RRC Letters - Citations, Comments, and Concerns

For the RRC, program requirements serve as the essential standards against which residency programs are evaluated and the quality of graduate medical education is enhanced. Following a site visit, the RRC often makes evaluative comments in its correspondence to program directors. According to the ACGME Program Directors' Handbook, "these comments must relate directly to specific standards in the institutional requirements or in the program requirements for that specialty." However, the various RRCs may use very different language to preface their evaluative comments.

Because there has been confusion about the nature of these comments, the Office of Graduate Medical Education asked the ACGME (Cynthia Taradejna, Assistant Director for ACGME Activities) to clarify the difference between a citation and other comment. On May 29, 2002, Ms. Taradejna replied:

Some letters refer to "citations" and some letters list "concerns." Further, some letters use other language. There is no real distinction between concerns or citations. Whatever the RRC has listed in your letters, and no matter what they called them, they should all be addressed before the time of the next review by the ACGME.

A Program Director or a Designated Institutional Official, in the case of an institutional review, does not have to write a reply about these comments unless specifically requested (e.g., progress report). If a Program Director believes a misunderstanding or lack of information caused the RRC to make an "erroneous" evaluative comment, the Program Director may choose to respond in writing. The RRC may or may not acknowledge receipt of this information. The acknowledgment that information has been received does not imply that the RRC has withdrawn the evaluative comment.

Once an evaluative comment has been attributed to a program, it becomes a permanent part of the program, and will be given particular attention by site visitors. For future program and institutional site visits, special efforts must be taken to ensure that previous citations (evaluative comments) have been corrected or are being addressed.

June 3, 2002