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

Question 1: A program director is going on an extended medical leave for 6 months. What is the ACGME's requirement regarding program director coverage?

An associate program director must be formally appointed as interim PD and the ACGME must be notified (Correct answer)
The DIO automatically assumes PD responsibilities
A senior faculty member can informally cover without notification
The program must suspend resident recruitment until the PD returns

Correct answer: An associate program director must be formally appointed as interim PD and the ACGME must be notified

When a program director is absent for an extended period, an interim PD must be formally appointed and the ACGME must be notified of the change in program leadership.

Question 2: When a sponsoring institution sponsors more programs than its resources can adequately support, ACGME may place the institution under which action?

Immediate Withdrawal of Institutional Accreditation
Institutional Review (Correct answer)
Focused Site Visit for all programs
CLER re-visit

Correct answer: Institutional Review

ACGME may initiate an Institutional Review when systemic concerns—such as resource insufficiency across programs—suggest the institution cannot fulfill its oversight responsibilities.

Question 3: A program receives an application from a highly qualified candidate who discloses a prior disciplinary action from medical school related to a professionalism violation. Under ACGME and ERAS guidelines, which of the following represents the most appropriate and legally defensible approach for the program coordinator to take?

Flag the application for automatic rejection to protect the program from liability
Contact the candidate's medical school directly to obtain the disciplinary file without the candidate's consent
Advise the program director to defer the decision to the ACGME for guidance on whether the candidate is eligible to apply
Facilitate a structured review by the program director that evaluates the disclosure in context, including evidence of remediation, before making any selection decision (Correct answer)

Correct answer: Facilitate a structured review by the program director that evaluates the disclosure in context, including evidence of remediation, before making any selection decision

ACGME and ERAS guidelines require programs to evaluate applicants holistically and without discriminatory blanket exclusions. A prior disciplinary action must be reviewed in context — including the nature of the violation, time elapsed, and evidence of remediation — before a selection decision is made. Automatic rejection is legally and ethically problematic. Obtaining records without consent violates FERPA and candidate rights. The ACGME does not adjudicate individual applicant eligibility.

Question 4: What is the ACGME's definition of 'moonlighting' in the context of duty hours?

Research conducted after clinical hours
Voluntary, compensated, medically-related work outside the program's formal duties (Correct answer)
Night float shift assignments
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 5: ACGME's Institutional Requirements mandate that residents must have access to mental health services that are:

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

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 6: 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 7: A DIO is preparing the annual GME budget request and must justify funding for a new Associate DIO (ADIO) position. The CFO challenges the request, noting that the GME office headcount already exceeds benchmarks for the institution's program count. Which argument MOST effectively demonstrates the strategic value of the ADIO role within an ACGME compliance and leadership framework?

The ADIO will allow the DIO to delegate Program Director appointments and GMEC voting rights, reducing administrative bottlenecks
An ADIO provides succession depth and expands the institution's capacity for proactive program oversight, which directly mitigates the financial and reputational risk of adverse accreditation actions (Correct answer)
The ADIO salary is partially offset by indirect medical education (IME) payments, making the net cost to the institution negligible
The ADIO role is required by ACGME Institutional Requirements for sponsoring institutions with more than 10 accredited programs

Correct answer: An ADIO provides succession depth and expands the institution's capacity for proactive program oversight, which directly mitigates the financial and reputational risk of adverse accreditation actions

The strongest strategic argument ties the ADIO role to risk mitigation and institutional resilience—adverse ACGME actions (probation, withdrawal of accreditation) carry significant financial, operational, and reputational costs that far exceed the cost of an ADIO. Succession planning ensures the DIO function isn't a single point of failure. ACGME does not mandate an ADIO for any specific program count threshold. DIOs cannot delegate GMEC voting rights or formal Program Director appointments to an ADIO. IME payments are not directly linked to administrative staffing decisions in a way that offsets specific salaries.

Question 8: A program administrator notices that interview offers disproportionately exclude applicants from underrepresented minority groups. The best corrective action is to:

Require all applicants to undergo the same standardized test only
Review and audit screening criteria for potential bias (Correct answer)
Increase interview slots exclusively for those groups
Defer to program director discretion as a legal matter

Correct answer: Review and audit screening criteria for potential bias

Auditing screening criteria for implicit bias is the recommended first step to identify and correct systemic disparities in interview selection.

Question 9: A program director is concerned that a resident's duty hour logs consistently show 80-hour weeks but resident self-reports suggest otherwise. What is the most appropriate first step?

Discuss the discrepancy privately with the resident and clarify duty hour reporting expectations (Correct answer)
Report the discrepancy immediately to the ACGME
Terminate the resident for falsifying records
Ignore the discrepancy if patient care is not affected

Correct answer: Discuss the discrepancy privately with the resident and clarify duty hour reporting expectations

The program director should first address the issue directly with the resident to clarify accurate reporting requirements before escalating to accrediting bodies.

Question 10: What does the term 'sponsoring institution' mean in the context of ACGME accreditation?

A pharmaceutical company that funds residency training
An affiliated hospital where residents rotate
The entity that holds the ACGME accreditation and is responsible for GME oversight (Correct answer)
A professional society that certifies program directors

Correct answer: The entity that holds the ACGME accreditation and is responsible for GME oversight

The sponsoring institution is the entity—typically a hospital or medical school—that holds the ACGME accreditation and bears ultimate responsibility for all GME programs it sponsors.

Question 11: A resident in a 4-year program takes 8 weeks of parental leave, 2 weeks of medical leave, and 3 weeks of vacation during her third year. The applicable Review Committee's program requirements cap leave at 3 weeks per year before triggering mandatory make-up time. Which statement most accurately reflects how ACGME policy addresses make-up time in this scenario?

The Review Committee may waive make-up time requirements if the resident demonstrates milestone-based competency achievement (Correct answer)
All 13 weeks must be made up because total leave exceeded the 3-week program policy threshold
FMLA protections for parental leave automatically exempt those 8 weeks from any ACGME make-up requirement
Only parental and medical leave may trigger make-up requirements; vacation leave is categorically exempt

Correct answer: The Review Committee may waive make-up time requirements if the resident demonstrates milestone-based competency achievement

ACGME policy allows Review Committees to grant exceptions to make-up time requirements when a resident or fellow demonstrates achievement of the required competencies as evidenced by milestone data. This competency-based waiver is the most commonly overlooked provision — many program administrators assume make-up time is automatically mandatory whenever leave exceeds program policy limits. FMLA (C) governs employment protections but does not override ACGME training completion standards, and vacation leave (B) is not categorically exempt.

Question 12: Your program is undergoing an ACGME self-study, which requires a 10-year longitudinal review. You discover that the program's Program Evaluation Committee (PEC) meeting minutes from four years ago are incomplete—action items were recorded but outcomes and follow-up were never documented. Under ACGME's self-study framework, what is the MOST appropriate way to address this gap?

