TAGME — Training Administrators of Graduate Medical Education Certification Exam — Questions and Answers

Question 1: During post-Match analysis, you discover your program sent ERAS interview invitations at a rate of 18% for IMGs with USMLE Step 1 scores ≥240 but 71% for USMGs with scores in the 220-230 range. An applicant files a discrimination complaint. Which regulatory or legal framework presents the GREATEST institutional risk in this scenario?

NRMP Violations Policy for preferential ranking
Title VII of the Civil Rights Act of 1964 via disparate impact theory (Correct answer)
ACGME Common Program Requirements Section II.D on resident eligibility
LCME accreditation standards for affiliated medical schools

Correct answer: Title VII of the Civil Rights Act of 1964 via disparate impact theory

This scenario describes a statistically significant disparate impact on a protected class (national origin correlates strongly with IMG status). Title VII's disparate impact theory does not require proof of intentional discrimination—it only requires showing that a facially neutral policy produces discriminatory outcomes that the employer cannot justify by business necessity. The EEOC and federal courts have applied Title VII to graduate medical education hiring. NRMP violations policy addresses rank order manipulation, not invitation decisions. ACGME Section II.D governs eligibility criteria (licensure, visa status), not selection ratios. LCME governs medical school accreditation, not residency programs.

Question 2: Your program receives a Continued Accreditation with Warning from the ACGME Review Committee citing inadequate resident assessment data. The warning specifies a 12-month response deadline. Which combination of actions BEST fulfills the procedural requirements for responding to this citation?

Submit a Progress Report through ADS with supporting data, implement a revised assessment plan, and ensure the APE formally reviews the citation and response (Correct answer)
Submit a Progress Report through ADS addressing the citation with supporting evidence, then await the RC's response before making further changes
Appeal the warning decision to the ACGME Appeals Panel within 30 days, suspending the 12-month deadline during the appeal process
Request a voluntary withdrawal of accreditation to reapply under a stronger assessment framework, thereby avoiding the warning notation

Correct answer: Submit a Progress Report through ADS with supporting data, implement a revised assessment plan, and ensure the APE formally reviews the citation and response

A Continued Accreditation with Warning requires a formal Progress Report submitted through ADS within the specified deadline, accompanied by evidence of corrective action. Critically, the Annual Program Evaluation must formally document the committee's review of the citation and the corrective measures taken — this closes the institutional loop and demonstrates systematic quality improvement. Voluntary withdrawal is an extreme and strategically inadvisable step. Appeals are reserved for Withdrawal decisions, not Warning outcomes, and do not pause response timelines.

Question 3: Under FERPA, a residency program receives a subpoena requesting a resident's complete training file, including evaluations and disciplinary records. Which response is MOST consistent with FERPA compliance?

Release all records immediately because a legal subpoena supersedes FERPA protections
Notify the resident of the subpoena and give them a reasonable opportunity to seek a protective order before releasing records, unless the subpoena explicitly states otherwise (Correct answer)
Refuse to release any records because FERPA prohibits disclosure to courts under all circumstances
Redact all evaluations but release demographic and scheduling data without notifying the resident

Correct answer: Notify the resident of the subpoena and give them a reasonable opportunity to seek a protective order before releasing records, unless the subpoena explicitly states otherwise

FERPA requires institutions to make a reasonable effort to notify the student (resident) of a subpoena before complying, unless the subpoena itself orders non-disclosure. Simply complying without notice, partially releasing records, or blanket refusal are all non-compliant responses. The resident must have the opportunity to seek a protective order.

Question 4: During the Annual Program Evaluation (APE), the Program Evaluation Committee (PEC) identifies that 40% of graduating residents over the past three years failed their specialty board examination on the first attempt. Under ACGME expectations, what is the most appropriate immediate next step for the program administrator to facilitate?

Submit a Scholarly Activity Report to the ACGME documenting the board failure trend and the program's remediation plan
Defer action until the program's next scheduled self-study, as the APE is a formative process and does not require immediate intervention documentation
Notify the Designated Institutional Official (DIO) within 30 days and place the program on internal probation pending a corrective action plan
Ensure the PEC documents this as a 'concern' in the APE written report and that the program director develops a written action plan with specific measurable outcomes and a timeline for reassessment (Correct answer)

Correct answer: Ensure the PEC documents this as a 'concern' in the APE written report and that the program director develops a written action plan with specific measurable outcomes and a timeline for reassessment

ACGME requires the PEC to use APE data to produce a written report that identifies program strengths and areas for improvement, and when a concern is identified (such as a pattern of board failures), the program must develop a documented action plan with measurable outcomes. There is no ACGME requirement to submit a Scholarly Activity Report for board performance. While notifying the DIO is good practice, 'internal probation' is not an ACGME-defined mechanism — it is an institutional construct. The APE is not simply formative; ACGME expects documented follow-through on identified deficiencies.

Question 5: A sponsoring institution's GMEC is being restructured following a compliance review. The DIO must ensure the GMEC composition meets ACGME Institutional Requirements. Which statement MOST precisely describes what ACGME mandates regarding resident/fellow representation on the GMEC?

Resident/fellow representation is encouraged but not required; institutions may substitute a patient safety officer as a proxy voice for trainees
One resident per sponsored specialty must serve on the GMEC, each with advisory (non-voting) input to protect institutional objectivity
At least one resident/fellow representative must serve, selected by their peers, and must have a vote on GMEC decisions (Correct answer)
At least two resident/fellow representatives must serve, with one appointed by the DIO and one elected by residents, both with full voting rights

Correct answer: At least one resident/fellow representative must serve, selected by their peers, and must have a vote on GMEC decisions

ACGME Institutional Requirements mandate that the GMEC include at least one resident/fellow member who is selected by the residents/fellows (i.e., peer-selected, not appointed by the DIO or administration) and who holds a vote on GMEC matters. This peer-selection requirement and the voting right are both non-negotiable. The ACGME does not require one representative per specialty, does not allow a non-trainee proxy, and does not restrict residents to advisory-only roles. This ensures that trainees have authentic, uncoerced representation in GME governance.

Question 6: During a CLER (Clinical Learning Environment Review) site visit, the accreditation field representative evaluates the institution across all six CLER focus areas. A program administrator is preparing an orientation for new residents and must correctly identify those six areas. Which of the following lists is COMPLETE and ACCURATE?

Patient Safety, Health Care Quality, Communication and Teamwork, Supervision, Duty Hours Compliance, Professionalism
Patient Safety, Health Care Quality, Diversity and Inclusion, Supervision, Fatigue Management and Mitigation, Resident Well-Being
Patient Safety, Health Care Quality, Care Transitions, Supervision, Fatigue Management and Mitigation, Professionalism (Correct answer)
Patient Safety, Population Health Equity, Care Transitions, Supervision, Resident Wellness and Burnout, Professionalism

Correct answer: Patient Safety, Health Care Quality, Care Transitions, Supervision, Fatigue Management and Mitigation, Professionalism

The ACGME CLER program evaluates sponsoring institutions across exactly six focus areas: (1) Patient Safety, (2) Health Care Quality, (3) Care Transitions, (4) Supervision, (5) Fatigue Management and Mitigation, and (6) Professionalism. Common distractors include 'Duty Hours' (which is an ACGME program requirement but not a distinct CLER focus area), 'Wellness' or 'Well-Being' (a related but separate initiative), and 'Diversity and Inclusion' (not among the original six). CLER visits occur approximately every 18 months and produce a Pathways to Excellence report, not a citation-based accreditation decision.

Question 7: What is the legal significance of a resident's employment contract in GME?

It is advisory only and not legally binding
It replaces the need for institutional policies
It is a binding agreement defining rights, responsibilities, compensation, and terms of appointment (Correct answer)
It is only applicable after the first year of training

Correct answer: It is a binding agreement defining rights, responsibilities, compensation, and terms of appointment

A resident's employment contract is a legally binding document outlining compensation, benefits, duties, program policies, and grounds for termination or non-renewal.

Question 8: A fellowship program receives a citation during an ACGME site visit for failing to maintain documentation of a required semi-annual evaluation for one fellow who was on approved medical leave for 5 of the 6 months in the evaluation period. What is the MOST appropriate corrective action the program administrator should take?

Retroactively complete the evaluation using faculty attestations and document the leave period, noting that competency assessment was limited due to absence (Correct answer)
File an appeal with the ACGME arguing the citation is invalid because the fellow was on approved leave
Request a leave of absence extension so the fellow can complete enough time for a full evaluation period
Document that the semi-annual evaluation requirement is waived for residents or fellows on approved medical leave exceeding 90 days

Correct answer: Retroactively complete the evaluation using faculty attestations and document the leave period, noting that competency assessment was limited due to absence

When a fellow is on extended leave, the program cannot simply skip the required semi-annual evaluation. The appropriate response is to conduct and document the evaluation to the extent possible, clearly noting the leave period and any limitations in competency assessment. ACGME expects programs to address gaps in documentation with a corrective action plan and transparency, not to seek extensions or assume the requirement is waived. Appealing a valid citation without remediation would not resolve the underlying compliance issue.

Question 9: A program administrator discovers that a graduating chief resident submitted a moonlighting activity log showing 180 hours of external moonlighting during the final six months of training, all within ACGME 80-hour weekly limits when combined with program hours. However, the institution's GME policy caps approved external moonlighting at 120 total hours per academic year. Which entity bears PRIMARY responsibility for addressing this policy violation?

The program administrator, because they are responsible for tracking and enforcing moonlighting logs
The Graduate Medical Education Committee (GMEC), because it must approve all moonlighting requests retroactively
The Designated Institutional Official (DIO), because moonlighting caps are an institutional GME policy matter that supersedes program-level decisions (Correct answer)
The program director, because duty hour compliance is the program's responsibility under ACGME requirements

Correct answer: The Designated Institutional Official (DIO), because moonlighting caps are an institutional GME policy matter that supersedes program-level decisions

Institutional GME policies — including moonlighting caps — are the domain of the DIO and the sponsoring institution. While program directors oversee duty hour compliance with ACGME requirements, when a violation involves a breach of an institutional (not just ACGME) policy ceiling, the DIO holds primary accountability for enforcement and remediation. The GMEC sets policy but does not typically retroactively approve individual moonlighting; the program administrator monitors logs but lacks institutional authority to adjudicate policy breaches.

Question 10: Which organization provides the accreditation standards that GME programs must follow?

Accreditation Council for Graduate Medical Education (ACGME) (Correct answer)
American Medical Association (AMA)
National Institutes of Health (NIH)
American College of Surgeons (ACS)

Correct answer: Accreditation Council for Graduate Medical Education (ACGME)

The Accreditation Council for Graduate Medical Education (ACGME) is the sole accrediting body for all-opathic graduate medical education programs in the United States. It sets the comprehensive standards and requirements that residency and fellowship programs must adhere to. Training Administrators are instrumental in helping programs navigate and comply with these essential accreditation guidelines.

Question 11: A program administrator is asked to prepare a summary of resident scholarly activity. Which of the following is NOT typically counted as scholarly activity for ACGME purposes?

Quality improvement projects with measurable outcomes
Podium presentations at national conferences
Participation in clinical care without a research or educational component (Correct answer)
Peer-reviewed journal publications

Correct answer: Participation in clinical care without a research or educational component

Routine clinical care delivery, without a research, educational, or quality improvement component, does not constitute scholarly activity under ACGME definitions.

Question 12: When a program seeks to add a new required rotation at a previously unapproved participating site, what must the program do before residents begin rotating?

Submit a request through the Annual Program Evaluation process
Inform the DIO and proceed with rotations while ACGME approval is pending
Notify residents at least 30 days in advance of the new rotation
Obtain ACGME approval and execute a Program Letter of Agreement with the new site (Correct answer)

Correct answer: Obtain ACGME approval and execute a Program Letter of Agreement with the new site

Programs must receive ACGME approval for new participating sites and execute a PLA before residents may rotate there, as all training sites must be formally approved and documented.

Question 13: An ACGME site visit results in a citation for non-compliance with Program Letters of Agreement (PLAs). Which element, if missing from a PLA, would most directly justify this citation under the Common Program Requirements?

A statement affirming that residents have access to the same duty-hour tracking system used at the sponsoring institution
Specification of the educational goals and objectives for the rotation and delineation of each program's responsibilities for supervision (Correct answer)
Identification of the supervising faculty member's board certification status at the participating site
Documentation that the participating site's GME Committee has approved the rotation

Correct answer: Specification of the educational goals and objectives for the rotation and delineation of each program's responsibilities for supervision

ACGME Common Program Requirements mandate that PLAs must specify educational goals and objectives for the rotation AND clearly delineate each program's responsibilities for supervision, evaluation, and duty hours. Board certification status and GME Committee approval of individual rotations are not explicitly required PLA elements. Duty-hour tracking system uniformity is not a PLA requirement, though duty hours oversight responsibility must be assigned.

Question 14: A program coordinator is reviewing the Annual Program Evaluation (APE) process. The Program Evaluation Committee (PEC) has drafted its report, but the program director wants to include aggregate resident survey data that was collected outside of the ACGME Resident Survey cycle using a locally developed tool. Under ACGME Common Program Requirements, which statement most accurately describes the permissibility and limitations of this approach?

The APE must be deferred until the next ACGME Resident Survey cycle if locally collected data is the primary evidence base for program improvement decisions.
Local survey data may be incorporated into the APE, but the PEC must document that it was used supplementally and cannot replace the requirement to act on ACGME Resident Survey results. (Correct answer)
Local survey data may fully substitute for the ACGME Resident Survey if the program director certifies that the tool covers equivalent content domains.
Only data collected through ACGME-sanctioned instruments (Resident Survey and Faculty Survey) may be used in the APE; local surveys are prohibited from inclusion.

Correct answer: Local survey data may be incorporated into the APE, but the PEC must document that it was used supplementally and cannot replace the requirement to act on ACGME Resident Survey results.

ACGME Common Program Requirements mandate that the PEC use ACGME-mandated survey results as part of the APE process, but programs are not prohibited from incorporating additional locally developed tools as supplementary evidence. However, the APE must still explicitly address results from the ACGME Resident/Fellow Survey and Faculty Survey—local instruments cannot replace this obligation. Programs that ignore mandated survey results, even if they have robust local data, are out of compliance.

Question 15: A sponsoring institution (SI) is required to provide financial support for a resident who goes on medical leave beyond what insurance covers. This obligation falls under which ACGME requirement area?

Clinical competency committee structure
Program director qualifications
Institutional support and resources (Correct answer)
Faculty development

Correct answer: Institutional support and resources

ACGME institutional requirements mandate that sponsoring institutions ensure adequate financial and administrative support for residents, including leave situations.

Question 16: Which federal legislation established protections requiring that resident stipends and benefits cannot be reduced mid-contract without consent, relevant to program financial obligations?

ACGME Common Program Requirements (institutional version)
The Balanced Budget Act of 1997
The House Staff Bill of Rights concepts codified in state law and ACGME policy (Correct answer)
The Consolidated Omnibus Budget Reconciliation Act (COBRA)

Correct answer: The House Staff Bill of Rights concepts codified in state law and ACGME policy

ACGME policy and many state laws protect residents from unilateral mid-year reductions in compensation or benefits, rooted in house staff rights principles.

Question 17: A program administrator receives a purchase order for $4,200 in medical textbooks but the approved budget line is $3,000. The correct compliance step is to:

Split the order into two invoices to stay under individual approval thresholds
Deny the order and inform faculty the line is exhausted
Seek a budget amendment or supplemental approval before committing funds (Correct answer)
Approve the order and adjust next year's budget accordingly

Correct answer: Seek a budget amendment or supplemental approval before committing funds

Spending in excess of an approved budget line requires prior authorization through a formal amendment process, not retroactive adjustment.

Question 18: What is the primary purpose of the Clinical Learning Environment Review (CLER) program?

To assess resident clinical competency
To evaluate how sponsoring institutions engage residents in patient safety and quality improvement (Correct answer)
To certify program directors
To accredit individual residency programs

Correct answer: To evaluate how sponsoring institutions engage residents in patient safety and quality improvement

CLER visits assess how well sponsoring institutions engage residents and fellows in six focus areas including patient safety, quality improvement, and well-being.

Question 19: Which software might a Training Administrator use to manage GME data?

EHR (Electronic Health Record) systems
LMS (Learning Management System)
Residency Management System (e.g., MedHub, New Innovations) (Correct answer)
CRM (Customer Relationship Management) tools

Correct answer: Residency Management System (e.g., MedHub, New Innovations)

Residency Management Systems like MedHub and New Innovations are specialized software platforms designed specifically for GME programs. Training Administrators use these comprehensive systems to manage a wide array of data, including resident schedules, evaluations, duty hours, and compliance documentation. They are central to efficient program administration, data tracking, and reporting.

Question 20: Which ACGME tool provides programs with data on resident case volumes, scholarly activities, and faculty information used for accreditation review?

Case Log System within the ADS portal (Correct answer)
ERAS applicant tracking module
FREIDA Online database
Milestone Management System (MMS)

Correct answer: Case Log System within the ADS portal

The Case Log System within the ACGME's ADS portal allows programs to track and report resident procedure and case volumes, which are reviewed during accreditation.

Question 21: When a resident is placed on probation, what procedural safeguard must programs provide according to ACGME requirements?

Immediate termination of clinical privileges pending review
A formal appeal mechanism and due process protections (Correct answer)
Automatic notification of the state licensing board
Mandatory transfer to a different clinical site

Correct answer: A formal appeal mechanism and due process protections

ACGME Common Program Requirements mandate that programs provide residents with due process protections, including a formal appeals process, when adverse actions such as probation or dismissal are taken.

Question 22: Under ACGME requirements, what is the maximum number of consecutive hours an intern (PGY-1 resident) may be scheduled to work?

28 hours
16 hours (Correct answer)
80 hours
24 hours

Correct answer: 16 hours

PGY-1 residents are limited to 16 consecutive hours of scheduled duty, a stricter limit than the 24+4 rule applied to more senior residents.

Question 23: A training administrator notices duplicate resident records in the GME management system. The BEST first step is to:

Compare both records for accuracy before merging or correcting (Correct answer)
Archive one record without review
Leave duplicates and notify the registrar only
Delete both records and re-enter the data

Correct answer: Compare both records for accuracy before merging or correcting

Comparing both records before any action prevents accidental loss of accurate data and ensures the merged or corrected record is complete.

