Diversity, Equity, and Inclusion (DEI) Initiatives from the Accreditation Council for Graduate Medical Education (ACGME) in Training Program Oversight

Mia Kang, MD
Associate Professor of Anesthesiology & Chief, Neuroanesthesiology Division
University of North Carolina

Paul Garcia, MD, PhD
Chair, DEI Committee
Associate Professor of Anesthesiology and Division Chief of Neuroanesthesiology
New York-Presbyterian/ Columbia University Irving Medical Center, Columbia University

Dr. Kang
Mia Kang, MD
Dr. Garcia
Paul Garcia, MD, PhD

Fellowship program directors are no doubt aware of the importance of promoting diversity, equity, and inclusion (DEI) in their training programs but many of us may not be aware that the Accreditation Council for Graduate Medical Education (ACGME) has implemented formal DEI policies into its evaluation of programs.

In recognition of the positive impact of diversity on patient outcomes, the ACGME has asked residency and fellowship programs to commit to increasing the diversity of the physician workforce.

William McDade, MD, PhD is the inaugural Chief DEI Officer of the ACGME. He is a prominent obstetric anesthesiologist, most recently at the University of Chicago, who has demonstrated true leadership on these issues. The University of North Carolina was privileged to have Dr. McDade present Grand Rounds recently on the importance of DEI efforts to benefit not just patients but also the healthcare workforce. A follow-up column will discuss some of the data that he presented on the impact of DEI efforts in more detail.

To summarize the ACGME’s DEI requirements briefly, training programs must implement policies and procedures which demonstrate commitment to recruiting and retaining a diverse and inclusive workforce. Evaluation of these efforts will be part of the ACGME’s formal review of programs. Residents and fellows must be able to raise concerns and provide feedback about a program’s DEI culture without fear of recrimination.

In addition, training programs must provide trainees with a “professional, and respectful environment free from discrimination, harassment, mistreatment, abuse, or coercion.”

Fellowship programs are now being asked to collect data on board certification pass rates “with the intent of decreasing reliance on first-time pass rates as a measure of excellence.” The intent of this change appears to be to recognize that being an effective physician involves myriad attributes and that while board certification pass rates are certainly significant, they should be considered as part of the overall picture instead of being the most important metric in evaluating programs.

Thus, annual first-time board certification pass rates will no longer be considered in isolation as part of the ACGME's evaluation of programs. Instead, programs will have their first-time pass rates averaged over a six-year period and will not be penalized as long as this rate is above the bottom 5th percentile of pass rates for all programs in that specialty. (For specialties that have high first-time board certification pass rates, programs that have an "admirable performance" but end up in the bottom 5th percentile will not be cited.)

What can you do to get involved in these efforts? The ACGME is asking for feedback on these initiatives and encourages programs to report measures that they have found to be successful in promoting DEI. In addition, the ACGME holds a forum on the second Wednesday of each month for DEI officers. To sign up for these sessions, please email Further information about the ACGME’s diversity policies and initiatives, as well as references and resources, can be found at

It is gratifying to note that as more and more research demonstrates the benefits of diversity on improving patient outcomes, the governing bodies in our medical training system are responding by incorporating DEI policies into formal program evaluation.

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