As trainees, you may experience situations that cause concern and require intervention to come to a resolution. The following resources provide you with practical tips on how to advocate for yourself and address concerns using the appropriate chain of escalation.
ACP Trainee Self-Advocacy Video Series
Watch these brief videos to learn more about how you can advocate for yourself and resolve concerns at various levels of escalation, including working with your program director, institution leadership, or engaging the ACGME Office of the Ombudsperson.
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Program and Institutional Policies and Responsibilities
Institutions are required to have policies and procedures that outline how trainees may escalate concerns. Most policies will have confidentiality exceptions for concern of trainee self-harm or trainee potential harm to patients—it is important to be aware of these exceptions before communicating your concerns. When you encounter a concern, be sure to follow these steps to ensure that your issue can be resolved at the appropriate level:
- Understand your program or institution’s policies for addressing trainee concerns. Ask your chief resident, program manager, or program director about where you might access this policy (this information is often provided during orientation)
- Report your concern following the appropriate chain of escalation. Concerns can be addressed at various levels within your institution. Consider following the appropriate chain of escalation for raising your concerns within your program or institution:
- Chief/resident fellow
- Program Director or Associate Program Director
- Designated Institutional Official
- Chair or Chief of Department
- Institution-based Human Resources Department
- Consider whether your concern requires an exception to using the chain of escalation. Most policies will have confidentiality exceptions for concern of trainee self-harm or trainee potential harm to patients- it is important to be aware of these exceptions before communicating your concern. In these cases, you may consider reporting your concerns to ACGME.
- Questions for consideration:
- What is the urgency of the situation?
- Are trainees or patients at risk of harm?
- Is there a history of mishandling these issues by your program or institution’s leadership?
- Questions for consideration:
Role of the Accreditation Council for Graduate Medical Education (ACGME)
The ACGME also offers resources that may help you address your concerns. Before contacting the ACGME, try to resolve at the program/institution level, unless there is a valid reason for not doing so. If you have determined that your concern needs third-party involvement, the ACGME offers the following resources:
- Office of the ACGME Ombudsperson: the Office of the ACGME Ombudsperson serves as an independent, impartial party that offers a safe space to raise concerns about training related issues. Reports here will not impact the accreditation status of your program.
- Office of Complaints: the Office of Complaint provides a confidential mechanism for reporting a formal complaint with the ACGME. The ACGME only addresses matters regarding non-compliance with ACGME accreditation requirements and complaints should allege violations of these requirements. Complaints may affect the accreditation status of the program.
The ACGME does not adjudicate disputes between individual persons and Sponsoring Institutions or residency or fellowship programs regarding matters of admission, appointment, contract, credit, discrimination, promotion, or dismissal of faculty members, residents, or fellows.