plans for residents failing to progress,
following institutional policies and procedures. (Core)
Background and Intent: Learning is an active process that requires effort from the
teacher and the learner. Faculty members evaluate a resident’s performance at least at
the end of each rotation. The program director or their designee will review those
evaluations. includina their proaress on the Milestones. at a minimum of everv six

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airector o a acuity mentor an ine resident, will take a variety or torms pasea on ine
specific learning needs of the resident. However, the ACGME recognizes that there are
situations which require more significant intervention that may alter the time course of
resident progression. To ensure due process, it is essential that the program director
follow institutional policies and procedures.
V.A.1.e)
V.A.1.f)
V.A.2.
V.A.2.a)
V.A.2.a). (1)
V.A.2.a).(2)
V.A.2.a).(2).(a)
V.A.2.a). (2).(b)
V.A.2.a). (2).(c)
V.A.3.
V.A.3.a)
At least annually, there must be a summative evaluation of
each resident that includes their readiness to progress to the
next year of the program, if applicable. (Core)
he evaluations of a resident’s pertormance must b
iccessible for review by the resident. (Core
Final Evaluation
The program director must provide a final evaluation for each
resident upon completion of the program. (Core)
The specialty-specific Milestones, and when applicable
the specialty-specific Case Logs, must be used as
tools to ensure residents are able to engage in
(coreonomous practice upon completion of the program.
The final evaluation must:
become part of the resident’s permanent record
maintained by the institution, and must be
accessible for review by the resident in
accordance with institutional policy; (Core)
verify that the resident has demonstrated the
knowledge, skills, and behaviors necessary to
enter autonomous practice; and, (Core)
e shared with the resident upon completion o
he program. (Core
A Clinical Competency Committee must be appointed by the
rogram director. (Core)
At a minimum, the Clinical Competency Committee must
include thres mamhare of the nrogram facultu at last one of

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commitee ao not preciuae or limit a program airector s parucipaton on ine blinical
Competency Committee. The intent is to leave flexibility for each program to decide the
best structure for its own circumstances, but a program should consider: its program
director’s other roles as resident advocate, advisor, and confidante; the impact of the
program director’s presence on the other Clinical Competency Committee members’
discussions and decisions; the size of the program faculty; and other program-relevant
factors. Inclusivity is an important consideration in the appointment of Clinical
Competency Committee members, allowing for diverse participation to ensure fair
evaluation. The program director has final responsibility for resident evaluation and
promotion decisions.
The program faculty may include more than the physician faculty members, such as
other physicians and non-physicians who teach and evaluate the program’s residents.
There may be additional members of the Clinical Competency Committee. Chief
residents who have completed core residency programs in their specialty may be
members of the Clinical Competency Committee.
V.A.3.b)
The Clinical Competency Committee must:
V.A.3.b). (1)
V.A.3.b).(2)
V.A. 3.b).(3)
review all resident evaluations at least semi-annually;
(Core)
the speciaty specific Milestones; and, achievement of
meet prior to the residents’ semi-annual evaluations
and advise the program director regarding each
resident’s progress. (Core)
V.B.
V.B.1.
Faculty Evaluation
The program must have a process to evaluate each faculty
member’s performance as it relates to the educational program at
Background and Intent: The program director is responsible for the educational
program and all educators. While the term “faculty” may be applied to physicians
within a given institution for other reasons, it is applied to residency program faculty
members only through approval by a program director. The development of the faculty
improves the education, clinical, and research aspects of a program. Faculty members
have a strong commitment to the resident and desire to provide optimal education and
work opportunities. Faculty members must be provided feedback on their contribution
to the miscion of tha nroaram All facultu mamhare who intaract with racidents dacira

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process Snould telect the local environment and identy the necessary mommaton.
The feedback from the various sources should be summarized and provided to the
[faculty on an annual basis by a member of the leadership team of the program.
V.B.1.a)
This evaluation must include a review of the faculty member’s
clinical teaching abilities, engagement with the educational
program, participation in faculty development related to their
skills as an educator, clinical performance, professionalism,
and scholarly activities. (Core)
V.B.1.b)
This evaluation must include written, anonymous, an‹
onfidential evaluations by the residents. (Core
V.B.2.
V.B.3.
