This policy pertains to the University at Buffalo (UB) as an ACGME-accredited sponsoring institution and its ACGME-accredited graduate medical education programs.
This policy defines the responsibilities of the University at Buffalo (UB) as an ACGME-accredited sponsoring institution, and its ACGME-accredited graduate medical education programs, in the event of a disaster or other extraordinary circumstances that significantly alter the educational experience in one or more residency/fellowship programs and/or impede/prevent the continued operation of the institution and/or any of its training programs.
Extraordinary circumstances do not include planned program closures.
In the event that the continued operation of the institution or a training program is impeded permanently or for an extended period- due to extraordinary circumstances as defined above, timely and appropriate steps will be taken collaboratively by the Office of Graduate Medical Education and the respective program director(s) to restructure the residents’/fellows’ educational experiences as necessary to ensure substantial compliance with ACGME Institutional, Common, and Specialty-specific requirements and/or secure either temporary or permanent arrangements suitable for completion of training. These arrangements will include assistance secured by UB in partnership with the affiliated hospital(s) for continuation of resident/fellow salary, benefits, professional liability coverage, and assignments in accordance with ACGME requirements, policies and procedures.
All efforts will be made to address extraordinary circumstances locally. The ACGME may also invoke the ACGME Extraordinary Circumstances policy in response to circumstances that significantly alter the ability of a sponsor and its programs to support resident/fellow education, in which case the sponsoring institution will take all necessary steps to comply with ACGME requirements, policies and procedures.
ACGME Institutional Requirements effective 7/1/2022, Reformatted 9/3/2025(4.14-4.14.a)
ACGME Policies and Procedures effective 2/2026 (23.00-23.60)
The ACGME may invoke the Extraordinary Circumstances policy in response to circumstances that significantly disrupt the ability of a Sponsoring Institution and/or its program(s) to support graduate medical education in compliance with applicable ACGME requirements. Extraordinary Circumstances may impact a Sponsoring Institution or program or have a regional or national impact. Examples of extraordinary circumstances include, but are not limited to, abrupt closure of a hospital or other essential clinical site resulting from a natural disaster; a catastrophic loss of funding; acts of terrorism or cyberterrorism; and loss of infrastructure or acute and prolonged health system disruption during epidemics or pandemics. The ACGME shall consider invocation of the Extraordinary Circumstances policy (1) at the request of a Sponsoring Institution’s or program’s designated institutional official (2) in response to verified public information, or (3) on the basis of other information received by the ACGME.
Upon receipt of information that suggests a potential Extraordinary Circumstance, the ACGME president and chief executive officer may initiate an investigation to determine credibility, degree of urgency, and/or course of action, or proceed immediately to consideration of declaration of extraordinary circumstance.
An investigation may include:
a. an accreditation site visit;
b. a request for information from the Sponsoring Institution and/or programs(s); and/or,
c. other methods of inquiry, including, but not limited to, a site visit that may include exchange of information that addresses the continuation of residents’/fellows’ educational experiences in compliance with applicable ACGME Requirements.
If the ACGME president and chief executive officer, in consultation with the ACGME board chair, determines that a Sponsoring Institution’s or program’s ability to support graduate medical education in compliance with applicable ACGME Requirements has been significantly disrupted, the ACGME president and chief executive officer shall invoke the Extraordinary Circumstances policy. Based on the severity and generalizability of the Extraordinary Circumstance, the ACGME administration may recommend emergency standards and/or other procedures to the ACGME Executive Committee and the ACGME Board for approval. Programs operating under Extraordinary Circumstances must comply with these ACGME Extraordinary Circumstances requirements as applicable.
Upon invocation of the Extraordinary Circumstances policy, a notice may be posted on the ACGME website with information relating to the ACGME’s response to the extraordinary circumstances.
When the Extraordinary Circumstances policy is invoked, the designated institutional official (DIO), or designee(s), on behalf of the affected Sponsoring Institution or program(s), shall:
a. contact the ACGME president and chief executive officer, or designee, to provide preliminary information regarding any major changes to the Sponsoring Institution and its programs resulting from the extraordinary circumstances within 10 days of the invocation of the policy;
b. provide a plan describing the continuation of residents’/fellows’ educational experiences and any major changes to the Sponsoring Institution and its programs, consistent with the applicable ACGME Requirements, to the ACGME president and chief executive officer within 30 days of the invocation of the policy, unless another due date is approved by the ACGME;
c. as needed, arrange timely reassignment of residents and fellows, including their temporary or permanent transfers to other ACGME-accredited programs to ensure they can continue their education;
d. ensure that residents and fellows are prospectively informed of the estimated duration of any temporary transfer to another ACGME-accredited program; and,
e. ensure that residents/fellows continually receive timely information regarding reassignments, transfer arrangements, and/or major changes to the Sponsoring Institution or its programs.
Programs operating under the Extraordinary Circumstances policy must continue to assess residents/fellows in all six Core Competencies, and such assessments must form the basis for decisions regarding promotion to subsequent appointment levels or satisfaction of requirements for program completion. Programs must follow the principles of competency-based medical education to make determinations regarding the assessment of the residents’/fellows’ readiness to progress to the next year of education and training or to enter autonomous practice. Individualized learning plans must be utilized to ensure adequate progression through the required elements of the program.
The Review Committee and/or the ACGME, as applicable, will inform the Sponsoring Institution(s) and program(s) of:
1) reporting requirements related to the impact of the extraordinary circumstance on the educational program(s) and the progress of the program(s) toward resuming normal operations; and,
2) the maximum length of time the program(s) may operate under extraordinary circumstances. At the end of this time period, the program(s) must demonstrate substantial compliance with the applicable ACGME Requirements. At the discretion of the Review Committee, a site visit may be conducted and, if the Review Committee does not determine substantial compliance with ACGME Requirements, the program(s) will be subject to an adverse accreditation action including, but not limited to, Withdrawal of Accreditation.
Sponsoring Institutions and programs must minimize disruption to resident/fellow education due to extraordinary circumstances and must consider the preferences of residents/fellows when arranging temporary or permanent transfers to other ACGME-accredited programs.
Programs must appoint transferring residents/fellows to approved positions and may request temporary or permanent increases in resident/fellow complement from their respective ACGME Review Committees through the Accreditation Data System (ADS). Under extraordinary circumstances, the ACGME Review Committees shall expedite their review of requests for temporary or permanent complement increases.
An ACGME Review Committee shall expedite review of a program’s request to add or delete participating sites or to change its educational format if the request is associated with a declaration of extraordinary circumstances.
At its discretion, the ACGME may determine a schedule for expedited review of applications for new programs that intend to accept transferring residents/fellows under extraordinary circumstances. If applications will be reviewed on an expedited basis, notice of the expedited review, including information about submission due date(s), shall be provided on the ACGME website.
Upon invocation of the Extraordinary Circumstances policy, the ACGME may determine that one or more accreditation site visits is required. Prior to the visit(s), the designated institutional official(s) shall receive notification of the advance information that will be required. This information, as well as information received by the ACGME during these accreditation site visits, may be used in the accreditation process (Policies 16.20-16.24; 19.30-19.34).
Depending on the nature and impact of the extraordinary circumstances, the ACGME president and chief executive officer may communicate with relevant public entities.
Established: 2008
Reviewed by GMEC: 05/08; 02/09; 202/13; 03/17; 05/18; 06/22; 11/23; 9/25; 05/26