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AAMC Reporter: October 2005
A Word from the President:
"The DIO: A New Leader in the GME Ranks"
Over the past several years, the Accreditation Council for
Graduate Medical Education (ACGME) has introduced
many important changes in its standards in an effort to
improve the quality and effectiveness of residency training.
None of those changes, in my view, have been more
important than those designed to strengthen the role of
the sponsoring institution in fostering high-performance
residency programs.
So much of what makes residency programs excel lies
not within the control of individual programs, but
rather within the capability of the sponsoring institution
and the commitment of its leadership. For GME to
flourish, sponsoring institutions must be held accountable
for establishing and enforcing high standards of
education and patient care, and for providing and maintaining
the administrative framework and resources to
support their training programs.
In recognition of this need, the ACGME promulgated
a new standard some eight years ago that required
all institutional sponsors of GME to identify a
Designated Institutional Official (DIO). This individual
was to be given overall authority and responsibility
for monitoring the performance of all the sponsor's
programs and for ensuring compliance with the
ACGME's many institutional requirements.
As intended, the DIO has become the institution's internal
and external GME advocate, the point person for
institutional oversight and accreditation, the champion
for educational improvement and innovation, the caretaker
of resident well-being, and the overseer of financial
management. (And, in the aftermath of Katrina, one
should add "coordinator of crisis communications.")
By any measure, the job of DIO has become Herculean
in scope and responsibility.
Realizing that both current and prospective DIOs might
benefit from some postgraduate training of their own,
the AAMC's Group on Resident Affairs (GRA) has been
hard at work thinking about what might be useful professional
development for individuals taking on those
key responsibilities. That thinking prompted the GRA
Steering Committee, in consultation with experienced
GME leaders, to draft a set of core competencies
describing the knowledge, skills, and behaviors that an
effective DIO would be expected to demonstrate. It was
anticipated that having such a document could serve not
only as a curricular framework for formal courses, but
also as a free-standing guide for anyone wishing to
understand what the DIO role actually entails, and as a
self-assessment tool for institutional GME leaders wishing
to improve their performance.
The latest draft of the document, Core Competencies for
Institutional Leaders/DIOs, was discussed at last month's
Executive Council meeting, and it received many favorable
comments and useful suggestions. Following is a
bird's-eye view of the topic areas that this multi-page
draft comprises; as you can see from the 12 categories
of proposed core competencies, DIOs do indeed have
far-ranging and critically important responsibilities:
- Be responsible and accountable for institutional
compliance with ACGME standards.
- Maintain accreditation of all the institution's
residency programs.
- Improve graduate medical education throughout
the institution.
- Develop and support the institution's residency
program directors.
- Manage the overall GME budget and be the
advocate for adequate resources.
- Oversee GME administration and manage
GME operations.
- Represent the GME enterprise to the institution's
governance, administrative leadership, and
affiliated organizations.
- Oversee the well-being of the institution's residents.
- Provide guidance on GME legal matters.
- Function effectively in relation to other GME
stakeholders (e.g., AAMC, NRMP, ECFMG,
NBME, and state licensing boards).
- Work knowledgeably in the broad health policy
context affecting GME (e.g., GME financing,
workforce issues, patient safety concerns, and
quality improvement).
- Engage in professional development to enhance
effectiveness as a GME leader.
As I noted above, having an agreed-upon set of core
competencies provides a robust framework for formal
professional development courses for individuals
aspiring to be DIOs, as well as for those already fulfilling
this responsibility. And that is precisely what the
GRA did in designing and implementing a three-part
GME Leadership Development Course. The first
offering of the course, the third segment of which
was completed last April, was judged a huge success.
Forty-five individuals attended all three sessions and
earned a handsome certificate from "DIO School."
I'm proud to say that I was able to serve (albeit
in absentia) as the school's virtual dean!
In view of the enthusiastic response to this initial
effort, the GRA is scheduling a second go-around of
the tripartite GME Leadership Development Course
for 2006-07. Part One will focus on the basics of
ACGME requirements, Part Two on administrative
and fiscal management, and Part Three on skill development.
Given the complexity of the DIO role, and
the growing importance of institutional oversight and
accountability for ensuring high-quality residency
training, I would urge as many institutional GME
leaders as possible to attend next year's course. Those
who cannot attend should certainly take a hard look at
the core competency document and consider using it
to benchmark their own roles and responsibilities.
With the myriad challenges facing teaching hospitals
and their GME programs, we are proud that the AAMC
is helping to field an army of well-trained DIOs to lead
the charge toward more effective GME.
Jordan J. Cohen, M.D.
AAMC President
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