The Accreditation Council for Graduate Medical Education – Scott Landman, DO

The Accreditation Council for Graduate Medical Education (ACGME) plays a central role in shaping graduate medical education (GME) in the United States. Its Common Program Requirements establish national standards for residency and fellowship training, including supervision, education, patient safety, physician well-being, and clinical and educational work hours. These standards ensure a consistent baseline that all accredited programs must meet, regardless of institution or specialty.

For residents and fellows, these requirements offer critical protections. The current standards limit clinical and educational work hours to a maximum of 80 per week, averaged over four weeks; mandate at least one day free of clinical and educational responsibilities in every seven; impose restrictions on continuous clinical assignments; and require time away from clinical work after extended shifts. Clinical work performed from home and moonlighting are also included in the 80-hour limit. These requirements are designed to provide a rigorous clinical education while safeguarding both resident and patient safety.

The ACGME has proposed revisions to Section VI of the Common Program Requirements, which addresses the learning and working environment. Notable changes include increased flexibility in scheduling time off, permitting residents to voluntarily remain beyond scheduled hours in exceptional situations after proper patient handoff, and allowing specialty-specific exceptions of up to 88 clinical work hours per week with Review Committee approval. The proposals also remove certain documentation requirements for variations in clinical and educational work hours.

There are compelling arguments in favor of increased flexibility. Programs vary in their clinical environments, specialties, and educational requirements, and flexibility may help maintain continuity of care and offer valuable learning experiences. The ACGME asserts that these changes aim to support patient safety, resident well-being, and education.

However, residents and fellows have legitimate concerns that increased flexibility may not consistently achieve these objectives in practice. Within the hierarchical structure of residency and fellowship, distinguishing between voluntarily staying beyond scheduled hours and feeling implicitly obligated to do so can be challenging. Residents may experience pressure to remain for a critically ill patient, an educational opportunity, or to support their clinical team, even when fatigued.

Furthermore, extending work hours beyond the established 80-hour limit raises questions about whether additional clinical time enhances education or instead leads to increased fatigue, burnout, and diminished rest. Removing certain documentation requirements may also hinder the ability to identify patterns of excessive workload and maintain accountability.

These concerns do not oppose flexibility itself. Rather, they highlight the necessity of ensuring that flexibility does not compromise essential protections for residents and patients. We should not be forced to choose between high-quality clinical education and resident well-being, or between continuity of care and effective safeguards against fatigue. Programs must remain responsible for managing workloads, and residents should be empowered to decline additional work without fear of negative consequences for their evaluations or educational opportunities

As the ACGME reviews these proposed revisions, input from residents and fellows is essential. Trainees are uniquely positioned to identify where flexibility may enhance education and where it may inadvertently increase workload or pressure. We must advocate for standards that ensure adequate rest, protect resident well-being, maintain patient safety, and assign responsibility for workload management to programs rather than individual trainees.

The ACGME is accepting public comments on the proposed Common Program Requirements until October 22, 2026. Residents and fellows are encouraged to share their experiences and concerns directly with the ACGME to ensure that future standards address both educational needs and the practical realities of providing safe patient care.

Residents and fellows must have a voice in shaping the standards that govern their training. Now is the time to exercise that voice. 

Submit your comments regarding the ACGME proposed changes at: https://www.acgme.org/programs-and-institutions/programs/review-and-comment/