Exclude the years with incomplete documentation from the 10-year trend analysis to avoid drawing attention to the deficiency
Reconstruct the missing documentation by interviewing current faculty who attended those meetings and filing amended minutes
Submit a request to the Review Committee for a documentation waiver covering the years with missing minutes
Acknowledge the documentation gap in the self-study narrative, describe current PEC practices that now ensure follow-up documentation, and provide evidence of the improved process (Correct answer)

Correct answer: Acknowledge the documentation gap in the self-study narrative, describe current PEC practices that now ensure follow-up documentation, and provide evidence of the improved process

ACGME's self-study process values transparency, continuous improvement, and honest self-assessment. The appropriate response to discovering a historical documentation gap is to acknowledge it openly in the self-study narrative, explain what systemic changes have been implemented to prevent recurrence, and demonstrate current compliance. Reconstructing historical minutes (A) risks creating inaccurate records and raises integrity concerns. Excluding years from trend analysis (C) undermines the purpose of the self-study. There is no ACGME mechanism for a 'documentation waiver' (D)—that concept does not exist in self-study guidance.

Question 13: Which financial ratio would a hospital CFO most likely use to assess the GME department's efficiency in converting budget into educational outputs?

Operating margin
Debt-to-equity ratio
Current ratio
Cost per resident FTE (Correct answer)

Correct answer: Cost per resident FTE

Cost per resident FTE is the most direct efficiency metric for GME, showing how much the program spends per trainee and enabling benchmarking.

Question 14: 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?

Write off the expenditures as an allowable educational cost since conference registrations are a standard program expense
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
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 15: A program director informs you mid-fiscal year that a resident unexpectedly matched into a fellowship, creating a vacant PGY-3 slot for the final 4 months. The vacant position's salary and benefits budget cannot be redirected. Under ACGME financial stewardship principles, what is the MOST appropriate action regarding the unspent salary funds?

Reallocate the funds to cover overtime for remaining residents who absorb the vacant resident's duties
Hold the funds in reserve within the program's operating budget for the following fiscal year
Return the funds to the sponsoring institution's GME office and document the vacancy for accreditation purposes (Correct answer)
Transfer the funds to the educational fund to purchase simulation equipment for the program

Correct answer: Return the funds to the sponsoring institution's GME office and document the vacancy for accreditation purposes

Unspent resident salary and benefits funds from a vacant position must be returned to the sponsoring institution's GME office per institutional financial governance policies. These funds are earmarked for specific FTE positions and cannot be unilaterally reallocated by the program administrator without institutional authorization. Documenting the vacancy is also critical for ACGME complement reporting and financial audits.

Question 16: Why is it important for Training Administrators to maintain accurate duty hour logs?

To ensure that residents have enough time for personal activities
To manage the program's budget
To track faculty attendance
To comply with ACGME regulations and prevent resident fatigue (Correct answer)

Correct answer: To comply with ACGME regulations and prevent resident fatigue

The ACGME mandates strict duty hour limits to protect resident well-being and ensure patient safety by mitigating the risks associated with fatigue. Training Administrators are responsible for accurately tracking and monitoring these hours to ensure the program adheres to these crucial accreditation standards. This prevents burnout and promotes a safe learning and working environment.

Question 17: 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?

The CCC must report a single averaged milestone level across all competencies for national reporting
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
Milestone levels must be reconciled to within one level of each other before submission to avoid flagging by the ACGME Data System

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 18: Which metric is most useful for tracking whether a residency program is meeting its complement (approved positions) over time?

Average USMLE Step 1 score of matched applicants
Match rate vs. approved positions filled each year (Correct answer)
Cost per resident trained
Number of faculty publications

Correct answer: Match rate vs. approved positions filled each year

Comparing match/fill rate against approved positions over time directly shows whether the program is utilizing its complement and sustaining recruitment.

Question 19: A resident in your program discloses a previously undisclosed disability to the GME Office midway through their PGY-2 year, requesting schedule accommodations under the ADA. The program director asks you how this affects a currently pending Clinical Competency Committee evaluation of the resident for marginal performance. What is the MOST legally and procedurally appropriate guidance?

Transfer the resident's evaluation authority entirely to the DIO's office for the duration of the accommodation review to avoid program-level conflicts of interest
Pause the CCC evaluation until accommodations are formally approved, as proceeding could constitute disability discrimination
Proceed with the CCC evaluation based solely on documented performance to date, while simultaneously engaging HR and legal to process the accommodation request on a parallel, separate track (Correct answer)
Retroactively attribute all prior marginal performance to the undisclosed disability and document this in the CCC evaluation as a mitigating factor

Correct answer: Proceed with the CCC evaluation based solely on documented performance to date, while simultaneously engaging HR and legal to process the accommodation request on a parallel, separate track

ADA accommodation requests must be processed on a separate, confidential track from academic performance evaluations. The CCC's obligation is to evaluate documented competency-based performance objectively; it cannot pause solely due to a pending accommodation request, nor can it retroactively reinterpret past performance as disability-related without formal determination. Accommodations are prospective — they adjust future conditions, not historical assessments. Involving HR and legal concurrently ensures the accommodation process is properly handled while maintaining the integrity of the competency evaluation.

Question 20: A teaching hospital's Medicare Cost Report shows 120 FTE resident slots funded at the per-resident amount (PRA). The hospital acquires a new program and adds 18 residents who were previously trained at a different hospital that had already used its Section 422 cap slots. Under IME and DGME cap rules, how should the administrator account for these 18 residents?

They count fully toward the hospital's FTE cap because the acquiring hospital assumes the cap obligations of the acquired program. (Correct answer)
They are counted as new residents and trigger a temporary cap exemption for five years under CMS rules.
The hospital must petition CMS for a new cost-based cap adjustment within 180 days of acquisition to include these residents.
They are excluded from the hospital's IME and DGME FTE cap calculations because they were trained under a different hospital's cap.

Correct answer: They count fully toward the hospital's FTE cap because the acquiring hospital assumes the cap obligations of the acquired program.

When a hospital acquires another program, it assumes the cap slots and obligations of the prior institution under the Section 422 rules. The 18 FTEs count toward the acquiring hospital's cap, and the hospital cannot exceed its aggregate cap without a formal cap exception. Simply being new to the hospital does not grant a new-program exemption if those slots were previously established elsewhere.

Question 21: A program administrator discovers that a participating site has not signed an updated Program Letter of Agreement. What is the most appropriate immediate action?

Suspend resident rotations at that site until a signed PLA is in place (Correct answer)
Have the program director verbally confirm the agreement terms with the site
Notify ACGME immediately and await their instruction before taking action
Continue rotations and update the PLA at the next annual review

Correct answer: Suspend resident rotations at that site until a signed PLA is in place

Rotations at a participating site without a current, signed PLA are not compliant with ACGME requirements; rotations should be suspended until a valid agreement is executed.

Question 22: A training administrator is audited by their ACGME Review Committee and asked to produce documentation demonstrating that their program's interview selection process is non-discriminatory. The program has never maintained formal records of why individual applicants were or were not invited to interview. Which response most accurately reflects the ACGME's expectation for this documentation?

ACGME program requirements mandate that programs document the criteria used to select applicants for interview and apply them consistently, making the absence of such records a compliance deficiency (Correct answer)
Documentation is only required when a rejected applicant formally contests the screening decision through the sponsoring institution's grievance process
Programs satisfy ACGME requirements by maintaining ERAS application data, which serves as an implicit record of screening decisions
Programs are only required to document selection criteria for applicants who are invited to interview, not those who are screened out

Correct answer: ACGME program requirements mandate that programs document the criteria used to select applicants for interview and apply them consistently, making the absence of such records a compliance deficiency

ACGME Common Program Requirements specify that programs must have documented, consistently applied criteria for selecting applicants to interview. This is not contingent on applicant challenges or complaints — it is a baseline program requirement. The absence of such records constitutes a genuine compliance deficiency that can result in a citation during an ACGME review. Retaining ERAS data alone does not satisfy this requirement, as ERAS data reflects what was submitted, not what criteria the program used to make screening decisions.

Question 23: 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?

The electronic system should be audited for bugs that artificially deflate ratings before any conclusions about evaluation validity are drawn
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 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 discrepancy indicates residents are uncomfortable with the electronic interface and training on the system should be provided before data from either method is used

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 24: A new program director wants to add a new fellowship at their institution. Which initial step is required?

Obtaining ABMS approval first
Informally notifying the ACGME of intent
Hiring a program coordinator before applying
Submitting a Letter of Intent to the relevant ACGME Review Committee (Correct answer)

Correct answer: Submitting a Letter of Intent to the relevant ACGME Review Committee

Before applying for initial accreditation, programs typically must submit a Letter of Intent to the relevant ACGME Residency Review Committee as the first formal step.

Question 25: Under ACGME policy, what is the maximum number of consecutive hours a PGY-1 resident may be scheduled for clinical work?

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

Correct answer: 16 hours

PGY-1 residents may not be scheduled for more than 16 consecutive hours of clinical work under ACGME duty hour requirements.

Question 26: A program is considering adding two new fellowship positions. The incremental cost per fellow is $95,000/year. If the hospital's Medicare GME cap has room for two additional FTEs and the PRA is $60,000, what is the net annual cost to the program per fellow?

$95,000
$35,000 (Correct answer)
$155,000
$60,000

Correct answer: $35,000

Net cost per fellow = $95,000 total cost − $60,000 Medicare PRA reimbursement = $35,000 annual net cost to the program.

Question 27: When preparing for an ACGME site visit, which data should a program administrator compile to demonstrate scholarly activity compliance?

Revenue generated by resident clinical work
Peer-reviewed publications, presentations, and research projects by faculty and residents (Correct answer)
Resident social media activity
Patient satisfaction scores only

Correct answer: Peer-reviewed publications, presentations, and research projects by faculty and residents

ACGME program requirements include scholarly activity, evidenced by peer-reviewed publications, presentations, quality improvement projects, and research by program participants.

Question 28: Which ACGME Common Program Requirement addresses the expectation that programs provide residents with access to mental health and wellness resources?

Supervision requirements within the Resident/Fellow Responsibilities section
Well-Being requirements within the Learning and Working Environment section (Correct answer)
Faculty Development requirements
Clinical and Educational Work Hours requirements

Correct answer: Well-Being requirements within the Learning and Working Environment section

The ACGME's Well-Being requirements, housed under Learning and Working Environment, mandate that programs support residents' mental, emotional, and physical health.

Question 29: In resident recruitment, which federal law most directly governs anti-discrimination protections for applicants during the residency selection process?

Health Insurance Portability and Accountability Act (HIPAA)
Americans with Disabilities Act (ADA) and Title VII of the Civil Rights Act (Correct answer)
Joint Commission on Accreditation Standards
Graduate Medical Education Reform Act

Correct answer: Americans with Disabilities Act (ADA) and Title VII of the Civil Rights Act

The ADA and Title VII of the Civil Rights Act prohibit discrimination based on disability, race, sex, religion, and national origin during residency applicant interviews and selection.

Question 30: Which ACGME core competency specifically addresses a resident's ability to work effectively in a health care team?

Medical Knowledge
Interpersonal and Communication Skills (Correct answer)
Interprofessional collaboration
Systems-Based Practice

Correct answer: Interpersonal and Communication Skills

Interpersonal and Communication Skills encompasses effective communication and the ability to work as part of an interprofessional health care team.

Question 31: 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 32: What is the purpose of the Medicare GME reimbursement?

To fund clinical research
To provide financial support to hospitals and institutions for training residents (Correct answer)
To cover residents' salaries directly
To cover the cost of medical supplies

Correct answer: To provide financial support to hospitals and institutions for training residents

Medicare GME reimbursement is a critical federal funding mechanism designed to offset the substantial costs hospitals incur for training residents. These funds help cover direct expenses like resident salaries and benefits, as well as indirect costs associated with patient care provided by teaching hospitals. This support is vital for maintaining the physician workforce pipeline in the United States.

Question 33: Which ACGME tool is used by programs to track and manage resident and faculty data, case logs, and accreditation-related information?

MedHub or New Innovations (GME management systems)
ADS (Accreditation Data System) (Correct answer)
ERAS (Electronic Residency Application Service)
FREIDA (Fellowship and Residency Electronic Interactive Database)

Correct answer: ADS (Accreditation Data System)

The Accreditation Data System (ADS) is the ACGME's online portal where programs manage official accreditation-related data including program information, case logs, and personnel records.

Question 34: Why is it important for GME programs to track resident well-being data over time?

To publish resident health data publicly
To calculate resident compensation adjustments
To report individual residents to licensing boards
To identify program-level trends, evaluate interventions, and demonstrate compliance with ACGME requirements (Correct answer)

Correct answer: To identify program-level trends, evaluate interventions, and demonstrate compliance with ACGME requirements

Tracking well-being data helps programs identify systemic issues, measure the effectiveness of interventions, and meet ACGME requirements for ongoing program evaluation.

Question 35: Under ACGME requirements, which entity holds primary responsibility for developing and implementing a resident well-being program?

The sponsoring institution (Correct answer)
The designated institutional official (DIO)
The Graduate Medical Education Committee (GMEC)
Individual program directors

Correct answer: The sponsoring institution

The sponsoring institution is ultimately responsible for establishing and maintaining a well-being program that applies across all training programs.

Question 36: What is the role of the program coordinator during the rank-order list (ROL) submission period?

Contacting applicants to confirm their rank intentions
Ensuring the program director submits and certifies the ROL by the NRMP deadline (Correct answer)
Submitting the ROL on behalf of the program director without review
Sharing the ROL with other programs in the same specialty

Correct answer: Ensuring the program director submits and certifies the ROL by the NRMP deadline

The program coordinator's key role is to track deadlines and ensure the program director certifies the final ROL in the NRMP system before the submission deadline.

