Medical Education, ACGME RC-EM

Update: The Single Accreditation System and How It Is Affecting AOA Residencies and Fellowships

We are 18 months into the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) merger to the Single Accreditation System (SAS). The date for completion of the SAS is June 30, 2020, so if a program is not ACGME accredited by that time, the program will no longer be an accredited emergency medicine program. A lot has changed and many things are still in flux.

The ACGME Review Committee for Emergency Medicine (RC-EM) is accepting and reviewing applications from AOA programs. To date, 61 AOA emergency medicine programs exist, of which 34 have applied for ACGME accreditation and are in various stages of accreditation.

Programs that have applied for accreditation but have not yet heard back from the RC-EM are considered pre-accredited. Programs that have applied to the ACGME for accreditation but require further changes prior to achieving accreditation are in continued pre-accreditation status. It takes 4-12 months for the RC-EM to review the application, depending on the timing of the submission.

The next tier of accreditation is initial accreditation, which allows graduates to sit for ABEM certification even if accreditation is granted on the last day of residency. Newly accredited residencies will, however, have a review in 2 years that includes a site visit to check on the program. If the program is deemed to be in compliance, it will receive continued accreditation. As of September 2016, 13 programs have obtained initial ACGME accreditation with a 2-year accreditation cycle.

If you are applying to any of these programs and wish to see its accreditation progress, check the AOA Osteopathic Medical Internships and Residencies website at or contact the program directly.1

What Are the Implications?

Many people want to know the implications of the different designations, especially for board certification. AOA program graduates may take the American Osteopathic Board of Emergency Medicine (AOBEM) Certification test while their residency program is AOA approved. Once the AOA program achieves ACGME initial accreditation, even if it is the last day of residency, the resident may also take the American Board of Emergency Medicine (ABEM) certification test.2

As for 3- versus 4-year training programs, all AOA-approved emergency medicine programs are required to be four-year programs. Under the SAS, many AOA programs applying for ACGME accreditation are contemplating whether they should stay a 4-year program or switch to a 3-year program. How will this affect students and residents? The matter is very simple: if you have not yet started residency and your program changes to a 3-year program, you will complete 3 years of residency.

For those who have already started residency, this can be confusing in terms of board eligibility. If you start your residency in a 4-year residency and it changes to a 3-year program, you must complete 24 months of training under the new ACGME accreditation. This effectively means that, if you are a PGY2 or greater, you will have to complete your program as a 4-year program in order to be board-eligible. Therefore, only the PGY1 class and future incoming classes would be able to graduate in 3 years.3

When it comes to transferring, if an AOA EM resident decides to transfer to a separate/different established ACGME EM program, s/he can receive partial credit for prior training. The program director of the resident's new program can award up to 6 months of credit for 12 months of completed AOA EM training. For 24 or more months of completed AOA EM training, a resident can be awarded up to, but no more than, 12 months of credit.

AOA fellowships are eligible to apply for accreditation once their core program has achieved initial accreditation. As of July 2015, any AOBEM-certified physician who enters and successfully completes an ACGME fellowship in a subspecialty that ABEM sponsors may apply to ABEM to take the subspecialty examination.

As the SAS process continues, there may be unforeseen situations requiring further changes. Rest assured the AOA, ACGME, AOBEM, and ABEM are working together to keep the best interests of students, residents, and fellows in mind and will continue to tackle problems as they arise. EMRA will keep you informed of these changes. Good luck to the students in the coming match!


  1. Opportunities: Osteopathic Medical Internships and Residencies
  2. American Board of Emergency Medicine