Question 24: An institution's GME office is implementing a new learning management system (LMS) that will replace three legacy systems managing curriculum, evaluations, and scholarly activity tracking. The migration plan proposes deleting legacy data after 18 months to reduce storage costs. Which consideration should the training administrator MOST urgently raise before approving this timeline?

Deleting legacy data before confirming complete data migration integrity creates a compliance gap that should be addressed by extending the parallel-run period to 24 months
ACGME program letters of agreement and resident records must be retained for a minimum period defined by both accreditation standards and state medical licensure board requirements, which often exceed 18 months and can extend to 7–10 years post-training (Correct answer)
The 18-month timeline conflicts with the institution's annual program evaluation cycle, which requires access to 3 years of historical trend data for meaningful longitudinal analysis
The cost savings from data deletion should be weighed against the risk of legal discovery requests during that 18-month window before any timeline is approved

Correct answer: ACGME program letters of agreement and resident records must be retained for a minimum period defined by both accreditation standards and state medical licensure board requirements, which often exceed 18 months and can extend to 7–10 years post-training

GME records—including training verification, evaluation data, and scholarly activity documentation—are subject to retention requirements from multiple authorities simultaneously: ACGME accreditation standards, state medical licensure boards (which may request verification years after training completion), The Joint Commission, and institutional policy. Many state boards require verification records to be producible for 7–10 years. An 18-month deletion timeline almost certainly violates these requirements. While migration integrity (B) and trend data (C) are valid concerns, the legal retention obligation is the most urgent and non-negotiable issue.

Question 25: A Program Evaluation Committee is completing its Annual Program Evaluation and has reviewed curriculum maps, faculty development activities, in-training exam scores, and resident feedback surveys. Which required data element — mandated by ACGME Common Program Requirements — is most frequently omitted from Annual Program Evaluations?

A five-year trend analysis of resident attrition and graduation rates
A formal assessment of the DIO's involvement in program oversight activities
Patient care outcomes data relevant to the educational program (Correct answer)
Comparison of the program's milestone distributions against national specialty norms

Correct answer: Patient care outcomes data relevant to the educational program

ACGME Common Program Requirements explicitly require that the Annual Program Evaluation include patient care outcomes relevant to the educational experience. This is the most routinely omitted element; programs frequently limit their APE to process measures such as curriculum reviews, feedback instruments, and exam performance, without incorporating data on the quality of patient care delivered by residents. National milestone comparisons (C) reflect best practice but are not universally mandated, and a five-year attrition trend (B) is not a specified APE requirement.

Question 26: A program's pass rate on specialty board examinations falls below the national average for two consecutive years. The GME administrator's role is primarily to:

Report the program to ACGME without internal review
Suppress the data to avoid negative accreditation consequences
Dismiss all residents who failed the boards
Compile and present the data accurately to the Clinical Competency Committee for program improvement planning (Correct answer)

Correct answer: Compile and present the data accurately to the Clinical Competency Committee for program improvement planning

The administrator's role is to ensure accurate data is available to leadership bodies like the CCC so they can identify root causes and implement improvement strategies.

Question 27: An anonymous report to the GMEC alleges that a program's culture discourages residents from using sick leave. Which ACGME principle is most directly at risk?

Scholarly activity requirements
Resident access to appropriate rest and self-care (Correct answer)
Program accreditation status
Faculty-to-resident ratio requirements

Correct answer: Resident access to appropriate rest and self-care

ACGME well-being requirements explicitly include that residents must be able to access sick leave and self-care without fear of reprisal or stigma.

Question 28: In the context of ACGME's Milestones reporting, what is the recommended minimum number of evaluations per resident per semi-annual reporting period?

One evaluation from the program director only
A single self-assessment
Multiple evaluations from faculty who have directly observed the resident (Correct answer)
Two evaluations from co-residents

Correct answer: Multiple evaluations from faculty who have directly observed the resident

ACGME recommends that milestone ratings reflect input from multiple faculty who have directly observed the resident to ensure validity and reliability.

Question 29: A program director requests that the DIO approve a new subspecialty fellowship that lacks sufficient case volume to meet ACGME program requirements, arguing that the cases will 'grow into compliance' within 18 months as the clinical service expands. The DIO's most appropriate strategic response according to sound GME governance principles is:

Decline to sponsor the program until minimum ACGME case requirements can be demonstrated prospectively, not projected (Correct answer)
Refer the decision to the GMEC voting membership, as program approval is outside unilateral DIO authority
Approve the program and disclose the volume deficit in the program's self-study submission to ACGME
Approve the program conditionally, with a written growth plan and quarterly GMEC review of case volume metrics

Correct answer: Decline to sponsor the program until minimum ACGME case requirements can be demonstrated prospectively, not projected

ACGME program requirements represent minimum educational standards, not aspirational targets. Sponsoring a fellow into a program that cannot currently meet case requirements exposes the fellow to a deficient educational environment, creates accreditation jeopardy (including potential withdrawal of accreditation after the fellow has enrolled), and places the institution in an untenable position. A DIO's fiduciary duty is first to the educational integrity of training. Conditional approval based on projected growth is inappropriate because projections are not guarantees, and the harm to a fellow who cannot meet graduation requirements is not reversible. Disclosing deficits in a self-study does not remedy them. GMEC input is valuable but does not override the DIO's gatekeeping responsibility.

Question 30: What is the role of the Training Administrator in the resident recruitment process?

To select residents for the program
To oversee the application and interview process (Correct answer)
To design the residency curriculum
To conduct interviews with candidates

Correct answer: To oversee the application and interview process

Training Administrators are central to the resident recruitment process, handling the extensive administrative tasks involved. They manage applications through systems like ERAS, coordinate interview schedules, communicate with candidates, and ensure all necessary documentation is collected. Their organizational skills are key to a fair, efficient, and compliant recruitment cycle.

Question 31: Which ACGME document outlines the specialty-specific requirements for each residency program?

Common Program Requirements
Institutional Requirements
Program Requirements (Correct answer)
Milestones Guidebook

Correct answer: Program Requirements

Program Requirements are specialty-specific documents that detail the educational standards, faculty qualifications, and resources each specialty program must meet.

Question 32: During an ACGME site visit, a program is cited for failing to address well-being because its only initiative is a monthly 'wellness lunch.' The site visitors note that the program lacks a systematic mechanism for identifying residents in distress. Which framework best describes what the program is missing?

The program's deficit is purely administrative: it needs to document existing informal support conversations as a formal identification system
The program must implement a peer support program led by chief residents, as this is the ACGME's preferred identification mechanism
The program is over-relying on population-level, passive well-being promotion without a proactive surveillance and individual support mechanism—the ACGME requires both (Correct answer)
The program lacks sufficient social programming; adding quarterly wellness events would bring it into compliance

Correct answer: The program is over-relying on population-level, passive well-being promotion without a proactive surveillance and individual support mechanism—the ACGME requires both

ACGME well-being requirements operate on two levels: (1) promoting general wellness for all residents (population-level), and (2) identifying and supporting individual residents who are in distress (surveillance/intervention level). A wellness lunch addresses the former but fails the latter. Programs must have a proactive, systematic process—not merely reactive or informal—for identifying residents who are struggling, which may include structured check-ins, anonymous surveys with follow-up protocols, or faculty alertness training.

Question 33: Which financial statement would a program administrator review to determine whether the GME department has sufficient cash to cover payroll at the end of the month?

Balance sheet
Cash flow statement (Correct answer)
Income statement
Statement of changes in equity

Correct answer: Cash flow statement

The cash flow statement shows actual cash inflows and outflows, making it the appropriate tool for assessing near-term payroll coverage.

Question 34: A program administrator is auditing resident well-being survey data and finds that 68% of residents report 'high burnout' on the validated Maslach Burnout Inventory administered annually. Under ACGME expectations for well-being program oversight, which response BEST reflects the program administrator's role?

Proactively analyze root causes by correlating burnout data with duty hours, rotation schedules, and workload metrics, then prepare an action plan with measurable interventions for the program director's review before the next GME Committee cycle (Correct answer)
Forward the data to the GME Committee and await institutional guidance before taking any program-level action
Recommend that the program director increase wellness events and mandatory social activities to address the burnout rate
Compile the data for the next Annual Program Evaluation and flag it as a quality improvement item for the following academic year

Correct answer: Proactively analyze root causes by correlating burnout data with duty hours, rotation schedules, and workload metrics, then prepare an action plan with measurable interventions for the program director's review before the next GME Committee cycle

A 68% burnout rate demands proactive, data-driven root cause analysis — not passive escalation or delayed Annual Program Evaluation inclusion. The program administrator's role includes operationalizing well-being monitoring, which means identifying correlations between burnout and structural program factors (duty hours, scheduling, supervision intensity) and supporting evidence-based interventions. Waiting for the next annual cycle or defaulting to social events misses both the urgency and the systemic nature of burnout causation. ACGME expects continuous, not retrospective, quality improvement for well-being.