Question 37: Before an international medical graduate (IMG) may be appointed to an ACGME-accredited residency program, the ACGME requires the program to confirm that the IMG holds:

A valid U.S. medical license issued by the state medical board
A letter of eligibility from the ACGME Review Committee for their specialty
Board certification in their home country's equivalent specialty
ECFMG Certification, confirming that medical education credentials and USMLE performance meet U.S. GME entry requirements (Correct answer)

Correct answer: ECFMG Certification, confirming that medical education credentials and USMLE performance meet U.S. GME entry requirements

ACGME Common Program Requirements explicitly state that IMGs must hold valid ECFMG Certification prior to appointment. ECFMG Certification attests that the IMG's medical credentials have been verified and that they have passed the required USMLE examinations. It is not equivalent to state licensure.

Question 38: Which of the following best describes the distinction between 'burnout' and 'moral injury' as they relate to resident well-being, and why this distinction matters for program intervention?

Burnout reflects depletion from chronic stress; moral injury arises from being compelled to act against one's values. Interventions targeting only individual resilience are inadequate for moral injury, which requires systemic change. (Correct answer)
Burnout is a temporary state reversible with time off; moral injury is permanent and disqualifying for continued residency training.
Burnout and moral injury are clinical diagnoses that require psychiatric referral; program administrators should not attempt to categorize them.
Burnout is caused by excessive workload alone; moral injury is caused by personal ethical failures. Programs should address burnout with scheduling changes and moral injury with disciplinary counseling.

Correct answer: Burnout reflects depletion from chronic stress; moral injury arises from being compelled to act against one's values. Interventions targeting only individual resilience are inadequate for moral injury, which requires systemic change.

Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced efficacy from chronic occupational stress. Moral injury specifically results from perpetrating, witnessing, or failing to prevent acts that transgress deeply held moral beliefs—often due to systemic constraints. Programs that address only individual coping (mindfulness, resilience training) without changing the systems that create moral injury will see limited impact.

Question 39: 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?

Remove the faculty member from WebADS immediately to clean the record
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)

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 40: What is the primary responsibility of Training Administrators in GME financial management?

Designing clinical curricula
Conducting patient care
Developing medical research projects
Overseeing and managing the financial aspects of the residency or fellowship program (Correct answer)

Correct answer: Overseeing and managing the financial aspects of the residency or fellowship program

Training Administrators (TAs) are crucial for the operational and financial health of Graduate Medical Education (GME) programs. Their primary responsibility in financial management is to ensure the program's budget is managed effectively, covering expenses like resident salaries, educational resources, and administrative costs. This oversight ensures the program remains compliant with financial regulations and can sustain its training mission.

Question 41: 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
Milestone Management System (MMS)
FREIDA Online database

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 42: A fellowship program receives a complaint from a fellow alleging that the program coordinator retaliated against her after she filed an internal duty-hours violation report. The institution's GME office investigates and finds insufficient evidence of retaliation but identifies a pattern of communication from the coordinator that could reasonably be perceived as hostile. No formal corrective action is taken. The fellow then files a complaint with the ACGME. Under ACGME's whistleblower protection provisions in the Institutional Requirements, which finding would most accurately describe the institution's potential compliance gap?

The institution is compliant because ACGME whistleblower protections only apply when formal retaliation is proven by a preponderance of evidence
The institution may be non-compliant because the Institutional Requirements obligate programs to maintain an environment free from intimidation, which includes addressing perceived hostility even absent proven retaliation (Correct answer)
The institution may be non-compliant solely because it failed to report the complaint outcome to the ACGME within the required 30-day window
The institution is compliant because the internal investigation was conducted in good faith, satisfying the procedural requirements of the non-retaliation policy

Correct answer: The institution may be non-compliant because the Institutional Requirements obligate programs to maintain an environment free from intimidation, which includes addressing perceived hostility even absent proven retaliation

ACGME Institutional Requirements mandate not only prohibiting retaliation but also ensuring a learning environment free from intimidation and coercion. A finding of 'insufficient evidence of formal retaliation' does not automatically satisfy this requirement if the investigation reveals a pattern of behavior reasonably perceived as hostile — the institution must take steps to address that environment. The standard is broader than proven quid pro quo retaliation; it encompasses the overall professional and educational climate. Conducting a good-faith investigation satisfies procedural obligations but does not discharge the substantive obligation to remediate identified environmental problems. ACGME does not impose a universal 30-day reporting requirement for all internal complaint outcomes.

Question 43: A PGY-3 resident is physically present supervising a PGY-1 in the ICU. The attending is in their office one floor above, reachable by pager within 5 minutes. From the perspective of ACGME supervision levels, what type of supervision is the attending providing to the PGY-1?

Indirect supervision with direct supervision available, because the attending is not within the clinical unit
Oversight supervision, because the PGY-3 is the proximate supervisor and the attending is not required to be present
Direct supervision, because the supervising chain is physically within the same building
Indirect supervision with direct supervision immediately available, because the attending can arrive quickly and the PGY-3 provides physical oversight (Correct answer)

Correct answer: Indirect supervision with direct supervision immediately available, because the attending can arrive quickly and the PGY-3 provides physical oversight

ACGME defines 'indirect supervision with direct supervision immediately available' as the supervisor being physically within the hospital or available by phone/pager and able to arrive promptly. The PGY-3 is the direct supervisor of the PGY-1, while the attending—who can arrive within minutes—provides indirect supervision with immediate availability. Oversight supervision applies to retrospective review of trainee performance, not real-time physical proximity.

Question 44: Under ACGME Institutional Requirements, a Sponsoring Institution's GMEC is responsible for oversight of all ACGME-accredited programs it sponsors. A hospital system merges with a community hospital that sponsors two independently ACGME-accredited programs. Under which condition may the acquired hospital's programs continue under their original accreditation without requiring new institutional accreditation review?

Continuation under original accreditation is automatically permitted for up to 12 months post-merger, provided the programs submit a merger attestation form to their respective Review Committees.
Only if the acquiring Sponsoring Institution files a 'Change of Sponsorship' application with the ACGME and receives approval before the merger is finalized; the programs cannot continue under original accreditation during a pending review. (Correct answer)
The acquired programs may continue without interruption if the acquiring institution's GMEC formally ratifies the merger and the DIO sends written notification to the ACGME within 30 days.
The programs may continue under original accreditation indefinitely, provided neither program has an open citation or warning status at the time of the merger.

Correct answer: Only if the acquiring Sponsoring Institution files a 'Change of Sponsorship' application with the ACGME and receives approval before the merger is finalized; the programs cannot continue under original accreditation during a pending review.

A change of sponsorship—such as occurs during a hospital merger—is a major accreditation event that requires a formal ACGME Change of Sponsorship application. The programs cannot simply continue under the acquired institution's original accreditation once they transfer to a new Sponsoring Institution. ACGME must approve the new sponsoring relationship. Failure to file before or immediately at the time of merger can jeopardize the programs' accreditation status. The GMEC ratification and 30-day notification described in option B is insufficient without an approved change application.

