Table 1.

Modified framework for how graduate medical education (GME) can effectively operate

	Stage 1: “Business as Usual”	Stage 2: Increased Clinical Demands Guidance	Stage 3: Pandemic Emergency Status Guidance
Definition	No significant disruption of patient care and educational activities; planning underway for increased demands	Some residents/fellows need to shift to patient care duties; some educational activities are suspended	Most or all residents/fellows need to shift to patient care; majority of educational activities are suspended
Requirements in effect	Governed by the common and specific program requirements	Governed by the common and specific program requirements and variances; see https://acgme.org/Stage-2-Increased-Clinical-Demands-Guidance	Governed by 4 overriding requirements: work hour limit requirements, resources and training requirements, supervision requirements, fellows allowed to function in core specialty
Flexibility	ACGME activities suspended: site visits, self-study, ACGME surveys. Telemedicine requirements in effect	Stage 1 plus variances (see above) on the following: fellows working as attendings; residents/fellows reassigned, fail to accrue required minimums, graduation; educational program changes; review committee evaluation of disruptions	Stages 1 and 2 plus specialty-specific requirements waived
ACGME notification			Sponsoring institutions can declare pandemic emergency status; contact institutional review committee executive director

Adapted from Accreditation Council for Graduate Medical Education. Three Stages of GME During the COVID-19 Pandemic. https://acgme.org/COVID-19/Three-Stages-of-GMEDuring-the-COVID-19-Pandemic.