Question 35: A resident who is also an international medical graduate (IMG) on a J-1 visa is placed on unpaid suspension pending investigation. The GME office must FIRST notify:

The resident's home country medical licensing board
The ACGME Review Committee within 24 hours
The National Resident Matching Program (NRMP)
The U.S. Department of State or the designated J-1 sponsor organization (Correct answer)

Correct answer: The U.S. Department of State or the designated J-1 sponsor organization

Suspensions affecting a J-1 visa holder's training status must be reported to the visa sponsor (typically the Educational Commission for Foreign Medical Graduates, ECFMG) to maintain visa compliance.

Question 36: What is the maximum consecutive hours a PGY-1 resident may work without a break according to ACGME duty hour rules?

30 hours
16 hours (Correct answer)
24 hours
28 hours

Correct answer: 16 hours

ACGME duty hour requirements limit PGY-1 residents to no more than 16 consecutive hours of clinical work.

Question 37: Under ACGME Common Program Requirements, what is the maximum number of hours residents may work in a 7-day period?

90 hours
80 hours (Correct answer)
60 hours
70 hours

Correct answer: 80 hours

ACGME Common Program Requirements limit residents to a maximum of 80 hours per week, averaged over a 4-week period.

Question 38: Which accreditation body requires programs to document their resident selection criteria and make them available to applicants?

ACGME (Correct answer)
ABMS
AMA
LCME

Correct answer: ACGME

ACGME program requirements mandate that programs have written selection criteria and that these are accessible to applicants.

Question 39: A program coordinator notices that required scholarly activity reports are incomplete for several faculty members. Whose primary responsibility is it to ensure faculty scholarly activity requirements are met?

The GMEC
The Program Director (Correct answer)
The Designated Institutional Official (DIO)
The Chief Resident

Correct answer: The Program Director

The Program Director is ultimately responsible for ensuring that faculty fulfill all ACGME requirements, including participation in scholarly activity.

Question 40: A residency program administrator notices that moonlighting income is being reported inconsistently across residents. What is the primary financial compliance concern?

Misclassification of moonlighting as residency-covered work
Inconsistent stipend calculations in the payroll system
Tax reporting obligations for the institution
Potential violation of duty hour regulations affecting program accreditation (Correct answer)

Correct answer: Potential violation of duty hour regulations affecting program accreditation

Inconsistent moonlighting reporting raises ACGME duty hour compliance concerns that can jeopardize program accreditation.

Question 41: A program administrator discovers that $14,000 in educational funds was spent by the prior coordinator on conference registrations for residents who subsequently did not attend and for whom no refunds were obtained. The expenditures occurred 18 months ago and are within the statute of limitations for institutional audit. What is the MOST appropriate immediate action?

Recover the funds directly from the residents who did not attend, since they are the primary beneficiaries of the registrations
Conduct an informal internal review and document the finding, but avoid escalating to avoid reputational harm to the program
Write off the expenditures as an allowable educational cost since conference registrations are a standard program expense
Report the finding to the institutional compliance or internal audit office and cooperate fully with any investigation (Correct answer)

Correct answer: Report the finding to the institutional compliance or internal audit office and cooperate fully with any investigation

Expenditures for goods or services not received ($14,000 in unrecoverable conference fees) represent a potential compliance issue, including possible waste or misappropriation of institutional funds. The appropriate action is immediate disclosure to the institutional compliance or internal audit office, consistent with most institutions' financial integrity policies and, where applicable, federal compliance obligations. Self-investigation or suppression of the finding exposes the administrator to personal liability. Recovering funds from residents is legally inappropriate — they were not party to the purchasing decision.

Question 42: Which federal law primarily governs the privacy and security of residents' educational records held by a GME program?

HIPAA
FERPA (Correct answer)
The ADA
The Sarbanes-Oxley Act

Correct answer: FERPA

FERPA (Family Educational Rights and Privacy Act) governs the privacy of educational records, including residency training records, giving trainees rights over their own information.

Question 43: A program director wants to guarantee a specific applicant a position before rank lists are submitted. This action is:

Permitted for applicants with exceptional qualifications
Permitted if both parties agree in writing
Allowed only for preliminary positions
A violation of the NRMP Match Participation Agreement (Correct answer)

Correct answer: A violation of the NRMP Match Participation Agreement

Pre-Match commitments or guarantees violate the NRMP Match Participation Agreement and can result in sanctions for the program.

Question 44: A program receives a request from an outside institution to verify a former resident's training dates. Under FERPA, the program administrator should:

Obtain written consent from the former resident before releasing information (Correct answer)
Provide the dates freely since training records are not educational records
Share only if the requesting institution is accredited
Deny all requests to protect privacy

Correct answer: Obtain written consent from the former resident before releasing information

FERPA protects educational records of former students/trainees, requiring written consent before disclosure to outside parties unless an exemption applies.

Question 45: According to ACGME Common Program Requirements, which statement MOST accurately characterizes the faculty development mandate?

Programs must document that faculty receive ongoing education in teaching, assessment, feedback, and the learning environment, with frequency and format determined by the program (Correct answer)
Programs must provide a minimum of 4 hours of faculty development annually, with at least half dedicated to resident assessment techniques
Responsibility for faculty development rests entirely with the Sponsoring Institution's GME office, relieving individual programs of documentation obligations
Faculty development is required only for core faculty who serve on the Clinical Competency Committee

Correct answer: Programs must document that faculty receive ongoing education in teaching, assessment, feedback, and the learning environment, with frequency and format determined by the program

ACGME Common Program Requirements mandate that programs ensure faculty members are educated in effective teaching, supervision, assessment, feedback, and the learning environment—but deliberately leave frequency and format to program discretion. Programs must document participation; however, ACGME sets no minimum hour requirement. The mandate extends to all faculty with teaching or supervisory roles, not only CCC members, and cannot be fully delegated to the Sponsoring Institution.

Question 46: What is 'co-teaching' or 'team-based supervision' in GME programs?

Two residents sharing the same patient load
Residents teaching medical students independently
Multiple faculty collaborating to supervise and teach the same resident cohort (Correct answer)
Faculty sharing administrative duties only

Correct answer: Multiple faculty collaborating to supervise and teach the same resident cohort

Team-based supervision involves multiple faculty members collaborating to provide consistent, complementary supervision and teaching across a resident cohort.

Question 47: The ACGME's 'Next Accreditation System' (NAS) shifted the accreditation model primarily toward which approach?

Outcomes-based assessment using Milestones and annual data reporting (Correct answer)
Process-based inputs such as faculty-to-resident ratios
Site visits every two years for all programs
Standardized national board scores as the sole metric

Correct answer: Outcomes-based assessment using Milestones and annual data reporting

NAS moved accreditation away from process and structure inputs toward outcomes-based assessment, relying on Milestones, annual program reviews, and Clinical Competency Committees.

Question 48: A PGY-3 internal medicine resident who has been performing internal moonlighting works 58 hours at the primary training site in a given week and 16 hours of internal moonlighting at the same hospital. The program director is auditing duty hours compliance. Which statement is most accurate regarding this scenario?

The week is non-compliant because internal moonlighting hours must be counted toward the 80-hour weekly average, bringing the total to 74 hours — still within the limit but only when averaged over four weeks
The week is non-compliant because internal moonlighting hours must be included in the 80-hour weekly average, and any week exceeding 80 hours total — including moonlighting — constitutes a violation regardless of the four-week average (Correct answer)
The week is non-compliant because internal moonlighting hours must be counted in the 80-hour weekly limit, and 74 hours is compliant, but the program must still document the moonlighting approval in writing
The week is compliant because internal moonlighting hours are excluded from the 80-hour weekly average calculation

Correct answer: The week is non-compliant because internal moonlighting hours must be included in the 80-hour weekly average, and any week exceeding 80 hours total — including moonlighting — constitutes a violation regardless of the four-week average

ACGME requires that ALL internal moonlighting hours be counted toward the 80-hour weekly limit. In this case, 58 + 16 = 74 hours, which is within the 80-hour cap — so this specific week is actually compliant. However, if the total had exceeded 80, it would be a violation regardless of the four-week averaging rule; the 80-hour cap is both a weekly AND a four-week averaged ceiling. The key principle is that internal moonlighting is never excluded from duty hour accounting. (Note: this scenario at 74 hours is compliant, making option C the closest — but option D correctly states the non-exclusion principle that would apply if the total exceeded 80.)

Question 49: Which of the following is a direct cost typically included in calculating the per-resident amount (PRA) for Medicare GME funding?

Costs of uninsured patient care at the teaching hospital
Malpractice insurance premiums for faculty attendings
Resident salaries, benefits, and program administrative costs (Correct answer)
Hospital overhead costs allocated to the GME department

Correct answer: Resident salaries, benefits, and program administrative costs

The PRA is based on direct costs attributable to training residents, including salaries, benefits, and program administration, not faculty malpractice or hospital overhead.

Question 50: A GME program director discovers that a resident's ACGME case log data was retroactively altered by the program coordinator after a site visit to correct an apparent deficiency. The alteration was not disclosed to the ACGME. Under TAGME data integrity principles, which action represents the MOST appropriate immediate response from the training administrator?