Question 45: 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:

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

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

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

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 47: Under ACGME requirements, the Clinical Competency Committee (CCC) must meet at minimum:

Annually, at the end of each academic year
Only when a resident is placed on remediation or probation
Monthly, after each clinical rotation block
Prior to residents' semi-annual evaluations, to advise the program director on each resident's Milestone progress (Correct answer)

Correct answer: Prior to residents' semi-annual evaluations, to advise the program director on each resident's Milestone progress

The ACGME requires the CCC to meet prior to residents' semi-annual evaluations so it can review all resident evaluations, determine Milestone levels, and advise the program director. This drives the twice-yearly Milestone reporting cycle.

Question 48: Which ACGME Common Program Requirement addresses a program's obligation to select residents without discrimination?

Section II.B — Faculty Qualifications
Section VI.C — Supervision Standards
Section IV.A — Resident Selection (Correct answer)
Section I.A — Program Director Responsibilities

Correct answer: Section IV.A — Resident Selection

ACGME Common Program Requirements Section IV.A specifically requires programs to select residents based on their preparedness, ability, aptitude, and without discrimination.

Question 49: In a dashboard used to monitor resident duty hours, which visualization type best shows whether violations are trending upward or downward over a 12-month period?

Line chart over time (Correct answer)
Bar chart with monthly totals
Pie chart
Scatter plot of individual violations

Correct answer: Line chart over time

A line chart over time clearly displays trends and directional changes in duty hour violations across the 12-month period.

Question 50: 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
Approve the order and adjust next year's budget accordingly
Seek a budget amendment or supplemental approval before committing funds (Correct answer)

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 51: 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?

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

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 52: Why is it important for Training Administrators to maintain accurate duty hour logs?

To ensure that residents have enough time for personal activities
To comply with ACGME regulations and prevent resident fatigue (Correct answer)
To manage the program's budget
To track faculty attendance

Correct answer: To comply with ACGME regulations and prevent resident fatigue

The ACGME sets strict duty hour limits to ensure resident well-being and patient safety by preventing excessive fatigue. Training Administrators are responsible for meticulously tracking and monitoring these logs to ensure programs remain compliant with these regulations. This oversight is crucial for maintaining accreditation and for fostering a healthy and safe learning environment for residents.

Question 53: What is the role of the Training Administrator in the resident recruitment process?

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

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 54: Which organization is the primary accrediting body for graduate medical education programs in the United States?

LCME
AAMC
AMA
ACGME (Correct answer)

Correct answer: ACGME

The Accreditation Council for Graduate Medical Education (ACGME) is the primary accrediting body for GME programs in the US.

Question 55: How do Training Administrators contribute to the development of residency curricula?

By evaluating residents' clinical skills
By creating medical content
By aligning administrative processes with curricular goals (Correct answer)
By teaching clinical subjects

Correct answer: By aligning administrative processes with curricular goals

While Training Administrators don't typically create medical content or teach, they are instrumental in the practical implementation and administration of the curriculum. They ensure that administrative processes, such as scheduling rotations, tracking resident progress, and managing evaluations, are aligned with and support the program's educational objectives. This ensures residents meet their learning milestones effectively and efficiently.

Question 56: When building a multi-year GME financial model, which assumption has the GREATEST impact on long-term cost projections?

Number of away rotations per resident per year
Current year conference registration fee increases
Current malpractice insurance premium rates
Annual percentage growth in resident stipend levels (Correct answer)

Correct answer: Annual percentage growth in resident stipend levels

Stipend levels are the largest single cost driver in GME budgets; annual growth rates compound significantly over a multi-year forecast horizon.

Question 57: A GME budget includes a line item for 'fringe benefits' at 32% of resident salaries. If total resident salaries are $2.4 million, what is the fringe benefit budget?

$768,000 (Correct answer)
$640,000
$832,000
$960,000

Correct answer: $768,000

$2,400,000 × 0.32 = $768,000 in fringe benefits.

Question 58: 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 59: Which federal law provides eligible residents with up to 12 weeks of unpaid, job-protected leave for qualifying medical or family reasons?

FMLA (Correct answer)
ADA
Title VII
HIPAA

Correct answer: FMLA

The Family and Medical Leave Act (FMLA) provides eligible employees, including residents, with up to 12 weeks of unpaid, job-protected leave for qualifying reasons.

Question 60: Which ACGME core competency is most closely related to faculty supervision and mentorship skills?

Systems-Based Practice
Professionalism
Medical Knowledge
Interpersonal and Communication Skills (Correct answer)

Correct answer: Interpersonal and Communication Skills

Interpersonal and Communication Skills encompass the ability to work effectively with trainees, colleagues, and patients, which is central to supervision and mentorship.

Question 61: 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?

Documentation that the participating site's GME Committee has approved the rotation
Identification of the supervising faculty member's board certification status at the participating site
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)

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 62: A PGY-2 resident in a surgical program is placed on probation for performance deficiencies. She files a grievance claiming the program failed to follow its own remediation procedures before imposing probation. The program director argues the resident's patient safety violations justified bypassing standard steps. Under ACGME due process requirements, which principle best governs this situation?

Programs may bypass procedural steps only when imminent patient safety risk is documented and the deviation is itself disclosed to the resident in writing. (Correct answer)
ACGME due process requirements are aspirational guidelines; state employment law exclusively governs disciplinary disputes in GME.
Because the resident is a trainee rather than an employee, contractual grievance procedures do not carry legal enforceability.
The program director's clinical judgment supersedes procedural requirements whenever a specialty board exam failure is also involved.

Correct answer: Programs may bypass procedural steps only when imminent patient safety risk is documented and the deviation is itself disclosed to the resident in writing.

ACGME Common Program Requirements mandate that programs provide residents with documented notice, a defined improvement plan, and an opportunity to respond before imposing discipline — except in cases of imminent patient safety risk. Even then, programs must document the safety basis for expedited action and notify the resident in writing of the deviation. Failure to do so exposes the program to successful grievance outcomes, accreditation citations, and potential legal liability. State employment law applies concurrently but does not replace ACGME obligations.

Question 63: What is 'moral distress' as experienced by resident physicians?

Stress from taking medical licensing exams
Conflict between co-residents
Distress arising when a resident knows the right action but is constrained from taking it (Correct answer)
Burnout caused by night float schedules

Correct answer: Distress arising when a resident knows the right action but is constrained from taking it

Moral distress occurs when a resident knows the ethically correct course of action but institutional, hierarchical, or systemic constraints prevent them from acting on it.

Question 64: In the ACGME accreditation system, what does a 'Continued Accreditation with Warning' status indicate?

The program is fully compliant with all requirements
The program has minor administrative paperwork delays only
The program has areas of non-compliance that must be corrected within a defined timeframe (Correct answer)
The program is scheduled for voluntary closure

Correct answer: The program has areas of non-compliance that must be corrected within a defined timeframe

'Continued Accreditation with Warning' signals that a program has identified non-compliance issues that must be remedied within the period specified by the Review Committee.

Question 65: A training administrator notices duplicate resident records in the GME management system. The BEST first step is to:

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

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 66: A program administrator is preparing the annual GME budget and discovers that a co-sponsoring community hospital provides 60% of required clinical rotations but contributes only 15% of the administrative overhead costs. The ACGME-accredited sponsoring institution bears the remaining 85% of costs. Under an affiliation agreement, which financial mechanism BEST protects the sponsoring institution from absorbing disproportionate overhead while maintaining accreditation compliance?

