Accreditation of postgraduate medical education in the United States and Canada: a comparison of two systems

Abstract

The systems for accrediting residency programmes in the United States and Canada, although they have developed independently in the two countries, have similar objectives and accreditation requirements. Both have become increasingly focused over the past several decades on the importance of educational programmes structured to provide graded professional responsibility with appropriate guidance and supervision to residents according to their level of training, ability and experience. The Canadian model used by the Royal College of Physicians and Surgeons of Canada is a centrist one, with accreditation decisions on all programmes in all specialties being vested in a single, multidisciplinary accreditation committee. The American model developed by the Accreditation Council for Graduate Medical Education is a distributive one, with accreditation decisions being vested in each specialty Residency Review Committee. In both models, accreditation is based on a system of periodic on-site visits during which both faculty and residents are interviewed by a surveyor to provide the accrediting body with a first-hand evaluation of the extent to which each accredited programme meets the standards of accreditation. While they are similar in purpose, there are significant differences in the operation of the two systems.

Bridging the continuum: Analysis of the alignment of undergraduate and postgraduate accreditation standards

“…A comparison of accreditation standards for post-graduate medical education in the United States compared to in Canada identified many similarities in terms of objectives and requirements (Cassie et al 1999). However, there are differences in the operation of the two systems.…”

“…This has led to an agreement that each organization sends two official observers to observe the review and decision-making operations of the other. This has proven beneficial in improving the understanding and communication between the two systems (Cassie et al 1999).…”

“…Similarly, the Education Committee of the General Medical Council (GMC) in the UK assures that high standards of medical education are upheld and updated regularly; however again, no alignment between post-graduate and graduate education has been reported. In the American model, postgraduate programmes are distributive with accreditation decisions made by each specialty Residency Review Committee (RRC), although the ACGME has institutional requirements that apply independently of the RRCs, therefore making alignment between undergraduate and graduate more complex with 26 specialty committees involved (Cassie et al 1999).…”

Interventional cardiology fellowship training in canada

“…IC was considered not to have met such criteria and therefore denied eligibility for independent accreditation in 2006. The reasons for varying conclusions reached by RCPSC compared with their US counterparts have not been made public, but the authors view this adverse assessment to be a result of operative differences in the accreditation process of ACGME and RCPSC as reported previously [14,15]. The absence of formal accreditation and national training standards poses significant challenges for programs and their trainees including potential for variability in training experience across institutions, ineligibility to take ABIM certification examination, and risk of adverse consequences for employment and hospital privileges after completion of training.…”

International standards for programmes of training in intensive care medicine in Europe

“…In Australia it is the responsibility of the Australian Medical Council to accredit (specialist) training organisations [18] to undertake peer assessment. The USA and Canada have a dispersed and a centralised system, respectively [19]. Accreditation of graduate training programmes in the USA is the responsibility of a private notfor-profit organisation, the Accreditation Council for Graduate Medical Education (ACGME), which produces common standards for all training centres and specialityspecific standards for each training programme.…”