Accreditation of postgraduate medical education in the United States and Canada: a comparison of two systems.

The systems for accrediting residency programmes in the United States and Canada, although they have developed independently in the two countries, have similar objectives and accreditation requirements. Both have become increasingly focused over the past several decades on the importance of educational programmes structured to provide graded professional responsibility with appropriate guidance and supervision to residents according to their level of training, ability and experience. The Canadian model used by the Royal College of Physicians and Surgeons of Canada is a centrist one, with accreditation decisions on all programmes in all specialties being vested in a single, multidisciplinary accreditation committee. The American model developed by the Accreditation Council for Graduate Medical Education is a distributive one, with accreditation decisions being vested in each specialty Residency Review Committee. In both models, accreditation is based on a system of periodic on-site visits during which both faculty and residents are interviewed by a surveyor to provide the accrediting body with a first-hand evaluation of the extent to which each accredited programme meets the standards of accreditation. While they are similar in purpose, there are significant differences in the operation of the two systems.

Accreditation of residency training in the US.

In the US, accreditation and certification of residency training are functions of separate public sector agencies. Accrediting decisions are made directly by 26 Residency Review Committees, which represent the primary medical specialties and function under the authority of the Accreditation Council for Graduate Medical Education. The accrediting bodies may consider only educational issues and are prohibited by the government from controlling physician supply. Only the programme, not the institution in which it is conducted, is accredited. The US residency is a structured educational programme that is expected to provide comparable experience to all enrolled residents. Length of training may vary from two to six years depending on the specialty. Additional training may be obtained in subspecialty programmes, which are subsets of the primary specialty residencies and are also reviewed for accreditation. These have increased in significant number in recent years as subspecialisation has proliferated in the US.