Faculty members must receive feedback on their evaluations at least
annually. (Core)
Results of the faculty educational evaluations should be
incorporated into program-wide faculty development plans. (Core)
Background and Intent: The quality of the faculty’s teaching and clinical care is a
determinant of the quality of the program and the quality of the residents’ future
clinical care. Therefore, the program has the responsibility to evaluate and improve the
program faculty members’ teaching, scholarship, professionalism, and quality care.
This section mandates annual review of the program’s faculty members for this
purpose, and can be used as input into the Annual Program Evaluation.
V.C.
V.C.1.
Program Evaluation and Improvement
The program director must appoint the Program Evaluation
Committee to conduct and document the Annual Program
Evaluation as part of the program’s continuous improvement
V.C.1.a)
The Program Evaluation Committee must be composed of at
least two program faculty members, at least one of whom is a
core faculty member, and at least one resident. (Core)
Program Evaluation Committee responsibilities must include:
V.C.1.b)
V.C.1.b). (1)
VE 1h1 191
review of the program’s self-determined goals and
progress toward meeting them; (Core)
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Dackgrouna ana intent: 1o acnieve its mission and equcate ana train quality
physicians, a program must evaluate its performance and plan for improvement in the
Annual Program Evaluation. Performance of residents and faculty members is a
reflection of program quality, and can use metrics that reflect the goals that a program
has set for itself. The Program Evaluation Committee utilizes outcome parameters and
other data to assess the program’s progress toward achievement of its goals and aims.
The Program Evaluation Committee advises the program director through program
oversight.
V.C.1.c)
The Program Evaluation Committee should consider the
outcomes from prior Annual Program Evaluation(s),
aggregate resident and faculty written evaluations of the
program, and other relevant data in its assessment of the
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Background and Intent: Other data to be considered for assessment include:
• Curriculum
• ACGME letters of notification, including citations, Areas for Improvement, and
comments
:
Quality and safety of patient care
Aggregate resident and faculty well-being; recruitment and retention; workforce
diversity, including graduate medical education staff and other relevant
academic community members; engagement in quality improvement and patient
safety; and scholarly activity
:
ACGME Resident and Faculty Survey results
Aggregate resident Milestones evaluations, and achievement on in-training
examinations (where applicable), board pass and certification rates, and
graduate performance.
•
Aggregate faculty evaluation and professional development
V.C.1.d)
The Program Evaluation Committee must evaluate the
Improve me a treats, strengths, areas for
V.C.1.e)
The Annual Program Evaluation, including the action plan,
must be distributed to and discussed with the residents and
the members of the teaching faculty, and be submitted to the
V.C.2.
ore program must complete a Self-Study and submit it to the DIO.

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manual or roices ana rrocedures. Maamonaly, a descripuon or te accreantaton
Self-Study process is available on the ACME website.
V.C.3.
V.C.3.a)
V.C.3.b)
V.C.3.c)
V.C.3.d)
V.C.3.e)
One goal of ACGME-accredited education is to educate physicians
who seek and achieve board certification. One measure of the
effectiveness of the educational program is the ultimate pass rate.
The program director should encourage all eligible program
graduates to take the certifying examination offered by the
applicable American Board of Medical Specialties (ABMS) member
board or American Osteopathic Association (AOA) certifying board.
For specialties in which the ABMS member board and/or AOA
certifying board offer(s) an annual written exam, in the
preceding three years, the program’s aggregate pass rate of
those taking the examination for the first time must be higher
(olcome bottom fifth percentile of programs in that specialty.
For specialties in which the ABMS member board and/or AOA
certifying board offer(s) a biennial written exam, in the
preceding six years, the program’s aggregate pass rate of
those taking the examination for the first time must be higher
truin the bottom fifth percentile of programs in that specialty.
For specialties in which the ABMS member board and/or AOA
certifying board offer(s) an annual oral exam, in the preceding
three years, the program’s aggregate pass rate of those
taking the examination for the first time must be higher than
(tomettom fifth percentile of programs in that specialty.
For specialties in which the ABMS member board and/or AOA
certifying board offer(s) a biennial oral exam, in the preceding
six years, the program’s aggregate pass rate of those taking
the examination for the first time must be higher than the
bottom fifth percentile of programs in that specialty. (Outcome)
For each of the exams referenced in V.C.3.a)-d), any program
whose graduates over the time period specified in the
requirement have achieved an 80 percent pass rate will have
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inere are specialues were inere is a very nign poara pass rate tat coula leave
successful programs in the bottom five percent (fifth percentile) despite admirable
performance. These high-performing programs should not be cited, and V.C.3.e) is
designed to address this.
