Examples/New Program Accreditation

New Residency & Fellowship Program Accreditation Examples

Most programs underestimate how much infrastructure ACGME expects before they ever see a resident.

Starting a new residency or fellowship program is one of the most complex undertakings in academic medicine — and one of the most frequently underestimated. Health systems routinely begin the ACGME application process before they have the infrastructure in place to support a program, then discover during the review process that they're missing fundamental requirements. Understanding what ACGME actually evaluates — and what a strong initial accreditation application looks like — is the difference between a smooth launch and a two-year delay.

What good looks like

A strong new program application demonstrates three things: that the clinical environment can support the educational experience ACGME requires, that the faculty are qualified and committed to education, and that the program has leadership with the time, expertise, and institutional support to run the program well. ACGME is not just evaluating whether you meet minimum requirements on paper — they're evaluating whether this program will actually work in practice.

Common mistakes to avoid

Starting the application before the program director is identified

The program director is the most scrutinized element of any new program application. Their qualifications, time commitment, and educational philosophy are central to the review. Programs that begin building the application without a committed program director are building on an unstable foundation.

Underestimating the patient volume requirements

Every specialty has specific patient volume and case mix requirements. Programs that assume their clinical volume is sufficient without verifying against current ACGME requirements frequently discover gaps during the review process that require years to address.

Treating the application as a paperwork exercise

ACGME conducts a site visit for new programs and interviews faculty, residents (if any are already training), and institutional leadership. Programs that have strong applications but weak infrastructure are identified during the site visit. The application and the reality must match.

No faculty development plan at launch

New programs often focus entirely on recruiting residents and forget that faculty need to be prepared to teach them. An initial accreditation application without a faculty development plan is incomplete and signals to ACGME that the educational environment hasn't been fully thought through.

Real examples

New program timeline — from decision to residents

A realistic timeline for a health system launching a new internal medicine residency program.

Month 1-3 — Feasibility and Decision. Conduct patient volume analysis against ACGME program requirements. Identify potential program director candidate and assess time commitment availability. Assess faculty roster for minimum qualifications. Evaluate institutional infrastructure — GME office capacity, DIO availability, hospital support. Decision to proceed and institutional commitment secured. Month 4-6 — Foundation Building. Program director formally appointed and released time negotiated. Initial curriculum framework developed with program director. Faculty development plan drafted. Application strategy meeting with DIO. Month 7-12 — Application Development. ACGME application built section by section — program description, curriculum, faculty roster, facilities. Internal review by DIO and legal. Application submitted. Month 13-18 — ACGME Review. ACGME preliminary review and questions responded to. Site visit preparation begins. Site visit conducted. Accreditation decision received — if initial accreditation granted, program may recruit. Month 19-24 — Launch. First resident match cycle. Residents begin training July 1. First year monitoring — duty hours, milestone reporting, PEC established.

What ACGME evaluates in a new program site visit

A breakdown of the major areas surveyors assess during an initial accreditation site visit, drawn from ACGME's published review criteria.

Institutional support: Does the sponsoring institution have the infrastructure to support this program? Is the DIO engaged and knowledgeable? Is the GME committee functioning? Program director: Is the program director qualified for this specialty? Do they have adequate protected time? Do they demonstrate the educational philosophy and commitment that residents need? Faculty: Are there enough qualified faculty? Do they have relevant expertise? Is there a faculty development plan? Clinical environment: Does the patient volume and case mix support the educational requirements of this specialty? Are supervision structures clear and appropriate? Curriculum: Is the curriculum comprehensive and aligned with specialty requirements? Are evaluation systems in place and appropriate? Is there a plan for resident assessment from day one? Well-being: Are there systems in place to support resident well-being, including duty hours monitoring, access to mental health resources, and a program culture that supports reporting concerns?

Key takeaways

✓Identify the program director before starting the application — they are the most scrutinized element
✓Verify patient volume against current ACGME requirements before committing to launch
✓Plan for 18-36 months from decision to first residents — most programs underestimate the timeline
✓The site visit evaluates reality, not paperwork — infrastructure must match the application
✓Faculty development planning starts at launch, not after residents arrive

Glossary: acgme accreditation Template: New Program Accreditation

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