Graduate Medical Education Committee Meetings 101

The Accreditation Council for Graduate Medical Education (ACGME) expects sponsoring institutions to conduct effective Graduate Medical Education Committee (GMEC) meetings. While the Institutional Requirements (IR) Section I.B–I.B.6 delineates Core, Detail, and Outcome statements, including the structure, composition, and other required attributes of the GMEC (eg, attendance, oversight responsibilities, subcommittees),¹  optimal processes for effective GMEC meetings are not delineated.²  The challenge for many institutions is how to conduct productive and efficient GMEC meetings that ensure compliance with Section I.B requirements.

In 2017, 50% of the total citations issued by the ACGME's Institutional Review Committee (IRC) related to items in IR Section I.B. These requirements offer a roadmap for the designated institutional officials (DIOs)—in partnership with institutional leadership—on how to properly constitute and operate the GMEC.²  Additional work is essential to ensure an efficient GMEC meeting, yet the literature on efficient and effective GMEC operations is limited. Drawing on the expertise of Institutional Review Committee (IRC) members, this Rip Out highlights strategies that new and established sponsoring institutions can use to improve GMEC productivity and reduce the risk of a Citation or Area for Concern/Improvement.

1. Create an annual calendar to frame the GMEC agenda. Avoid common omissions! Create an operational calendar using IR Section I.B.4 to identify regularly scheduled events in the annual work of your sponsoring institution (figure). This calendar serves as a blueprint for your GMEC meeting agendas and minutes. List each GMEC member by role and voting prerogative, and establish the minimum quorum status. Consider recording these in a formal GMEC charter document. Frame GMEC agendas by committee responsibility, including oversight, review/approval of institutional changes, graduate medical education (GME) policies and procedures, new program applications, and appointment of new program directors. Design the agenda to mirror the IRs to affirm the GMEC is meeting the various requirements.

2. Make a record of GMEC discussion topics and actions. Detailed meeting minutes are an important attribute of high-quality GMEC functioning. As in a doctor-patient note, “If it wasn't documented, the discussion didn't occur.” Documentation is key. Annual review of accreditation status for the institution and its ACGME-accredited programs and letters of notification is critical and must be documented in the meeting minutes.

3. Choose the optimal size for the GMEC. Selecting the membership of the GMEC requires a balance of what meets ACGME requirements with what fits the sponsoring institution's needs. Bigger is not always better. Sometimes a smaller GMEC with members capable of representing all programs, not just their own, is more functional and efficient. IR Section I.B.1 specifies the minimum required voting members for a sponsoring institution with 1 program (N = 5) versus multiple programs (N = 6). The GMEC also may create subcommittees (IR Section I.B.2) to efficiently execute required responsibilities. While the actions of these committees must be approved by the GMEC, they can be a useful asset (eg, having them conduct the special review process).

4. Stipends and benefits: Recommendations to the sponsoring institution's administration regarding stipends and benefits must be approved and documented in GMEC meeting minutes on an annual basis.

5. The annual institutional review (AIR) demonstrates that there is an institutional process for oversight and monitoring procedures of its accredited programs and the action plans resulting from each program's Annual Program Evaluation.

1. Increase GMEC efficiency, function, and effectiveness through an ongoing process. To achieve GMEC meeting efficiency, ask questions such as: Has the institution used the GMEC to problem solve unique situations at either the program or the institutional level? What is or is not working for how the GMEC and the institution conduct the AIR? What monitoring procedures are in place for action items resulting from program- and institution-level reviews? What are special characteristics of the local GMEC that make it highly effective—the “special sauce” for ensuring effective and efficient meetings and activities between meetings? Use the answers to these questions to continuously improve GMEC meetings and functioning. Conduct process reviews and identify opportunities to ensure your sponsoring institution is conducting meetings effectively. Do the most productive GMEC meetings occur when the DIO sits back and listens? Consider succession planning for GMEC members, including peer-selected resident representatives. Plan the meeting agenda to include 2 to 3 major topics that represent longer-term goals. Finding what works best for a given sponsoring institution may be challenging, but it is an achievable and worthwhile goal.

2. Use your GMEC as a consultative body. GMEC members typically possess the greatest GME knowledge within the institution and can function as resources to others.

3. Use your special review process not only for underperforming programs, but also to prepare programs and PDs for the ACGME Self-Study and all types of accreditation and Clinical Learning Environment Review site visits.

4. Double check GMEC activities meet requirements. Ensure GMEC oversight for programs' annual program reviews; monitor action plans and improvement in each accredited program and the institution on an annual cycle.