V.C.3.f)
Programs must report, in ADS, board certification status
annually for the cohort of board-eligible residents that
graduated seven years earlier. (Core)
Background and Intent: It is essential that residency programs demonstrate knowledge
and skill transfer to their residents. One measure of that is the qualifying or initial
certification exam pass rate. Another important parameter of the success of the
program is the ultimate board certification rate of its graduates. Graduates are eligible
for up to seven years from residency graduation for initial certification. The ACGME
will calculate a rolling three-year average of the ultimate board certification rate at
seven years post-graduation, and the Review Committees will monitor it.
The Review Committees will track the rolling seven-year certification rate as an
indicator of program quality. Programs are encouraged to monitor their graduates’
performance on board certification examinations.
In the future, the ACGME may establish parameters related to ultimate board
certification rates.
VI.
The Learning and Working Environment
Residency education must occur in the context of a learning and working
environment that emphasizes the following principles:
• Excellence in the safety and quality of care rendered to patients by residents
today
Presidents i in eir future prad quality of care rendered to patients by today’s
• Excellence in professionalism through faculty modeling of:
• Appreciation for the privilege of providing care for patients
• Commitment to the well-being of the students, residents, faculty members, and
all members of the health care team
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VI.A.1.a).(1).(a)
VI.A.1.a).(2)
VI.A.1.a). (2).(a)
VI.A.1.a). (2).(a).(i)
VI.A.1.a). (2).(a).(ii)
VI.A.1.a).(2).(b)
of vulnerabilities and a willingness to transparently
deal with them. An effective organization has formal
mechanisms to assess the knowledge, skills, and
attitudes of its personnel toward safety in order to
identify areas for improvement.
The program, its faculty, residents, and fellows
must actively participate in patient safety
systems and contribute to a culture of safety.
(Core)
Patient Safety Events
Reporting, investigation, and follow-up of safety
events, near misses, and unsafe conditions are pivotal
mechanisms for improving patient safety, and are
essential for the success of any patient safety
program. Feedback and experiential learning are
essential to developing true competence in the ability
to identify causes and institute sustainable systems-
based changes to ameliorate patient safety
vulnerabilities.
Residents, fellows, faculty members, and other
clinical staff members must:
know their responsibilities in reporting
patient safety events and unsafe
conditions at the clinical site, including
how to report such events; and, (Core)
be provided with summary information
of their institution’s patient safety
reports. (Core)
Residents must participate as team members in
real and/or simulated interprofessional clinical
patient safety and quality improvement
activities, such as root cause analyses or other
activities that include analysis, as well as
formulation and implementation of actions. (Core)
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vI.M.1.a/.(0/(a)
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data on quality metrics and benchmarks related
to their patient populations. (Core)
VI.A.2.
VI.A.2.a)
VI.A.2.a).(1)
Supervision and Accountability
Although the attending physician is ultimately responsible for
the care of the patient, every physician shares in the
responsibility and accountability for their efforts in the
provision of care. Effective programs, in partnership with
their Sponsoring Institutions, define, widely communicate,
and monitor a structured chain of responsibility and
accountability as it relates to the supervision of all patient
care.
Supervision in the setting of graduate medical education
provides safe and effective care to patients; ensures each
resident’s development of the skills, knowledge, and attitudes
required to enter the unsupervised practice of medicine; and
establishes a foundation for continued professional growth.
Residents and faculty members must inform each
patient of their respective roles in that patient’s care
when providing direct patient care. (Core)
VI.A.2.a).(1).(a)
This information must be available to residents,
faculty members, other members of the health
care team, and patients. (Core)
Background and Intent: Each patient will have an identifiable and appropriately
VI.A.2.a). (2)
The program must demonstrate that the appropriate
level of supervision in place for all residents is based
on each resident’s level of training and ability, as well
as patient complexity and acuity. Supervision may be
exercised through a variety of methods, as appropriate
to the situation. (Core)
Background and Intent: Appropriate supervision is essential for patient safety and
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VI.A.L.D)
VI.A.2.b) (1)
VI.A.2.b) (1).(a)
VI.A.2.b).(1).(a).(i)
VI.A.2.b).(2)
VI.A.2.b).(3)
VI.A.2.c)
VI.A.2.d)
VI.A.2.d). (1)
VI.A.2.d).(2)
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Levels or supervision
To promote appropriate resident supervision while providing
for graded authority and responsibility, the program must use
the following classification of supervision:
Direct Supervision:
the supervising physician is physically present
with the resident during the key portions of the
patient interaction.