Notify the DIO and legal counsel, document the unauthorized alteration, and self-report to the ACGME as required by institutional policy (Correct answer)
Conduct an internal audit first to determine the full scope of alterations before deciding whether external reporting is warranted
Restore the original data quietly and implement new access controls to prevent future alterations without disclosing the incident
Accept the corrected data since the alteration was made in good faith to address a legitimate deficiency and no harm occurred

Correct answer: Notify the DIO and legal counsel, document the unauthorized alteration, and self-report to the ACGME as required by institutional policy

ACGME institutional accreditation standards require transparency and honest reporting. Retroactive alteration of case logs without disclosure constitutes a data integrity violation that must be escalated to the DIO and likely self-reported to ACGME. Concealing the alteration—even temporarily for audit purposes—compounds the violation. Legal counsel involvement protects the institution while ensuring appropriate corrective action.

Question 51: What is the purpose of the ACGME's Milestones 2.0 initiative?

To replace subjective evaluations with nationally benchmarked, developmental competency markers (Correct answer)
To align GME milestones with undergraduate medical education EPAs
To eliminate annual evaluations in favor of real-time dashboards
To reduce the number of competency domains from six to three

Correct answer: To replace subjective evaluations with nationally benchmarked, developmental competency markers

Milestones 2.0 refines milestone descriptors to provide clearer, nationally consistent developmental benchmarks for assessing trainee progress.

Question 52: Which system is commonly used by Training Administrators to manage residency applications?

CRM (Customer Relationship Management)
LMS (Learning Management System)
EHR (Electronic Health Records)
ERAS (Electronic Residency Application Service) (Correct answer)

Correct answer: ERAS (Electronic Residency Application Service)

ERAS (Electronic Residency Application Service) is the standardized online application service used by applicants to apply to residency and fellowship programs in the United States. Training Administrators extensively use ERAS to receive, review, and manage the thousands of applications submitted each year. It streamlines the initial, critical phase of the resident recruitment process.

Question 53: A hospital system is considering consolidating GME administrative services across three programs to reduce overhead. This strategy is best described as seeking:

Zero-based budget reductions
Economies of scale (Correct answer)
Revenue cycle optimization
Activity-based costing efficiencies

Correct answer: Economies of scale

Consolidating services to reduce per-unit administrative costs across multiple programs is a classic example of achieving economies of scale.

Question 54: What is the primary purpose of the ACGME Clinical Learning Environment Review (CLER) program?

To assess how institutions engage residents in patient safety and quality improvement (Correct answer)
To accredit new programs
To conduct financial audits of GME programs
To verify duty hour compliance

Correct answer: To assess how institutions engage residents in patient safety and quality improvement

CLER visits evaluate how Sponsoring Institutions engage residents and fellows in patient safety, quality improvement, and other clinical learning environment areas.

Question 55: Which NRMP report provides programs with data on their Match outcomes compared to national trends in their specialty?

NRMP Program Results Report (Correct answer)
ACGME Annual Data Report
GME Track Summary
ERAS Statistics Report

Correct answer: NRMP Program Results Report

The NRMP Program Results Report provides program-specific match data including fill rates and applicant characteristics, which programs can use to benchmark against national specialty trends.

Question 56: What is FERPA and when does it apply in graduate medical education?

A credentialing standard for fellowship programs
A federal law protecting the privacy of educational records that may apply to resident education files (Correct answer)
A financial reporting law for nonprofit hospitals
An accreditation standard for osteopathic programs

Correct answer: A federal law protecting the privacy of educational records that may apply to resident education files

FERPA (Family Educational Rights and Privacy Act) protects educational records; it may apply to certain GME training records, particularly at university-affiliated programs.

Question 57: Which ACGME accreditation pathway is designed for new programs that have not yet trained residents?

Provisional Accreditation
Continued Accreditation
Initial Accreditation
Pre-Accreditation (Correct answer)

Correct answer: Pre-Accreditation

Pre-Accreditation is the status granted to new programs that have been approved to recruit residents but have not yet begun training; it converts to Initial Accreditation after the first class completes training.

Question 58: Which organization publishes the Common Program Requirements that all ACGME-accredited programs must follow?

AAMC
AOA
ACGME (Correct answer)
ABMS

Correct answer: ACGME

The ACGME (Accreditation Council for Graduate Medical Education) publishes and enforces the Common Program Requirements applicable to all accredited residency and fellowship programs.

Question 59: Which document outlines the specific educational and clinical experience requirements unique to a particular specialty residency program?

Program Requirements (specialty-specific) (Correct answer)
Milestones document
Institutional Requirements
Common Program Requirements

Correct answer: Program Requirements (specialty-specific)

Specialty-specific Program Requirements supplement the Common Program Requirements and detail the unique clinical and educational standards for each specialty.

Question 60: A GME office is transitioning to a new residency management software. Which data migration step is MOST critical to perform first?

Back up all existing data and verify its integrity before migration (Correct answer)
Customize the new system's user interface
Train users on the new system immediately
Deactivate the old system as soon as the new one is installed

Correct answer: Back up all existing data and verify its integrity before migration

Creating a verified backup before migration ensures that data can be restored if errors occur during the transition process.

Question 61: Which national system is used for matching applicants to ACGME-accredited residency programs in the United States?

Graduate Medical Education Tracking System (GMETS)
Electronic Residency Application Service (ERAS)
National Resident Matching Program (NRMP) (Correct answer)
American Medical College Application Service (AMCAS)

Correct answer: National Resident Matching Program (NRMP)

The National Resident Matching Program (NRMP) administers the Main Residency Match, which assigns applicants to residency positions using a rank-order list algorithm.

Question 62: The Clinical Competency Committee (CCC) is required to meet at minimum how often per year under ACGME Common Program Requirements?

Monthly
Twice per year (Correct answer)
Once per year
Once per quarter

Correct answer: Twice per year

ACGME Common Program Requirements mandate that the CCC must meet at least twice per year to review resident milestone progress.

Question 63: A sponsoring institution receives a new 5-year grant from HRSA to fund two additional residency positions in a shortage specialty. During year 3, HRSA modifies the grant terms, reducing allowable indirect cost recovery from 26% to 18%. The program administrator must revise the budget. Which approach BEST reflects sound grant financial management in this scenario?

Terminate the two grant-funded positions mid-program year to avoid operating at a financial deficit
Renegotiate the indirect cost rate with the institution's cognizant federal agency to restore the original 26% rate retroactively
Absorb the indirect cost reduction into the program's operating budget without notifying HRSA, since indirect costs are an institutional matter
Submit a formal budget modification request to HRSA and identify direct cost offsets to compensate for the reduced indirect recovery (Correct answer)

Correct answer: Submit a formal budget modification request to HRSA and identify direct cost offsets to compensate for the reduced indirect recovery

When a federal grant's terms are modified mid-award, the administrator must submit a formal budget modification (budget revision) to the awarding agency per 2 CFR §200.308. Identifying direct cost offsets — such as reducing supply costs or deferring non-essential purchases — compensates for lost indirect recovery while keeping the program compliant. Silently absorbing the shortfall violates federal reporting requirements, and unilaterally terminating funded positions could trigger grant non-compliance penalties.

Question 64: A program director receives a complaint that a supervising attending is delegating all patient presentations directly to interns without providing feedback, citing efficiency concerns. Under ACGME supervision requirements, which framework should the program director primarily invoke when addressing this behavior?

The entrustable professional activity (EPA) framework, requiring demonstration of observable competence before unsupervised practice
The supervision continuum framework, which mandates that faculty progression from direct to indirect supervision must align with demonstrated resident milestone achievement (Correct answer)
The duty hours framework, arguing that inadequate supervision extends residents' effective workload
The professionalism milestone sub-competency, classifying the behavior as an interpersonal communication deficiency

Correct answer: The supervision continuum framework, which mandates that faculty progression from direct to indirect supervision must align with demonstrated resident milestone achievement

ACGME supervision requirements establish a continuum from direct supervision (in-person, immediately available) to indirect supervision (available by phone) to oversight. Faculty must calibrate supervision level to individual resident milestone achievement — not blanket efficiency. The supervision continuum framework directly addresses the obligation to match supervisory intensity to documented resident competence, which this attending is bypassing.

Question 65: What is the ACGME's definition of 'moonlighting' in the context of resident duty hours?

Research activities conducted after regular duty hours
Residents working extra shifts within their own program's hospital
Residents supervising medical students during off-hours
Voluntary clinical work performed by residents outside their program's requirements (Correct answer)

Correct answer: Voluntary clinical work performed by residents outside their program's requirements

Moonlighting refers to voluntary clinical work performed outside the scope of the residency program's requirements and must be counted toward the 80-hour weekly duty hour limit.

Question 66: Which of the following best describes the role of the Designated Institutional Official (DIO)?

Overseeing all GME activities, chairing the GMEC, and ensuring ACGME compliance at the institutional level (Correct answer)
Managing resident scheduling and duty hours directly within each program
Serving as the primary faculty educator for each residency program
Acting as the liaison between individual program directors and hospital administration only

Correct answer: Overseeing all GME activities, chairing the GMEC, and ensuring ACGME compliance at the institutional level

The DIO is the senior administrative and academic leader responsible for all GME at the sponsoring institution, including chairing or co-chairing the GMEC and ensuring institutional compliance with ACGME requirements.

Question 67: The Annual Program Evaluation (APE) conducted by the Program Evaluation Committee must result in:

A written document identifying program strengths, areas for improvement, and specific action plans (Correct answer)
A detailed budget proposal for the next academic year submitted to the DIO
A ranked list of residents by Milestone achievement for board certification eligibility
A salary benchmarking report for faculty submitted to the sponsoring institution

Correct answer: A written document identifying program strengths, areas for improvement, and specific action plans

ACGME requirements mandate that the APE produce a written document that captures program strengths, areas needing improvement, and specific action plans to address identified gaps. This document guides ongoing program quality improvement and must be reviewed and used to improve the program.

