ACGME extends accreditation abroad to improve physician training

For more than three decades, the Accreditation Council for Graduate Medical Education has evaluated and accredited graduate medical education programs in the U.S. Now it is expanding its reach with an international program aimed at raising GME standards in other countries around the world.

ACGME-International recently completed the first phase of a partnership with the Ministry of Health in Singapore to revamp the GME accreditation system in that country. Meanwhile, the ACGME-I has signed contracts in Qatar and Abu Dhabi in the United Arab Emirates and is negotiating with officials in Oman, said John Nylen, ACGME-I executive vice president and chief operating officer.

The goal is to institute the same rigorous standards and training that exist in the U.S., said ACGME CEO Thomas J. Nasca, MD. Officials in other countries aim to improve the quality of care for their citizens and help ensure that physicians remain in their home countries rather than pursue training abroad.

“The idea is not just to take the U.S. model and imprint it on each country, but to work with the country and develop a model that is appropriate for that country and their patient population,” Dr. Nasca said. “When we bring these systems in, we immediately raise the level of the graduates, and we raise the standards of the educational program.”

The initiative launched in 2009 after the Ministry of Health in Singapore contacted the ACGME asking for help in switching the country’s GME system from the British to American model. ACGME officials traveled to Singapore to help the country set up its own GME accreditation system. Because there are only three teaching hospitals in Singapore, they determined that it would be impossible to develop a rigorous system of peer review like the one that exists in the U.S., Dr. Nasca said. Thus, ACGME-I was established to accredit international GME programs.

Expanding to the Middle East

A second phase of the project is under way in the Middle East, where the ACGME-I is working to accredit GME programs at two institutions in Qatar, six in Abu Dhabi and one sponsoring institution with two teaching hospitals in Oman, Nylen said. Accreditation efforts are being tailored to each country, including its local medical licensing and specialty certification requirements, Nylen said.

“The international standards are not equivalent to the domestic standards, but they are just as rigorous,” Nylen said. “We have to take into account the different delivery systems.”

For example, U.S. emergency medicine residents are required to learn how to treat patients at a crash site, either in person or by coordinating with emergency responders. In Singapore, however, that training isn’t required, because no matter where a person is in the country, they are no more than 10 minutes from a hospital.

“We allowed them to not have to meet that particular requirement,” Nylen said.

Officials with the Ministry of Health of Singapore said they want to improve the quality of care for the country’s citizens. ACGME-I accreditation of residency programs is being done on a voluntary basis.

“The goals of the process are to evaluate, improve and publicly recognize programs and sponsoring institutions in GME that are in substantial compliance with standards of educational quality established by ACGME-I,” said Ministry of Health spokeswoman Poon Jing Ting. “Accreditation was developed to benefit the public, protect the interests of residents, and improve the quality of teaching, learning, research and professional practice.”

Before making the agreement with Singapore, the ACGME had received numerous requests from countries and individual institutions abroad for help with accreditation. Once the Singapore project proved to be a success, some of those institutions have renewed their requests, Nylen said.

Although the U.S. has emphasized graduate medical education for many years, many other countries have just begun to realize its importance during the last five to seven years, Dr. Nasca said. Before the ACGME partnership, 50% of physicians in Singapore left GME training after one year. Now they will be in training for a minimum of five years, he said.

“We are receiving requests from other parts of the world,” Dr. Nasca said. “Our hope is to go into areas of great need such as Sub-Saharan Africa and Central America, where GME doesn’t exist at all.”

A lack of GME training opportunities in those regions means that many medical school graduates train in other countries such as the U.S. and Australia and never return, Dr. Nasca said. The hope is that establishing GME training there will help those regions retain much-needed doctors, he said.

Another motivator for some institutions abroad is the limited GME funding in the U.S., Nylen said. There are concerns that fewer international medical graduates will be able to train in the U.S., driving a need to improve GME training opportunities in other countries, he said.