PGY-1 residents must initially be
supervised directly, only as described in
VI.A.2.b).(1).(a). (Core)
Indirect Supervision: the supervising physician is not
providing physical or concurrent visual or audio
supervision but is immediately available to the
resident for guidance and is available to provide
appropriate direct supervision.
Oversight - the supervising physician is available to
provide review of procedures/encounters with
feedback provided after care is delivered.
The program must define when physical presence of a
supervising physician is required. (Core)
The privilege of progressive authority and responsibility,
conditional independence, and a supervisory role in patien
care delegated to each resident must be assigned by the
program director and faculty members. (Core)
The program director must evaluate each resident’s
abilities based on specific criteria, guided by the
Milestones, (Core
Faculty members functioning as supervising
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faculty member(s). (Core)
VI.A.2.e).(1)
Each resident must know the limits of their scope of
authority, and the circumstances under which the
resident is permitted to act with conditional
independence. (Outcome)
Background and Intent: The ACGME Glossary of Terms defines conditional
independence as: Graded, progressive responsibility for patient care with defined
oversight.
VI.A.2.f)
Faculty supervision assignments must be of sufficient
duration to assess the knowledge and skills of each resident
and to delegate to the resident the appropriate level of patient
care authority and responsibility. (Core)
VI.B.
VI.B.1.
Professionalism
Programs, in partnership with their Sponsoring Institutions, must
educate residents and faculty members concerning the professional
and ethical responsibilities of physicians, including but not limited
to their obligation to be appropriately rested and fit to provide the
care required by their patients. (Core)
Background and Intent: This requirement emphasizes the professional responsibility
of residents and faculty members to arrive for work adequately rested and ready to
care for patients. It is also the responsibility of residents, faculty members, and other
VI.B.2.
VI.B.2.a)
The learning objectives of the program must:
be accomplished without excessive reliance on residents to
fulfill non-physician obligations; (Core)
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residents routinely and must pe kept to a minimum to opumize resiaent education.
VI.B.2.b)
ensure manageable patient care responsibilities; and, (Core)
Background and Intent: The Common Program Requirements do not define
”manageable patient care responsibilities” as this is variable by specialty and PGY
level. Review Committees will provide further detail regarding patient care
responsibilities in the applicable specialty-specific Program Requirements and
accompanying FAQs. However, all programs, regardless of specialty, should carefully
assess how the assignment of patient care responsibilities can affect work
compression, especially at the PGY-1 level.
VI.B.2.c)
include efforts to enhance the meaning that each resident
finds in the experience of being a physician, including
protecting time with patients, providing administrative
support, promoting progressive independence and flexibility
and enhancing professional relationships. (Core
VI.B.3.
The program director, in partnership with the Sponsoring Institution,
must provide a culture of professionalism that supports patient
safety and personal responsibility. (Core)
Background and Intent: The accurate reporting of clinical and educational work hours,
patient outcomes, and clinical experience data are the responsibility of the program
leadership, residents, and faculty.
VI.B.4.
Residents and faculty members must demonstrate an understanding
of their personal role in the safety and welfare of patients entrusted
to their care, including the ability to report unsafe conditions and
safety events. (Core)
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VI.B.5.
sexual and other forms of harassment, mistreatment, abuse, or
coercion of students, residents, faculty, and staff. (Core)
Background and Intent: Psychological safety is defined as an environment of trust and
respect that allows individuals to feel able to ask for help, admit mistakes, raise
oncerns, suggest ideas, and challenge ways of working and the ideas of others on thi
eam, including the ideas of those in authority, without fear of humiliation, and th
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VI.C.
VI.C.1.
VI.C.1.a)
VI.C.1.b)
nave a process tor education or residents and tacuity regarding
unprofessional behavior and a confidential process for reporting,
investigating, and addressing such concerns. (Core)
Well-Being
Psychological, emotional, and physical well-being are critical in the
development of the competent, caring, and resilient physician and require
proactive attention to life inside and outside of medicine. Well-being
requires that physicians retain the joy in medicine while managing their
own real-life stresses. Self-care and responsibility to support other
members of the health care team are important components of
professionalism; they are also skills that must be modeled, learned, and
nurtured in the context of other aspects of residency training.