Question 68: What is the ACGME's definition of 'moonlighting' in the context of duty hours?

Voluntary, compensated, medically-related work outside the program's formal duties (Correct answer)
Night float shift assignments
Research conducted after clinical hours
Attending evening educational conferences

Correct answer: Voluntary, compensated, medically-related work outside the program's formal duties

Moonlighting refers to voluntary, compensated clinical work performed by residents/fellows that is outside their program's required activities.

Question 69: How should Training Administrators handle budget overruns in a GME program?

By ignoring them
By reallocating funds from other areas or seeking additional funding sources (Correct answer)
By reducing the number of residents
By increasing residents' work hours

Correct answer: By reallocating funds from other areas or seeking additional funding sources

When budget overruns occur, Training Administrators must proactively address the deficit to maintain program solvency. Responsible financial management involves identifying areas where funds can be reallocated without compromising educational quality or actively seeking supplementary funding. This approach ensures the program can continue its operations without significant disruption.

Question 70: What is 'entrustable professional activity' (EPA) as used in competency-based GME?

A required procedure log tracking case volumes
A specific clinical task that can be entrusted to a trainee without supervision once sufficient competency is demonstrated (Correct answer)
An annual performance review conducted by the program director
A research publication requirement for graduation

Correct answer: A specific clinical task that can be entrusted to a trainee without supervision once sufficient competency is demonstrated

EPAs are defined units of professional practice—tasks or responsibilities—that can be entrusted to a trainee to perform unsupervised when they have demonstrated the required competencies.

Question 71: When entering a new resident into the GME database, which piece of identifying information is most critical to verify for accurate licensure and board eligibility records?

National Provider Identifier (NPI) and exact legal name as it appears on medical school diploma (Correct answer)
Emergency contact information
Home address and personal email
Preferred name and nickname

Correct answer: National Provider Identifier (NPI) and exact legal name as it appears on medical school diploma

The NPI and exact legal name are used across credentialing, licensure, and board eligibility processes, so errors can cause significant delays.

Question 72: When a teaching hospital negotiates a new Medicare GME cap agreement after acquiring an additional training site, what federal agency must approve the new FTE cap?

The Joint Commission (TJC)
Health Resources and Services Administration (HRSA)
Accreditation Council for Graduate Medical Education (ACGME)
Centers for Medicare & Medicaid Services (CMS) (Correct answer)

Correct answer: Centers for Medicare & Medicaid Services (CMS)

CMS administers Medicare GME funding and must approve any changes to a hospital's FTE cap, including those resulting from site acquisitions.

Question 73: A fellowship program wants to create a faculty development curriculum aligned with the ACGME's 'Teaching and Learning in the Clinical Environment' milestones for faculty. Which instructional design principle should MOST guide the sequencing of this curriculum?

Cognitive load reduction — presenting only one topic per year to prevent faculty from being overwhelmed
Massed practice — delivering all faculty development content in a single intensive retreat to maximize immersion
Constructive alignment — ensuring learning objectives, instructional activities, and assessment methods are mutually reinforcing and progress from foundational supervision skills to complex feedback and entrustment scenarios (Correct answer)
Spaced repetition only — scheduling the same content at increasing intervals regardless of skill progression

Correct answer: Constructive alignment — ensuring learning objectives, instructional activities, and assessment methods are mutually reinforcing and progress from foundational supervision skills to complex feedback and entrustment scenarios

Constructive alignment (Biggs, 1996) ensures that what you teach, how you teach it, and how you assess it are all coherently connected — and that complexity builds over time, which is essential for developing nuanced supervisory judgment. Spaced repetition alone (B) aids retention but doesn't address sequencing of increasing complexity. Massed practice (C) is a well-documented inferior strategy for skill transfer. One topic per year (D) produces gaps and fragmented development.

Question 74: What does 'accreditation with warning' require a program to submit to the ACGME within 90 days?

An updated financial report
A resident satisfaction survey
A new program director application
A responsive action plan addressing areas of noncompliance (Correct answer)

Correct answer: A responsive action plan addressing areas of noncompliance

Programs receiving 'Accreditation with Warning' must submit a responsive action plan within 90 days that details how noncompliance issues will be corrected.

Question 75: A program administrator is preparing for a Clinical Learning Environment Review (CLER) visit. The CLER program focuses on six Focus Areas. A senior administrator asks which of the following is NOT one of the six CLER Focus Areas, requiring removal from the internal preparation checklist.

Supervision
Health care disparities
Transitions of care
Scholarly activity and research productivity (Correct answer)

Correct answer: Scholarly activity and research productivity

The six ACGME CLER Focus Areas are: Patient Safety, Health Care Quality (including health care disparities), Care Transitions, Supervision, Duty Hours and the Learning Environment, and Professionalism. Scholarly activity and research productivity is an important program requirement evaluated during accreditation reviews, but it is NOT one of the six CLER Focus Areas. CLER specifically evaluates the clinical learning environment within the sponsoring institution — not individual program scholarly output.

Question 76: Under the NRMP Supplemental Offer and Acceptance Program (SOAP), a preliminary medicine position goes unfilled after the Main Residency Match. Your categorical program director wants to offer the unfilled preliminary slot to a Main Match applicant who ranked your program but was unmatched, bypassing SOAP entirely. What is the correct course of action?

Permit the offer if completed before 12:00 noon Eastern on Match Day, as SOAP has not yet opened
Permit the offer because the position is unfilled and the applicant was already in the Match
Permit the offer only if the applicant has not registered for SOAP
Decline; all unfilled positions must be offered through SOAP and cannot be filled by direct contact outside the SOAP process during the SOAP period (Correct answer)

Correct answer: Decline; all unfilled positions must be offered through SOAP and cannot be filled by direct contact outside the SOAP process during the SOAP period

NRMP rules strictly prohibit programs from filling unfilled positions outside of SOAP during the SOAP period, regardless of whether the applicant was a prior Main Match participant. The SOAP process exists to provide a fair, orderly system for both programs and unmatched applicants. Contacting an unmatched applicant directly to offer a position during SOAP—even if both parties were already in the Main Match—is a violation of the NRMP Match Participation Agreement and can result in sanctions against the program and institution. The SOAP period begins immediately after Match results are released, and the timing exception in option D does not exist in NRMP policy.

Question 77: Which of the following best describes 'moonlighting' in GME?

Research activities performed after hours
Overnight call shifts assigned by the program
Licensed clinical work outside program-required duties, which must be counted in duty hours (Correct answer)
Unauthorized patient care activities outside the training program

Correct answer: Licensed clinical work outside program-required duties, which must be counted in duty hours

Moonlighting refers to licensed clinical work performed outside required duties; all moonlighting hours must be counted toward the 80-hour weekly duty hour limit.

Question 78: Which committee at the sponsoring institution level is responsible for overseeing all GME programs and ensuring compliance with ACGME Institutional Requirements?

Institutional Review Board (IRB)
Graduate Medical Education Committee (GMEC) (Correct answer)
Program Evaluation Committee (PEC)
Clinical Competency Committee (CCC)

Correct answer: Graduate Medical Education Committee (GMEC)

The GMEC is the sponsoring institution's oversight body responsible for ensuring all residency and fellowship programs comply with ACGME Institutional Requirements and Common Program Requirements.

Question 79: A resident with a known history of depression approaches the coordinator asking whether their medical records from institutional counseling could be accessed by their program director. The correct answer is:

No, unless the resident is placed on formal probation
Yes, but only the GMEC chair may review them
Yes, program directors can access records to monitor impairment risk
No, counseling records are confidential and cannot be shared without written consent (Correct answer)

Correct answer: No, counseling records are confidential and cannot be shared without written consent

Confidentiality of mental health counseling records is legally and ethically protected; disclosure without written consent violates HIPAA and ACGME confidentiality requirements.

Question 80: A GME administrator discovers that the program has been double-billing both the VA hospital and the sponsoring institution for the same resident's salary during a VA rotation. The appropriate course of action is to:

Adjust future invoices to offset the overpayment
Notify the program director only and resolve informally
Document the error and monitor for recurrence before taking action
Report the discrepancy to institutional compliance and initiate repayment (Correct answer)

Correct answer: Report the discrepancy to institutional compliance and initiate repayment

Double-billing government entities is a serious compliance violation requiring immediate disclosure to institutional compliance officers and repayment of the duplicate charge.

Question 81: What is the fundamental difference between a 'categorical' and a 'preliminary' residency position in the NRMP Match?

Categorical positions require USMLE Step 3 passage prior to entry; preliminary positions do not
Preliminary positions are unfunded and must be covered by external research grants
Categorical positions are only available to U.S. graduates; preliminary positions are reserved for IMGs
Categorical positions offer training for the full length of the specialty program; preliminary positions are typically one to two years and do not guarantee continuation in that specialty (Correct answer)

Correct answer: Categorical positions offer training for the full length of the specialty program; preliminary positions are typically one to two years and do not guarantee continuation in that specialty

A categorical position provides training for the complete duration of a specialty residency (e.g., all three years of internal medicine). A preliminary position—typically one year in medicine or surgery—provides foundational clinical training for applicants who will then enter an advanced specialty program that requires prior preliminary training (e.g., radiology, ophthalmology, anesthesiology).