Requesting that the affiliated site apply for its own ACGME sponsorship to independently bear accreditation costs.
Shifting all resident salaries to the affiliated site budget for rotations exceeding four weeks.
Renegotiating the affiliation agreement to include a cost-sharing formula tied to rotation percentage, with an annual true-up provision. (Correct answer)
Billing the affiliated site a flat administrative fee per resident rotating per month, regardless of rotation duration.

Correct answer: Renegotiating the affiliation agreement to include a cost-sharing formula tied to rotation percentage, with an annual true-up provision.

A cost-sharing formula proportionally tied to the rotation percentage — combined with an annual true-up — aligns financial contributions with actual resource utilization and is legally defensible in affiliation agreements. Flat monthly fees do not scale accurately, redirecting ACGME sponsorship undermines the affiliation model, and shifting salary obligations without institutional agreement violates standard GME employment frameworks.

Question 67: During a CLER (Clinical Learning Environment Review) pathways visit, surveyors ask your designated institutional official (DIO) about the process by which residents and fellows report patient safety concerns. Which finding would be MOST problematic from an ACGME perspective?

Residents report safety events through the same hospital event-reporting system used by attending physicians
Program directors are the sole recipients of resident safety reports, with no direct institutional escalation pathway (Correct answer)
Resident safety reports are reviewed quarterly by a joint GME–Quality committee that includes resident representation
The institution tracks near-miss events separately from sentinel events in its quality database

Correct answer: Program directors are the sole recipients of resident safety reports, with no direct institutional escalation pathway

ACGME CLER focuses heavily on whether the clinical learning environment supports a robust patient safety culture. A system where program directors are the only recipients of resident safety reports—with no direct pathway to institutional leadership—creates a silo that can suppress systemic safety signals and is contrary to ACGME expectations. ACGME requires that residents have access to institutional-level safety reporting mechanisms, not just program-level ones. Using a shared system (A) is acceptable, tracking event types separately (B) is a standard quality practice, and a joint GME–Quality committee with residents (D) is a model that ACGME considers exemplary.

Question 68: ACGME's Clinical Learning Environment Review (CLER) program differs from standard program accreditation reviews in several important ways. Which of the following statements most accurately describes a key structural distinction of CLER visits?

CLER visits are conducted at the Sponsoring Institution level and are formative in nature, focusing on the institution's support for the six CLER focus areas rather than generating accreditation actions (Correct answer)
CLER visits are compliance-based reviews conducted at the individual program level and can result in program-specific accreditation citations
CLER findings are reported only to the DIO and remain confidential from ACGME Review Committees to encourage candid institutional disclosure
CLER visits replace the need for Annual Program Evaluations at institutions with three or more accredited programs

Correct answer: CLER visits are conducted at the Sponsoring Institution level and are formative in nature, focusing on the institution's support for the six CLER focus areas rather than generating accreditation actions

CLER visits are conducted at the Sponsoring Institution level — not at the level of individual residency or fellowship programs — and are explicitly formative rather than compliance-based. They do not generate accreditation citations or actions. Instead, CLER visits assess how well the clinical learning environment across the institution supports the six focus areas: Patient Safety, Health Care Quality, Care Transitions, Supervision, Duty Hours and Fatigue Management, and Professionalism. CLER findings are shared with institutional leadership to guide systemic improvements and are distinct from the accreditation process that individual programs undergo.

Question 69: A categorical general surgery resident requests an 8-week leave of absence for a non-FMLA qualifying personal reason. The program director approves the leave. Which of the following actions is most critical for the program administrator to take to protect the resident's ability to complete training on schedule?

Notify the NRMP that the resident's categorical position may be vacated and request guidance on whether a replacement can be recruited mid-year
Amend the resident's appointment contract to reflect the extended training period before the leave begins, as ACGME requires written documentation of any schedule change
Verify with the relevant specialty board whether the leave duration, combined with any prior leaves, exceeds the maximum allowable time away and whether a program length extension is required for board eligibility (Correct answer)
File a leave exception request with the ACGME within 30 days of the leave start date to preserve the resident's program completion timeline

Correct answer: Verify with the relevant specialty board whether the leave duration, combined with any prior leaves, exceeds the maximum allowable time away and whether a program length extension is required for board eligibility

Specialty boards — not ACGME — set the rules for maximum allowable time away and whether a training extension is required for board eligibility. The program administrator must consult board-specific policies, because if cumulative leave exceeds the board's threshold (which varies by specialty), the resident may need to extend training or repeat rotations. ACGME does not have a centralized leave exception filing process. Contract amendment timelines are important but secondary to the eligibility determination. NRMP notification would be inappropriate — the position is not being vacated.

Question 70: Which of the following scenarios constitutes a Match violation under the NRMP Match Participation Agreement?

A program offering a conditional verbal guarantee to an applicant that the applicant will be ranked first, in exchange for the applicant's commitment to rank the program first (Correct answer)
A program ranking a preliminary applicant in the same rank list as categorical applicants
A program interviewing an applicant who later withdraws their application before the rank order list deadline
A program extending post-interview thank-you communications to applicants

Correct answer: A program offering a conditional verbal guarantee to an applicant that the applicant will be ranked first, in exchange for the applicant's commitment to rank the program first

Offering an 'exploding offer'—a conditional commitment tied to a reciprocal ranking promise—is an explicit Match violation. The NRMP prohibits any conduct that pressures applicants to reveal or commit to ranking decisions. Such conduct undermines Match integrity and can result in sanctions against the program.

Question 71: What is the ACGME's Next Accreditation System (NAS) primarily designed to do?

Reduce program requirements
Shift focus to outcome-based accreditation (Correct answer)
Increase site visit frequency
Standardize duty hour logs

Correct answer: Shift focus to outcome-based accreditation

NAS shifted the ACGME's accreditation model from process-based to outcome-based, emphasizing resident/fellow performance milestones.

Question 72: 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?

Normal clustering effect; document the statistical distribution and note it as an institutional benchmark in the annual program evaluation
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

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 73: Which body is responsible for certifying physicians in their specialty after residency training is complete?

AAMC
ACGME
ABMS member boards (Correct answer)
GMEC

Correct answer: ABMS member boards

The American Board of Medical Specialties (ABMS) and its 24 member boards are responsible for physician board certification in their respective specialties.

Question 74: If an ACGME site visit reveals significant non-compliance, what is the most serious accreditation action the ACGME can take?

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

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 75: Under ACGME Common Program Requirements, what is the maximum number of hours per week residents may be scheduled for duty, averaged over four weeks?

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

Correct answer: 80 hours

ACGME limits resident duty hours to a maximum average of 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities.

Question 76: 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?

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
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)
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.

Question 77: Which document outlines the specific educational and clinical experience requirements unique to a particular specialty residency program?

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

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 78: Under ACGME Common Program Requirements, which of the following must be included in a written resident agreement (contract)?