Residents and faculty members are at risk for burnout and depression.
Programs, in partnership with their Sponsoring Institutions, have the same
responsibility for the well-being of each other. A positive culture in a
clinical learning environment models constructive behaviors, and prepares
residents with the skills and attitudes needed to thrive throughout their
careers.
The responsibility of the program, in partnership with the
Sponsoring Institution, must include:
attention to scheduling, work intensity, and work
compression that impacts resident well-being; (Core)
evaluating workplace safety data and addressing the safety of
residents and faculty members; (Core)
Background and Intent: This requirement emphasizes the responsibility shared by the
physical or emotional violence, vehicle collisions, and emotional well-being after safety
events.
VI.C.1.c)
policies and programs that encourage optimal resident and
faculty member well-being; and, (Core)

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VI.C.1.c) (1)
Residents must be given the opportunity to attend
medical, mental health, and dental care appointments,
including those scheduled during their working hours.
(Core)
VI.C.1.d)
VI.C.1.d).(1)
VI.C.1.d). (2)
education of residents and faculty members in:
identification of the symptoms of burnout, depression,
and substance use disorders, suicidal ideation, or
potential for violence, including means to assist those
who experience these conditions; (Core)
recognition of these symptoms in themselves and how
to seek appropriate care; and, (Core)
VI.C.1.d).(3)
access to appropriate tools for self-screening. (Core)
Background and Intent: Programs and Sponsoring Institutions are encouraged to review
materials to create systems for identification of burnout, depression, and substance use
disorders. Materials and more information are available in Learn at ACGME
(https://dl.acgme.org/pages/well-being-tools-resources).
Individuals experiencing burnout, depression, a substance use disorder, and/or suicidal
ideation are often reluctant to reach out for help due to the stigma associated with these
conditions and may be concerned that seeking help may have a negative impact on their
career. Recognizing that physicians are at increased risk in these areas, it is essential
that residents and faculty members are able to report their concerns when another
resident or faculty member displays signs of any of these conditions, so that the
program director or other designated personnel, such as the department chair, may
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VI.C.1.e)
providing access to confidential, affordable mental health
assessment, counseling, and treatment, including access to
(orent and emergent care 24 hours a day, seven days a week.

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The reference to affordable counseling is intended to require that financial cost not be a
barrier to obtaining care.
VI.C.2.
There are circumstances in which residents may be unable to attend
work, including but not limited to fatigue, illness, family
emergencies, and medical, parental, or caregiver leave. Each
program must allow an appropriate length of absence for residents
unable to perform their patient care responsibilities. (Core)
VI.C.2.a)
The program must have policies and procedures in place to
ensure coverage of patient care and ensure continuity of
VI.C.2.b)
These policies must be implemented without fear of negative
consequences for the resident who is or was unable to
provide the clinical work. (Core)
Background and Intent: Residents may need to extend their length of training
depending on length of absence and specialty board eligibility requirements.
Teammates should assist colleagues in need and equitably reintegrate them upon
return.
VI.D.
VI.D.1.
Fatigue Mitigation
Programs must educate all residents and faculty members in
recognition of the signs of fatigue and sleep deprivation, alertness
management, and fatigue mitigation processes. (Detail)
esperan enge a sure a aroman an engage retent tor
managing fatigue in practice. It is expected that programs adopt fatigue mitigation
processes and ensure that there are no negative consequences and/or stigma for using
fatigue mitigation strategies.
Strategies that may be used include but are not limited to strategic napping; the
judicious use of caffeine; availability of other caregivers; time management to maximize
sleep off-duty; learning to recognize the signs of fatigue, and self-monitoring
performance and/or asking others to monitor performance; remaining active to promote
alertness; maintaining a healthy diet; using relaxation techniques to fall asleep;
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VI.E.
VI.E.1.
