History of the Transition to a Single GME Accreditation System

The transition to a single US graduate medical education (GME) accreditation system—the culmination of a five-year transition that began in July 2015 with a Memorandum of Understanding (MOU) among the ACGME, American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM)—concluded in June 2020. The MOU provided a roadmap for integration of the osteopathic educational tradition into the ACGME accreditation system; as the osteopathic accreditor of GME, the AOA phased out the accreditation of GME programs. This included:

• The AOA and AACOM became Member Organizations of the ACGME.
• Four AOA-nominated and four AACOM-nominated Directors were added to the ACGME Board of Directors.
• The AOA serves as a nominating organization to ACGME Review and Recognition Committees.
• The ACGME began accrediting the specialty of osteopathic neuromusculoskeletal medicine, historically accredited by the AOA, and formed a Review Committee to oversee it.
• The ACGME created Osteopathic Recognition to formally acknowledge ACGME-accredited residency or fellowship programs that integrate formal education in Osteopathic Principles and Practice in their curriculum, consistent with the Osteopathic Recognition Requirements. Osteopathic Recognition provides an opportunity for US and international medical school graduates to receive osteopathic medical education. The Osteopathic Recognition Committee oversees Osteopathic Recognition.
• The ACGME’s senior leadership includes a Senior Vice President, Osteopathic Accreditation who oversees an administrative structure focused on osteopathic GME.

During a five-year transition period beginning in July 2015, institutions and programs solely accredited by the AOA had to demonstrate substantial compliance with relevant ACGME requirements through an application for accreditation. Ninety-eight percent of previously-AOA-approved programs that applied and completed the application process for ACGME accreditation during the transition period have achieved it. Since July 2015, filled post-graduate positions in previously-AOA-approved programs grew 22 percent to 10,462 in 2020.

The ACGME’s accreditation model preserves the osteopathic medical education continuum, by integrating the opportunity to offer and receive osteopathic education within ACGME-accredited residency and fellowship programs, while maintaining the other aspects of the continuum (accreditation of Colleges of Osteopathic Medicine, AOA certifying boards, osteopathic licensing examinations, etc.). It also allows all US medical school graduates to complete their residency and/or fellowship education in ACGME-accredited programs and demonstrate achievement of common Milestones and competencies.

Benefits of this single GME accreditation system include:

• Uniform GME accreditation that enhances the choices and opportunities for residents and fellows and provides transparency to the federal government, licensing boards, credentialing committees, and the public.
• Increased collaboration among the medical education community to address the challenges facing GME for the benefit of all medical residents and fellows, as well as their patients.
• Reduced costs and increased efficiencies by eliminating duplicative accreditation costs and reporting.
• Consistency across GME programs in evaluation methods and accountability standards, using specialty-specific Milestones for assessing the competence of residents/fellows graduating from all ACGME-accredited US GME programs.
• Opportunities for all medical school graduates to receive formal osteopathic medical education during residency/fellowship in programs with Osteopathic Recognition and in the specialty of osteopathic neuromusculoskeletal medicine.

The ACGME, AOA, and AACOM remain committed to continued collaboration toward the shared goal of improving health care through the advancement of GME across all medical specialties, with a focus on promoting patient safety, learner education, and physician well-being.

To learn more about osteopathic medicine, view a series of videos presented by former ACGME Board Chair and osteopathic physician Dr. Karen Nichols in the ACGME’s online learning portal, Learn at ACGME.