TAGME Legal, Ethical, and Policy Frameworks in GME 4 — Questions and Answers
Question 1: Under the Americans with Disabilities Act (ADA), a GME program must provide reasonable accommodations to a resident with a documented disability unless the accommodation would:
- Require hiring additional staff
- Create an undue hardship or fundamentally alter the nature of the program (Correct answer)
- Cost more than $500 to implement
- Require approval from the ACGME Review Committee
Correct answer: Create an undue hardship or fundamentally alter the nature of the program
The ADA requires reasonable accommodations unless they impose an undue hardship or fundamentally alter the essential nature of the training program.
Question 2: 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:
- Immediately terminate the resident
- Report the incident to the state medical board
- Conduct a thorough review and notify the privacy officer and compliance department (Correct answer)
- Issue a written warning and close the case
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 3: Which federal law governs the confidentiality of resident drug and alcohol treatment records and may be MORE restrictive than HIPAA?
- The Rehabilitation Act of 1973
- 42 CFR Part 2 (Correct answer)
- The Mental Health Parity and Addiction Equity Act
- The Employee Assistance Program Act
Correct answer: 42 CFR Part 2
42 CFR Part 2 provides heightened confidentiality protections for substance use disorder treatment records, often exceeding HIPAA's requirements.
Question 4: An ACGME-accredited program wants to require residents to sign mandatory arbitration agreements waiving their right to sue the institution. This practice is:
- Encouraged by ACGME as an efficient dispute resolution mechanism
- Permissible only in states that ban class action lawsuits
- Legally complex and potentially unenforceable; institutions should seek legal counsel (Correct answer)
- Fully compliant with ACGME Common Program Requirements
Correct answer: Legally complex and potentially unenforceable; institutions should seek legal counsel
Mandatory arbitration clauses in resident contracts are legally contested and may be unenforceable in some jurisdictions, requiring institution-specific legal review.
Question 5: The principle of 'duty to report' in GME most commonly refers to a program's obligation to report which of the following to the ACGME?
- All resident grievances filed against faculty
- Sentinel events, significant program changes, and adverse actions meeting defined thresholds (Correct answer)
- Monthly duty hour compliance percentages
- All resident salary adjustments
Correct answer: Sentinel events, significant program changes, and adverse actions meeting defined thresholds
Programs must self-report to ACGME events such as major program changes, loss of key personnel, and certain adverse resident actions as defined in institutional requirements.
Question 6: A resident who is also an international medical graduate (IMG) on a J-1 visa is placed on unpaid suspension pending investigation. The GME office must FIRST notify:
- The ACGME Review Committee within 24 hours
- The U.S. Department of State or the designated J-1 sponsor organization (Correct answer)
- The resident's home country medical licensing board
- The National Resident Matching Program (NRMP)
Correct answer: The U.S. Department of State or the designated J-1 sponsor organization
Suspensions affecting a J-1 visa holder's training status must be reported to the visa sponsor (typically the Educational Commission for Foreign Medical Graduates, ECFMG) to maintain visa compliance.
Question 7: Which ethical principle is MOST directly violated when a program director pressures a resident not to report a patient safety event to protect the program's reputation?
- Beneficence
- Justice
- Non-maleficence
- Non-retaliation and transparency (Correct answer)
Correct answer: Non-retaliation and transparency
Pressuring residents to suppress safety reports violates non-retaliation principles and the ethical obligation to transparency in patient safety culture.
TAGME Legal, Ethical, and Policy Frameworks in GME 4
Under the Americans with Disabilities Act (ADA), a GME program must provide reasonable accommodations to a resident with a documented disability unless the accommodation would: