The implementation of the ACGME’s accreditation model (a.k.a., “the Next Accreditation System”) in 2012 offered an opportunity to help catalyze, recognize, and highlight innovation in graduate medical education (GME). While the current Program Requirements already provide substantial flexibility to test new educational and assessment approaches, the ACGME recognizes the need to offer waivers to compliance with select requirements to enable further innovation. To help achieve this goal, the ACGME provides a program with the dual aims of 1) enabling the exploration of novel approaches and pathways in GME, and 2) enhancing the attainment of educational and clinical outcomes through innovative structures and processes in resident and fellow education. The program, Advancing Innovation in Residency Education (AIRE), encourages the adoption of the key principles of competency-based medical education (CBME), educational outcomes, and improving health and health care.

AIRE proposals undergo a three-step review process. The goals of the review process are to help programs implement a rigorous design and to assist in evaluating the effectiveness of the innovation. The ACGME will work to efficiently complete these reviews understanding that completing all steps in the review process may take six months or longer. An overview of the three-stage review process is provided below:

Stage 1.

The initial stage of review is completed by AIRE staff members with experience in curricular design and assessment and the executive director of the Review Committee responsible for the accreditation of programs participating in the proposed pilot.

AIRE staff members critically review submitted proposals to ensure that all required proposal content is addressed. This review is an iterative exchange between the AIRE team and the proposal lead intended to ensure the proposal is competency-based and outlines approaches to learning, teaching, faculty development, and assessment for each of the ACGME’s six Core Competencies.

Once this stage is completed, the proposal advances to Stage 2 review if the AIRE pathway is appropriate.

Duration of Stage 1: Variable, depending on any need for revisions to the initial proposal.

Stage 2.

In the next stage, the proposal is reviewed by the Accreditation Review Team. This team meets quarterly as needed to review AIRE proposals. The Accreditation Review Team is composed of senior leaders from the ACGME’s accreditation staff and includes the Review Committee Executive Directors involved in the proposed innovation. The review assesses the completeness and methodological rigor of the proposal. Proposals meeting criteria are advanced to Stage 3 of the review process.

Duration of Stage 2: Based on the schedule of Accreditation Review Team meetings, which are typically scheduled quarterly.

Stage 3.

Following Accreditation Review Team approval, the proposal is forwarded to the appropriate Review Committee(s) for final review and approval, revision, or rejection. The third-stage review addresses whether relief will be granted for any targeted accreditation requirements and the identification of any additional requirements needed for approval of the proposal. Once this review is completed, a letter documenting the outcome (approval, revision, or rejection) is sent to the proposal lead. If the proposal is approved, letters are also sent to programs approved as participating sites.

With receipt of the approval letters, the innovation can launch.

Duration of Stage 3: Based on the agenda and meeting schedule for the involved Review Committee(s).

Additional Information and AIRE Proposal Template
AIRE Annual Reporting Form
Form for Requesting Approval of Additional Programs in an AIRE Program

Direct further questions about the AIRE pilot program to AIRE@acgme.org.