Byron Joyner, MD, MPA
The University of Washington School of Medicine sponsors over 85 clinical fellowship programs that are not accredited by the ACGME. This month, I have invited Gabrielle Pett, Senior Director, Business Affairs, to share information about these non-ACGME Programs and GME Office initiatives to support these non-ACGME programs and fellows.
Byron Joyner, MD, MPA
Vice Dean for Graduate Medical Education, Designated Institutional Official
Gabrielle Pett
The University of Washington School of Medicine (UWSOM) is one of the largest sponsoring institutions of ACGME-accredited programs in the country, with 128 ACGME accredited residency and fellowship programs. But did you know the UWSOM also has over 80 non-ACGME clinical residency and fellowship programs?
In 2014 – in response to findings of variable support and oversight for these programs at a systems level – the UWSOM delegated responsibility to the UW Graduate Medical Education Committee (GMEC) for ensuring the educational quality of UWSOM non-accredited training programs at the institution. The GMEC charged the Non-ACGME Program Oversight Subcommittee (formerly known as the GMEC-Approved Non-ACGME Fellowship Program Subcommittee) to undertake this oversight with key goals of ensuring:
- all non-ACGME programs have a solid educational learning environment to facilitate quality fellowship training
- non-ACGME programs are provided with adequate personnel, clinical activities, and other resources necessary to support the program
- non-ACGME fellowship programs enhance, but do not interfere, with existing ACGME accredited programs or other existing non-ACGME fellowships
The Non-ACGME Program Oversight Committee is charged with recommending approval of new non-ACGME programs, supporting institutional oversight of ACGME non-standard training programs, maintaining Educational Standards for Non-ACGME Programs, providing input on GME policies to include relevant requirements of non-ACGME programs and/or trainees, and conducting annual surveys of non-ACGME programs and program graduates to inform areas of need and support for non-ACGME programs. Subcommittee members include program directors, ACGME and non-ACGME trainees, program administrators, and GME staff. Dr. Catherine Kling, program director for Abdominal Transplant Surgery, chairs the Subcommittee this year.
Landscape of Non-ACGME Programs in the UWSOM (AY25)
The number of non-ACGME programs changes each year as new programs are approved, some transition to ACGME accreditation, and others are phased out. For the 2024-2025 academic year there are 88 Non-ACGME programs across 18 clinical departments. Eighty-five percent (85%) of these programs are one-year in length, typically appointing only one fellow per year. The Subcommittee has approved 39 new non-ACGME programs since 2014 and 8 new programs since January of this year. These have included:
- Neurological Surgery: Functional Neurosurgery
- Neurology: Neonatal Neurocritical Care
- Ophthalmology: Glaucoma and Neuro-Ophthalmology
- Radiology: Cancer Imaging and Theranostics
- Rehabilitation Medicine: Cancer Rehabilitation
- Surgery: Breast Surgical Oncology
These programs represent growing subspecialties with national accreditation standards and evolving fields in medicine.
Within these programs fellows may either hold a position of Acting Instructor – spending a portion of their time as both learners and attendings – or in a position of Fellow Non-ACGME without an independent attending role.
What are the Requirements for Non-ACGME Programs?
Unlike ACGME programs which follow specialty requirements developed under the ACGME’s Common Program Requirements, non-ACGME programs do not follow uniform standards. Some are accredited or recognized by their national specialty societies and councils while others do not follow formal guidelines. In February 2022, the ACGME announced new Non-Standard Training (NST) Recognition requirements for Sponsoring Institutions with non-ACGME programs that train foreign national physicians on J-1 visas sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG), adding another set of requirements for some non-ACGME programs.
22 UW programs are currently accredited or recognized by one of 13 different national specialty societies or councils, and 9 programs in the past two years have been approved by the ACGME to train foreign nationals under J-1 visa sponsorship.
To manage this diverse structure, and help support these programs, the Non-ACGME Program Oversight Subcommittee introduced Educational Standards for Non-ACGME Programs in 2018. These standards outline minimum requirements and expectations for all non-ACGME accredited clinical programs in the UWSOM. These are reviewed and updated each year by the Subcommittee based on various inputs. The current standards address ACGME NST recognition requirements; sponsoring institution oversight of programs; personnel (program directors, faculty, program administration); fellow appointments; curriculum; assessment and evaluation; and support for the learning environment. These standards also serve as a resource for departments in the development of new programs and as guide for the Subcommittee in facilitating review of new program applications.
What is the role of the GME Office in supporting these programs?
GME Office management of non-ACGME programs has grown in recent years, a reflection of continued compliance with external requirements, input from the Non-ACGME Program Oversight Subcommittee, and transitions in title management in the UWSOM.
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Where can I find more information about non-ACGME programs?
The Non-ACGME Program Resources page on the GME website includes resources for non-ACGME programs including:
- ACGME Requirements for Sponsoring Institutions with Non-Standard Training Programs for J-1 Visa Sponsorship
- Department Chair Letter of Support for New Non-ACGME Program Directors
- Educational Standards for Non-ACGME Programs
- Links to relevant GME policies
- New Non-ACGME Program Application and Submission Instructions
- Non-ACGME Program Complement Expansion Questions and Guidelines
- Orientation Guidelines
- Recruitment Resources
- Resources for Non-ACGME Fellow Appointments
- Visa guidelines and Non-ACGME Fellow Visa Matrix
We’re grateful to department faculty, staff, and leadership for their efforts in developing new and novel clinical programs and for collaborating with the Non-ACGME Program Oversight Subcommittee and the GME Office. We also want to thank program directors and administrators for their ongoing participation in our annual non-ACGME program survey, which plays a vital role in guiding our work to support these programs and their trainees.
Gabrielle Pett, MHA
Senior Director, Business Affairs, GME
Program Manager, Non-ACGME Program Oversight Subcommittee