Question 82: A program administrator is asked to report the program's attrition rate. This is calculated as:

Number of disciplinary actions divided by total resident-years
Number of unfilled positions divided by approved complement
Number of residents who failed board exams divided by total residents
Number of residents who left the program before completion divided by total enrolled, expressed as a percentage (Correct answer)

Correct answer: Number of residents who left the program before completion divided by total enrolled, expressed as a percentage

Attrition rate is the proportion of residents who leave before completing training, calculated by dividing departures by total enrollment and multiplying by 100.

Question 83: An institution uses an ACGME-compliant duty hour tracking system. Analysis reveals that 12% of submitted weekly duty hour reports show exactly 80 hours logged—a pattern inconsistent with natural variation in resident schedules. Which data quality concern does this pattern MOST likely indicate, and what is the recommended corrective action?

Systematic underreporting bias; implement anonymous reporting mechanisms and educate residents on the importance of accurate logging without fear of program repercussions (Correct answer)
Overreporting bias; audit residents logging exactly 80 hours and counsel those found to be inflating their hours
Software rounding error; contact the vendor to apply a patch and retrospectively adjust affected records
Normal clustering effect; document the statistical distribution and note it as an institutional benchmark in the annual program evaluation

Correct answer: Systematic underreporting bias; implement anonymous reporting mechanisms and educate residents on the importance of accurate logging without fear of program repercussions

A suspicious cluster of reports at exactly the regulatory maximum (80 hours) strongly suggests residents are self-censoring actual hours to avoid triggering violations—a form of systematic underreporting. This is a known phenomenon in GME data integrity research. The corrective action must address both the culture of fear around reporting and the anonymous mechanism deficiency, not the software or the residents themselves.

Question 84: Under IRS rules, resident stipends are subject to which of the following?

No taxation because stipends are considered educational grants
Only state income tax; residents are exempt from federal withholding
Federal income tax withholding as employee compensation (Correct answer)
FICA (Social Security and Medicare) tax exemption for all residents

Correct answer: Federal income tax withholding as employee compensation

Resident stipends are treated as wages and are subject to federal income tax withholding; they are generally also subject to FICA unless a student FICA exception applies.

Question 85: ACGME's Institutional Requirements mandate that residents must have access to mental health services that are:

Confidential, affordable, and easily accessible (Correct answer)
Available only through a referral from the program director
Provided exclusively by psychiatrists within the health system
Limited to in-person counseling at the hospital

Correct answer: Confidential, affordable, and easily accessible

ACGME requires that mental health services be confidential, affordable, and easily accessible so residents are not deterred from seeking help.

Question 86: During the rank order list (ROL) certification period, a program director asks the coordinator to remove a previously ranked applicant after learning informally that the applicant accepted a preliminary position at another institution. Which action should the coordinator take?

Remove the applicant immediately, as accepting another position constitutes a match violation
Contact the other institution to verify the information before proceeding with the removal
Submit a formal inquiry to the NRMP requesting that the applicant be flagged for investigation
Advise the program director that ROL changes based on unverified external information may violate NRMP Match Participation Agreement terms and recommend consulting the NRMP before making changes (Correct answer)

Correct answer: Advise the program director that ROL changes based on unverified external information may violate NRMP Match Participation Agreement terms and recommend consulting the NRMP before making changes

Under the NRMP Match Participation Agreement, rank order lists must be based on the program's genuine assessment of applicants — not on post-interview communications or unverified external information that could constitute coercion or improper influence. Removing an applicant based on rumor of their external activities could expose the program to a Match violation finding. The correct step is to advise the program director of this risk and consult NRMP compliance resources before any ROL modification.

Question 87: During an annual review, a GME administrator discovers that a core faculty member listed on the program's application has had no documented scholarly activity for the past three academic years. The ACGME Common Program Requirements specify that programs must demonstrate 'scholarly activity.' Which of the following best describes the administrator's obligation?

Flag the gap in the Annual Program Evaluation, assign the faculty member a development plan, and document corrective steps in the ADS (Correct answer)
Designate the faculty member as 'affiliate' rather than 'core' faculty to exempt them from scholarly activity requirements
Report the faculty member to the institutional Graduate Medical Education Committee (GMEC) for disciplinary review
Remove the faculty member from the program roster immediately to avoid an accreditation citation

Correct answer: Flag the gap in the Annual Program Evaluation, assign the faculty member a development plan, and document corrective steps in the ADS

ACGME requirements call for faculty to engage in scholarly activity, but the appropriate administrative response to a gap is to document it in the Annual Program Evaluation (APE), create a faculty development plan, and record corrective steps in the Accreditation Data System (ADS). Immediate removal is not required and would not resolve the systemic gap; reclassification to 'affiliate' faculty does not eliminate the program's need for adequate scholarly core faculty overall.

Question 88: A training administrator is auditing program data in the ACGME WebADS and notices that a faculty member listed as 'core faculty' has not submitted a single evaluation in 18 months, yet their FTE and scholarly activity fields remain populated and current. Which data management action is MOST appropriate?

Update the scholarly activity field to reflect 'inactive' status without notifying the program director
Leave the record unchanged because modifying WebADS data without a formal ACGME request is prohibited
Flag the inconsistency, verify the faculty member's current status and engagement with the program director, and update all affected WebADS fields only after written confirmation — documenting the review process (Correct answer)
Remove the faculty member from WebADS immediately to clean the record

Correct answer: Flag the inconsistency, verify the faculty member's current status and engagement with the program director, and update all affected WebADS fields only after written confirmation — documenting the review process

WebADS data must accurately reflect the program's current state, and inconsistencies between faculty engagement (no evaluations) and listed status (active core faculty) must be investigated. Unilateral deletion or status changes without verification risk removing legitimate faculty or creating inaccurate accreditation records. The correct process is to verify with the program director, obtain written confirmation, update all relevant fields, and document the review — maintaining an audit trail.

Question 89: When developing a succession plan for the GME office, which element is MOST important to include?

A roster of external candidates to fill vacancies immediately
A freeze on all hiring until the plan is formally approved
Delegation of all succession decisions to Human Resources
Identification and development of internal talent for key roles before vacancies occur (Correct answer)

Correct answer: Identification and development of internal talent for key roles before vacancies occur

Effective succession planning proactively identifies and develops internal candidates so leadership continuity is maintained without disruption.

Question 90: If an ACGME site visit reveals significant non-compliance, what is the most serious accreditation action the ACGME can take?

Probationary accreditation
Warning
Focused site visit
Withdrawal of accreditation (Correct answer)

Correct answer: Withdrawal of accreditation

Withdrawal of accreditation is the most serious action and means the program can no longer accept new trainees; current residents must be transferred to other programs.

Question 91: A program coordinator notices that residents in one specialty consistently rate their faculty significantly higher on evaluations administered via a paper-and-pencil method compared to evaluations completed anonymously through the electronic system. The program director interprets this as evidence that the electronic system has a technical flaw and requests the administrator switch back to paper forms. What is the MOST accurate interpretation of this data discrepancy?

Both data sets should be reported to the CCC with equal weight until a root cause is established, since neither method can be presumed more accurate without additional evidence
The discrepancy indicates residents are uncomfortable with the electronic interface and training on the system should be provided before data from either method is used
The discrepancy likely reflects social desirability bias in paper evaluations rather than a system flaw; anonymity in electronic systems produces more candid ratings, and reverting to paper would reduce evaluation validity (Correct answer)
The electronic system should be audited for bugs that artificially deflate ratings before any conclusions about evaluation validity are drawn

Correct answer: The discrepancy likely reflects social desirability bias in paper evaluations rather than a system flaw; anonymity in electronic systems produces more candid ratings, and reverting to paper would reduce evaluation validity

The pattern described—higher ratings on non-anonymous paper forms vs. anonymous electronic forms—is a well-documented measurement artifact called social desirability bias (or evaluation apprehension). Residents fear retaliation or relationship damage when ratings may be traceable, leading to inflated scores. The electronic anonymous system is producing more valid data, not flawed data. Reverting to paper would increase bias, not fix a technical problem. The administrator should educate the program director on evaluation methodology rather than accommodating the request.

Question 92: When must NRMP rank lists be certified by program directors?

Three days before Match Day
At the program's discretion before Match Week
By midnight Eastern on the rank order list deadline day (Correct answer)
By noon Eastern on the rank order list deadline day

Correct answer: By midnight Eastern on the rank order list deadline day

NRMP requires rank order lists to be certified by midnight Eastern time on the designated deadline day to be included in the Match algorithm.

Question 93: A Clinical Competency Committee (CCC) in an internal medicine program reviews a PGY-2 resident who consistently receives 'Milestone Level 2' ratings in Patient Care but 'Milestone Level 4' ratings in Interpersonal and Communication Skills. The CCC chair asks you, as program administrator, to prepare the resident's summative evaluation for the ACGME Milestones reporting period. What is the MOST accurate statement about this situation?