Clinical Responsibilities
The clinical responsibilities for each resident must be based on PGY
level, patient safety, resident ability, severity and complexity of
patient illness/condition, and available support services. (Core)
VI.E.1.a)
Assuming that the severity and complexity of illnesses or
conditions and available support services are comparable for the
patients cared for by residents at each level of education, then
PGY-2 residents are expected to carry a clinical case load equal
to at least 50 percent of that of PGY-4 residents, and PGY-3
residents are expected to carry a clinical case load equal to at
least 75 percent of that of PGY-4 residents. (Detail)
Background and Intent: The changing clinical care environment of medicine has meant
that work compression due to high complexity has increased stress on residents.
Faculty members and program directors need to make sure residents function in an
environment that has safe patient care and a sense of resident well-being. It is an
essential responsibility of the program director to monitor resident workload. Workload
should be distributed among the resident team and interdisciplinary teams to minimize
work compression.
VI.E.2.
Teamwork
Residents must care for patients in an environment that maximizes
communication and promotes safe, interprofessional, team-based
care in the specialty and larger health system. (Core)
Background and Intent: Effective programs will have a structure that promotes safe,
interprofessional, team-based care. Optimal patient safety occurs in the setting of a
coordinated interprofessional learning and working environment.
VI.E.2.a)
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VI.E.O.U)
must ensure and monitor effective, structured hand-off
processes to facilitate both continuity of care and patient
safety. (Core)
VI.E.3.c)
Programs must ensure that residents are competent in
communicating with team members in the hand-off process.
(Outcome)
VI.F.
Clinical Experience and Education
Programs, in partnership with their Sponsoring Institutions, must design
an effective program structure that is configured to provide residents with
educational and clinical experience opportunities, as well as reasonable
opportunities for rest and personal activities.
Background and Intent: The terms “clinical experience and education,” “clinical and
educational work,” and “clinical and educational work hours” replace the terms “duty
hours,
,” “duty periods,” and “duty.” These terms are used in response to concerns that
the previous use of the term “duty” in reference to number of hours worked may have
led some to conclude that residents’ duty to “clock out” on time superseded their duty
to their patients.
VI.F.1.
Maximum Hours of Clinical and Educational Work per Week
Clinical and educational work hours must be limited to no more than
80 hours per week, averaged over a four-week period, inclusive of all
in-house clinical and educational activities, clinical work done from
home, and all moonlighting. (Core)
Background and Intent: Programs and residents have a shared responsibility to ensure
atten with the inter of allowing residen note remain be yond their scheduled wors been
periods to care for a patient or participate in an educational activity, these additional
hours must be accounted for in the allocated 80 hours when averaged over four weeks.
Work from Home
While the requirement specifies that clinical work done from home must be counted
toward the 80-hour maximum weekly limit, the expectation remains that scheduling be
structured so that residents are able to complete most work on site during scheduled
clinical work hours without requiring them to take work home. The requirements
acknowledge the changing landscape of medicine, including electronic health records,
mand tha
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ine resident s supervisor. In sucn circumstances, residents snoula pe minatul or tneir
professional responsibility to complete work in a timely manner and to maintain patient
confidentiality.
Residents are to track the time they spend on clinical work from home and to report that
time to the program. Decisions regarding whether to report infrequent phone calls of
very short duration will be left to the individual resident. Programs will need to factor in
time residents are spending on clinical work at home when schedules are developed to
ensure that residents are not working in excess of 80 hours per week, averaged over
four weeks. There is no requirement that programs assume responsibility for
documenting this time. Rather, the program’s responsibility is ensuring that residents
report their time from home and that schedules are structured to ensure that residents
are not working in excess of 80 hours per week, averaged over four weeks.
VI.F.2.
Mandatory Time Free of Clinical Work and Education
VI.F.2.a)
Residents should have eight hours off between scheduled
clinical work and education periods. (Detail)
Background and Intent: There may be circumstances when residents choose to stay to
care for their patients or return to the hospital with fewer than eight hours free of clinical
experience and education. This occurs within the context of the 80-hour and the one-
day-off-in-seven requirements. While it is expected that resident schedules will be
structured to ensure that residents are provided with a minimum of eight hours off
between scheduled work periods, it is recognized that residents may choose to remain
beyond their scheduled time, or return to the clinical site during this time-off period, to
care for a patient. The requirement preserves the flexibility for residents to make those
choices. It is also noted that the 80-hour weekly limit (averaged over four weeks) is a
deterrent for scheduling fewer than eight hours off between clinical and education work
periods, as it would be difficult for a program to design a schedule that provides fewer
than eight hours off without violating the 80-hour rule.