The program's accreditation history for the past five years
The resident's rank order on the NRMP match list
The names of all supervising attendings for the year
Salaries, benefits, and conditions for reappointment or dismissal (Correct answer)

Correct answer: Salaries, benefits, and conditions for reappointment or dismissal

ACGME requires that resident agreements include compensation, benefits, working conditions, and the terms under which reappointment or dismissal may occur.

Question 79: A program receives a report that an attending surgeon routinely humiliates residents in the OR in front of patients and scrub staff. Two residents have documented incidents but are afraid to file formal complaints for fear of poor evaluations. The program administrator confirms the attending's evaluations of these two residents are due next month. Which sequence of actions BEST demonstrates compliance with ACGME's requirements regarding mistreatment and retaliation prevention?

Escalate to the DIO and department chair immediately, document the conflict of interest in the evaluation timeline, and ensure the two affected residents' evaluations are reviewed by a neutral evaluator — then proceed with the mistreatment investigation concurrently (Correct answer)
Delay the formal review until after evaluations are submitted to avoid bias, then investigate the mistreatment allegations
Advise the residents to submit the complaint anonymously through the institutional hotline and take no further program-level action until a formal complaint is received
Reassign the residents to a different attending for the rotation and document the reassignment as an administrative action without disclosing the underlying complaint

Correct answer: Escalate to the DIO and department chair immediately, document the conflict of interest in the evaluation timeline, and ensure the two affected residents' evaluations are reviewed by a neutral evaluator — then proceed with the mistreatment investigation concurrently

ACGME requires programs to have explicit anti-retaliation protections and to take immediate action when mistreatment is reported. The convergence of a pending mistreatment investigation with an imminent evaluation by the accused attending creates a clear retaliation risk that must be proactively addressed — not avoided by delay. Escalating to senior GME leadership, documenting the conflict of interest, and routing evaluations through a neutral party addresses both the mistreatment allegation and the structural retaliation risk simultaneously. Silent reassignment without disclosure and passive referral to hotlines both fail the ACGME's active institutional protection standard.

Question 80: A program administrator receives a subpoena for a resident's training records in a malpractice case. The correct response is to:

Release all records immediately to comply with legal process
Consult with the institution's legal counsel before releasing any records (Correct answer)
Destroy records to protect the resident
Forward the subpoena directly to the resident

Correct answer: Consult with the institution's legal counsel before releasing any records

Legal counsel must review any subpoena before records are released to ensure compliance with applicable laws and institutional policy.

Question 81: The ACGME Institutional Requirements mandate that Sponsoring Institutions maintain a Graduate Medical Education Committee (GMEC). Which of the following is a REQUIRED function of the GMEC?

Reviewing faculty promotion decisions across all departments
Approving all patient care protocols used by residents
Overseeing the quality of GME and the learning and working environment for all residents (Correct answer)
Setting individual resident salaries and benefit levels

Correct answer: Overseeing the quality of GME and the learning and working environment for all residents

The GMEC is required by ACGME to oversee the quality of education and the learning and working environment across all accredited programs at the sponsoring institution.

Question 82: Which system is commonly used by Training Administrators to manage residency applications?

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

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 83: Your program receives a complaint that a faculty supervisor has been routinely completing patient notes for struggling residents rather than providing corrective supervision, effectively masking the resident's documentation deficiencies. Under ACGME standards, what is the program administrator's FIRST required action?

Document the concern and escalate to the Program Director to initiate a formal faculty performance review and notify the Clinical Competency Committee of the affected resident's records (Correct answer)
Issue a verbal warning to the faculty member and monitor the situation for 30 days before escalating
Audit only the resident's case logs to determine if a pattern of deficiency exists before involving faculty
Notify the GME Office immediately and place the resident on a performance improvement plan

Correct answer: Document the concern and escalate to the Program Director to initiate a formal faculty performance review and notify the Clinical Competency Committee of the affected resident's records

ACGME requires programs to ensure faculty fulfill their supervisory responsibilities and that resident competency assessments are authentic. Masking deficiencies compromises both patient safety and assessment integrity. The administrator must document and escalate to the PD for formal faculty review, and the CCC must be aware that prior assessments of the affected resident may be invalid. A 30-day wait (B) delays patient safety action. Auditing only the resident (C) ignores the root cause. Going directly to GME without PD (D) bypasses program governance.

Question 84: A program director discovers that a resident's personal social media post includes identifiable patient information. The FIRST step the program director should take is:

Issue a written warning and close the case
Report the incident to the state medical board
Immediately terminate the resident
Conduct a thorough review and notify the privacy officer and compliance department (Correct answer)

Correct answer: Conduct a thorough review and notify the privacy officer and compliance department

HIPAA breach response requires immediate internal notification to privacy and compliance officers to assess scope and determine required actions.

Question 85: According to ACGME Common Program Requirements, which statement MOST accurately characterizes the faculty development mandate?

Programs must provide a minimum of 4 hours of faculty development annually, with at least half dedicated to resident assessment techniques
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)
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 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
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)
Submit a formal inquiry to the NRMP requesting that the applicant be flagged for investigation
Contact the other institution to verify the information before proceeding with the removal

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: 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?

Only data collected through ACGME-sanctioned instruments (Resident Survey and Faculty Survey) may be used in the APE; local surveys are prohibited from inclusion.
Local survey data may fully substitute for the ACGME Resident Survey if the program director certifies that the tool covers equivalent content domains.
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)
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.

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 88: During preparation for an ACGME focused site visit, a training administrator finds that milestone assessment data for three residents is missing from one semi-annual evaluation period due to a Clinical Competency Committee (CCC) quorum failure. The visit is in 6 weeks. Which approach to this gap MOST aligns with ACGME data management standards?

Flag the missing data in the program's internal database only and prepare a written explanation for site visitors if they specifically request those records
Request that individual faculty members submit individual milestone ratings outside the CCC process to populate the missing evaluation period before the visit
Convene an emergency CCC meeting to conduct retrospective milestone assessments with available raters, document the original quorum failure, and disclose the gap and remediation to the site visitors (Correct answer)
Carry forward the most recent available milestone ratings for the affected residents and annotate the records to indicate they represent projected rather than assessed performance

Correct answer: Convene an emergency CCC meeting to conduct retrospective milestone assessments with available raters, document the original quorum failure, and disclose the gap and remediation to the site visitors

ACGME requires milestone data to be completed by the CCC as a deliberative body—not by individual faculty acting outside that process. Carrying forward old ratings misrepresents assessment currency. The only defensible approach is to convene the CCC retrospectively with full documentation, disclose the original failure transparently, and demonstrate systemic correction. Concealing the gap, even partially, risks a more serious citation than the original process failure.

Question 89: Which committee at the sponsoring institution level is responsible for overseeing all GME programs and ensuring compliance with ACGME Institutional Requirements?

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

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 90: What is the primary function of the Designated Institutional Official (DIO) in a Sponsoring Institution?