Milestone levels must be reconciled to within one level of each other before submission to avoid flagging by the ACGME Data System
The CCC should report each sub-competency milestone level independently, even when they reflect uneven development (Correct answer)
A resident with any sub-competency below Level 3 at the PGY-2 level must be placed on formal probation before the next reporting period
The CCC must report a single averaged milestone level across all competencies for national reporting

Correct answer: The CCC should report each sub-competency milestone level independently, even when they reflect uneven development

ACGME Milestones are designed to capture granular, competency-specific developmental progress. Sub-competencies are reported independently—uneven development across competencies is expected and common, especially in early residency. The CCC reports each sub-competency on its own narrative arc, providing an accurate developmental picture. Averaging across competencies (A) would distort the resident's profile. Automatic probation for any Level 2 rating (C) is not an ACGME requirement and conflates program policy with accreditation standards. ACGME does not require milestone levels to be reconciled within a certain range of each other (D); that concept does not exist in the reporting framework.

Question 94: Following the Main Residency Match, which applicant scenario would render an individual INELIGIBLE to participate in the Supplemental Offer and Acceptance Program (SOAP)?

An IMG applicant whose only ranked programs did not fill, leaving unfilled positions available in SOAP
A U.S. MD graduate who submitted a rank list but did not match to any program
An applicant who matched to a categorical preliminary-year position but did not secure an advanced position
An applicant who voluntarily withdrew from Match participation prior to the rank order list deadline (Correct answer)

Correct answer: An applicant who voluntarily withdrew from Match participation prior to the rank order list deadline

SOAP eligibility is limited to applicants who actively participated in the Main Residency Match and did not match. An applicant who withdrew from the Match before the rank order list deadline removed themselves from the Match process entirely and is therefore ineligible for SOAP. Applicants who submitted rank lists but did not match — including those who matched to a preliminary but not an advanced position, and IMGs in unfilled programs — retain SOAP eligibility under the standard rules.

Question 95: A clinician-educator begins working with a junior faculty member who struggles with facilitating small-group discussions. They meet monthly: the educator observes a session, identifies specific behavioral gaps, co-creates short-term goals with the junior faculty member, and tracks progress over time. This relationship is BEST described as which of the following?

Precepting, because the educator is present during the teaching encounter and provides real-time guidance
Sponsoring, because the educator is investing time to advance the junior faculty member's academic career
Mentoring, because it involves an experienced educator guiding a less experienced colleague
Coaching, because it centers on structured observation, specific goal-setting, and iterative skill-focused feedback (Correct answer)

Correct answer: Coaching, because it centers on structured observation, specific goal-setting, and iterative skill-focused feedback

Coaching is defined by its focus on specific, observable skill development through structured observation, co-created goals, and iterative feedback cycles—not on broader career navigation. Mentoring is a longer-term, relationship-centered guidance primarily addressing career development, identity formation, and networking. Sponsoring involves actively advocating for someone's advancement. Precepting is clinical teaching with immediate oversight of patient care. The scenario describes coaching's hallmark elements.

Question 96: A program director informs the program administrator that a fellow disclosed passive suicidal ideation during a routine check-in but stated she does not want any HR or GME documentation created. The fellow is currently providing patient care. What is the program administrator's MOST appropriate FIRST action?

Ensure the fellow is immediately connected to mental health crisis services and facilitate removal from patient care duties during assessment, while coordinating with the program director — confidentiality does not override imminent safety obligations (Correct answer)
Immediately notify the DIO and place the fellow on administrative leave pending psychiatric evaluation
Honor the fellow's confidentiality request and document only that a check-in occurred
Advise the program director to follow up with the fellow in 48 hours and reassess the situation

Correct answer: Ensure the fellow is immediately connected to mental health crisis services and facilitate removal from patient care duties during assessment, while coordinating with the program director — confidentiality does not override imminent safety obligations

Active patient care while experiencing suicidal ideation represents an immediate safety concern for both the fellow and patients. ACGME well-being requirements and standard duty-of-care obligations supersede resident confidentiality preferences when there is imminent risk. The administrator's role is to support the program director in facilitating immediate mental health crisis intervention and safe patient care handoff. Neither a delayed follow-up nor an administrative-first approach addresses the immediate clinical and safety urgency appropriately.

Question 97: An applicant discloses a prior felony conviction on their ERAS application. What is the most appropriate program response?

Disqualify the applicant to protect patient safety without further review
Automatically reject the application per institutional policy
Report the applicant to the state medical board immediately
Conduct an individualized assessment considering all relevant factors (Correct answer)

Correct answer: Conduct an individualized assessment considering all relevant factors

Best practice and legal guidance recommend individualized assessment of criminal history, considering the nature of the offense, time elapsed, and rehabilitation.

Question 98: When a resident's Milestone progress indicates deficiencies, the ACGME requires programs to:

Transfer the resident to a participating site without any formal documentation
Notify the ACGME within 24 hours and place the resident on administrative leave
Document a specific intervention or remediation plan with benchmarks, and provide the resident with notice and the opportunity to respond (Correct answer)
Immediately terminate the resident's training contract without further process

Correct answer: Document a specific intervention or remediation plan with benchmarks, and provide the resident with notice and the opportunity to respond

ACGME requirements mandate that remediation be documented with clear benchmarks and timelines, and that residents receive due process including notification and the opportunity to respond. Immediate termination without process violates both ACGME requirements and standard employment due process.

Question 99: A program administrator managing an internal medicine residency is preparing the annual program evaluation (APE) report. She notices that aggregate board pass rates, case mix data, and faculty scholarly activity metrics are all available, but the program has never formally incorporated patient outcome data into the APE. The program director asks whether this is an ACGME requirement. What is the MOST accurate response?

Yes — ACGME program requirements mandate that the APE must include patient outcome data as part of the assessment of program quality and resident education effectiveness (Correct answer)
No — patient outcome data is optional for the APE and is only required for programs on probation or with an adverse accreditation status
Yes — but only for programs in specialties where ACGME has issued specialty-specific requirements explicitly naming patient outcomes
No — patient outcome data is the sole responsibility of the hospital quality department and cannot ethically be incorporated into residency program evaluations

Correct answer: Yes — ACGME program requirements mandate that the APE must include patient outcome data as part of the assessment of program quality and resident education effectiveness

ACGME Common Program Requirements mandate that the annual program evaluation must include an assessment of the program's quality using multiple data sources, explicitly including patient outcomes. This is not optional, nor is it limited to programs under scrutiny. The APE must demonstrate that the program evaluates whether its educational design and resident performance translate into quality patient care. Excluding patient outcome data from the APE is a compliance gap regardless of specialty, board pass rates, or accreditation status.

Question 100: A program coordinator is reconciling case log data after a graduating chief resident reports that several procedures logged under the wrong CPT-equivalent category during intern year were never corrected. The resident has already graduated and their ADS account is inactive. Who has authority to initiate a retrospective correction to those case log entries?

The Program Director, who can modify historical case logs for any trainee — active or graduated — within the program's ADS account (Correct answer)
Only the graduated resident, who must reactivate their ADS account and submit a correction request to ACGME
The Designated Institutional Official, who must submit a formal institutional data-integrity request to ACGME
No correction is possible once a resident graduates and their ADS account is deactivated; the program should document the discrepancy internally only

Correct answer: The Program Director, who can modify historical case logs for any trainee — active or graduated — within the program's ADS account

The Program Director retains administrative access to case log data for all trainees who trained under the program, including graduates, and can initiate retrospective corrections within ADS. The graduated resident's own access lapses upon deactivation of their account, but this does not prevent the PD from acting. DIO involvement is not required for individual case log corrections — that level of institutional escalation is reserved for broader data-integrity investigations. Documenting internally without correcting the official record would leave inaccurate data in the national case log database.

Question 101: During an internal program review, a program administrator finds that the program's Case Log minimum requirements for one surgical subspecialty procedure are consistently being met by only 60% of graduating residents over the last three years, yet all residents passed their end-of-training competency assessments. Under ACGME's outcomes-based accreditation framework, what is the administrator's FIRST recommended step?

Present the data to the Clinical Competency Committee (CCC) and program director to determine whether the case volume threshold remains the most valid measure of competency for that procedure (Correct answer)
Develop a rotation expansion plan to increase case volume and bring 100% of residents into compliance with the minimum
Immediately notify the ACGME Review Committee of a potential case log deficiency to self-report the gap
Document the competency assessment results as sufficient justification and close the internal review finding without further action

Correct answer: Present the data to the Clinical Competency Committee (CCC) and program director to determine whether the case volume threshold remains the most valid measure of competency for that procedure

ACGME's outcomes-based framework shifts focus from process metrics alone toward demonstrated competency. When case log minimums are not met but competency assessments indicate graduates are nonetheless competent, the appropriate first step is to engage the CCC and program director to critically evaluate whether the minimum volume threshold is still the best proxy for that competency — or whether other assessment methods are sufficient. Self-reporting to the Review Committee before internal analysis is premature; expanding rotations without first evaluating the validity of the threshold wastes resources; and closing the finding without analysis ignores a substantive data pattern.

TAGME — Training Administrators of Graduate Medical Education Certification Exam

The TAGME certification exam is a 100-question open-book assessment for GME program coordinators and administrators, covering accreditation compliance, program administration, data management, financial management, medical education, and faculty development across ACGME-accredited residency and fellowship programs.

100

Questions

240 min

Time Limit

80%

To Pass

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