VI.F.2.b)
Residents must have at least 14 hours free of clinical work
and education after 24 hours of in-house call. (Core)
Background and Intent: Residents have a responsibility to return to work rested, and
thus are expected to use this time away from work to get adequate rest. In support of
this goal, residents are encouraged to prioritize sleep over other discretionary activities.
VI.F.2.c)
Residents must be scheduled for a minimum of one day in
seven free of clinical work and required education (when
averaged over four weeks). At-home call cannot be assigned
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requirement tor one tree day in seven snoula not pe interpreted as precluaing a golden
weekend. Where feasible, schedules may be designed to provide residents with a
weekend, or two consecutive days, free of work. The applicable Review Committee will
evaluate the number of consecutive days of work and determine whether they meet
educational objectives. Programs are encouraged to distribute days off in a fashion that
optimizes resident well-being, and educational and personal goals. It is noted that a day
off is defined in the ACGME Glossary of Terms as “one (1) continuous 24-hour period
free from all administrative, clinical, and educational activities.”
VI.F.3.
Maximum Clinical Work and Education Period Length
VI.F.3.a)
Clinical and educational work periods for residents must not
exceed 24 hours of continuous scheduled clinical
assignments. (Core)
VI.F.3.a).(1)
Up to four hours of additional time may be used for
activities related to patient safety, such as providing
effective transitions of care, and/or resident education.
Additional patient care responsibilities must not be
assigned to a resident during this time. (Core)
Background and Intent: The additional time referenced in VI.F.3.a).(1) should not be
sed for the care of new patients. It is essential that the resident continue to function a
member of the team in an environment where other members of the team can asses
resident fatigue, and that supervision for post-call residents is provided. This 24 hours
and up to an additional four hours must occur within the context of 80-hour weekly limit,
VI.F.4.
VI.F.4.a)
Clinical and Educational Work Hour Exceptions
In rare circumstances, after handing off all other
responsibilities, a resident, on their own initiative, may elect
to remain or return to the clinical site in the following
circumstances: to continue to provide care to a single
severely ill or unstable patient; to give humanistic attention to
the needs of a patient or patient’s family; or to attend unique
educational events. (Detail)
VI.F.4.b)
These additional hours of care or education must be counted
toward the 80-hour weekly limit. (Detail)
Background and Intent: This requirement is intended to provide residents with some

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VI.F.4.c)
VI.F.5.
VI.F.5.a)
A Review Committee may grant rotation-specific exceptions
for up to 10 percent or a maximum of 88 clinical and
educational work hours to individual programs based on a
sound educational rationale.
The Review Committee for Dermatology will not consider requests
for exceptions to the 80-hour limit to the residents’ work week.
Moonlighting
Moonlighting must not interfere with the ability of the resident
VI.F.5.b)
Time spent by residents in internal and external moonlighting
(as defined in the ACGME Glossary of Terms) must be
counted toward the 80-hour maximum weekly limit. (Core)
VI.F.5.c)
PGY-1 residents are not permitted to moonlight. (Core)
Background and Intent: For additional clarification of the expectations related to
moonlighting, please refer to the Common Program Requirement FAQs (available at
http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements).
VI.F.6.
VI.F.7.
In-House Night Float
Night float must occur within the context of the 80-hour and one-
day-off-in-seven requirements. (Core)
Maximum In-House On-Call Frequency
Residents must be scheduled for in-house call no more frequently
than every third night (when averaged over a four-week period). (Core)
At-Home Call
VI.F.8.
VI.F.8.a)
Time spent on patient care activities by residents on at-home
call must count toward the 80-hour maximum weekly limit.
The frequency of at-home call is not subject to the every-
third-night limitation, but must satisfy the requirement for one

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resident is taking at-home call must count toward the 80-hour maximum weekly limit.
This acknowledges the often significant amount of time residents devote to clinical
activities when taking at-home call, and ensures that taking at-home call does not result
in residents routinely working more than 80 hours per week. At-home call activities that
must be counted include responding to phone calls and other forms of communication,
as well as documentation, such as entering notes in an electronic health record
Activities such as reading about the next day’s case, studying, or research activities do
not count toward the 80-hour weekly limit.
In their evaluation of residency/fellowship programs, Review Committees will look at the
overall impact of at-home call on resident/fellow rest and personal time.