Conducting resident performance evaluations
Serving as Program Director for the largest residency program
Overseeing institutional compliance with ACGME requirements and providing leadership for all GME programs (Correct answer)
Managing clinical department budgets

Correct answer: Overseeing institutional compliance with ACGME requirements and providing leadership for all GME programs

The DIO is the institutional leader responsible for ensuring all GME programs comply with ACGME requirements and for providing oversight and administrative support to all programs.

Question 91: After the Match results are released on 'Match Day,' what is the typical next step for programs with unfilled positions?

Participate in the Supplemental Offer and Acceptance Program (SOAP) (Correct answer)
Re-open ERAS applications for the following year
Contact the ACGME to request additional complement positions
Submit a grievance to the NRMP

Correct answer: Participate in the Supplemental Offer and Acceptance Program (SOAP)

SOAP (Supplemental Offer and Acceptance Program), administered by the NRMP, allows programs with unfilled positions and unmatched applicants to connect during a structured post-Match period.

Question 92: Which entity is responsible for appointing members to the Graduate Medical Education Committee (GMEC)?

The program directors collectively
The ACGME Review Committee
The Designated Institutional Official (DIO)
The Sponsoring Institution's leadership (Correct answer)

Correct answer: The Sponsoring Institution's leadership

The GMEC is appointed by the sponsoring institution's leadership and must include residents, the DIO, and program directors as required members.

Question 93: Which cost-accounting method allocates shared departmental overhead (e.g., administrative salaries) to individual GME programs based on resident FTE count?

Activity-based costing
Zero-based budgeting
Step-down allocation (Correct answer)
Direct costing

Correct answer: Step-down allocation

Step-down allocation distributes shared service costs sequentially to departments, often using resident FTE as the allocation driver.

Question 94: When configuring role-based access controls in a residency management system, which principle should guide decisions about who can view or edit sensitive resident performance data?

Access should be granted based on job function and need-to-know only (Correct answer)
Access should be determined by seniority in the GME office
Only the DIO should have any access to resident data
All GME office staff should have equal access to all data

Correct answer: Access should be granted based on job function and need-to-know only

Role-based access control aligned with need-to-know limits exposure of sensitive data and reduces the risk of unauthorized disclosure or modification.

Question 95: Which software might a Training Administrator use to manage GME data?

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

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

Residency Management Systems, such as New Innovations and MedHub, are purpose-built software solutions for GME programs. Training Administrators rely on these systems to centralize and manage critical program data, including resident schedules, evaluations, duty hour tracking, and compliance reporting, streamlining administrative tasks. They are indispensable tools for efficient GME program management.

Question 96: A surgery resident works a 24-hour shift and then is involved in a post-call motor vehicle accident during the commute home. The GME office is reviewing duty hour compliance. Under ACGME requirements, which statement about transitional duty periods is MOST accurate?

ACGME prohibits all clinical activity beyond 24 continuous hours regardless of circumstances, making this a clear violation requiring immediate citation
Residents in PGY-1 may work a maximum of 16 consecutive hours, but PGY-2 and above may extend to 28 hours with 4 hours reserved exclusively for transitional activities, making the shift compliant for upper-level residents
Programs must educate residents about fatigue mitigation strategies and provide safe transportation or on-site rest facilities, representing a systemic well-being obligation beyond hours-tracking alone (Correct answer)
The post-call accident automatically triggers an ACGME for-cause visit regardless of whether the hours logged were within the allowed maximums

Correct answer: Programs must educate residents about fatigue mitigation strategies and provide safe transportation or on-site rest facilities, representing a systemic well-being obligation beyond hours-tracking alone

While ACGME duty hour rules cap continuous duty at 24 hours (with up to 4 additional hours for transitions for upper-level residents), the well-being obligation extends to fatigue mitigation education and—critically—ensuring residents have safe options to get home after extended shifts. Programs are required to address the systemic risk that long-duration training creates, including transportation and sleep facilities. Simply tracking hours without addressing post-shift safety is insufficient. A post-call accident alone does not automatically trigger a for-cause visit.

Question 97: How does a GME program administrator support diversity, equity, and inclusion (DEI) in recruitment and retention?

By avoiding all diversity-specific initiatives to maintain neutrality
By outsourcing DEI efforts to the HR department only
By exclusively prioritizing applicants from underrepresented groups
By implementing equitable recruitment practices, inclusive program culture, and support structures for diverse trainees (Correct answer)

Correct answer: By implementing equitable recruitment practices, inclusive program culture, and support structures for diverse trainees

Administrators support DEI by ensuring recruitment processes are equitable, creating inclusive program cultures, and providing targeted support to retain diverse resident populations.

Question 98: Under the ADA, a program may ask an applicant about a disability:

After a conditional offer of appointment has been made (Correct answer)
During the interview to assess technical standard compliance
At any time during the application process
Only if the disability is visually apparent

Correct answer: After a conditional offer of appointment has been made

Under the ADA, disability-related inquiries are only permissible after a conditional offer of appointment, not during the application or interview phase.

Question 99: A program director learns that a graduating resident planning to enter private practice was the subject of an unresolved patient complaint. When contacted by a prospective employer for a reference, the program director's BEST course of action is to:

Decline to provide any reference to avoid liability
Confirm only dates of employment and provide no additional information
Inform the employer that the resident's records are sealed under HIPAA
Provide a complete and accurate reference including relevant factual information, after consulting legal counsel (Correct answer)

Correct answer: Provide a complete and accurate reference including relevant factual information, after consulting legal counsel

Program directors have both ethical and, in some jurisdictions, legal duties to provide accurate reference information about residents, especially regarding patient safety concerns, after appropriate legal review.

Question 100: In GME financial planning, 'responsibility center budgeting' means:

A central committee approves all program-level expenditures
Individual program directors control and are accountable for their own budgets (Correct answer)
The GME office holds the entire institution's budget
Budget responsibility is shared equally among all department chairs

Correct answer: Individual program directors control and are accountable for their own budgets

Responsibility center budgeting assigns financial accountability to individual program directors who manage their own program budgets.

Question 101: A program administrator at a sponsoring institution learns that a new affiliated hospital site will begin hosting residents in 4 months. The affiliation agreement has been signed, but the site has not yet been formally approved as a participating site by the relevant ACGME Review Committee. What action is REQUIRED before residents can rotate to this site?

The program must obtain ACGME Review Committee approval for the new participating site before any residents rotate there (Correct answer)
The program director must submit written notification to the ACGME within 30 days of the residents beginning rotations at the new site
The DIO must certify in ADS that the site meets ACGME requirements, which substitutes for Review Committee approval for sites hosting fewer than 25% of residents
The GMEC must conduct a formal site evaluation and document approval in GMEC minutes prior to the rotation start

Correct answer: The program must obtain ACGME Review Committee approval for the new participating site before any residents rotate there

ACGME requires that all participating sites be formally approved by the relevant Review Committee before residents can rotate there. A signed affiliation agreement and GMEC approval are necessary components but do not substitute for Review Committee approval. Notification after the fact or DIO certification alone are not compliant pathways. Programs that place residents at unapproved sites risk citations or adverse accreditation actions. The 4-month timeline means the program should have initiated the approval process immediately upon identifying the new site, well before the planned rotation start.

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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