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Reference for Designated Institutional Officials and Institutional Review Coordinators: Residency-Dependent and -Independent Subspecialty (Fellowship) Programs Institutional Review Committee

ACGME-accredited subspecialty (fellowship) programs are either residency-dependent (associated with a core residency program in the same Sponsoring Institution), or residency- independent (unassociated with a core residency program in the same Sponsoring Institution). Each ACGME specialty Review Committee determines whether or not accredited programs in a particular subspecialty must be residency-dependent.

This reference document indicates Review Committee determinations of whether subspecialty (fellowship) programs (1) are always residency-dependent, (2) are always residency- independent, or (3) are residency-dependent except in limited circumstances.

Questions regarding program dependence or independence should be directed to the staff of the respective ACGME Review Committee, whose contact information can be found on the applicable specialty’s section of the ACGME website.

09/2018 ©2018 Accreditation Council for Graduate (ACGME) Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Anesthesiology Adult Cardiothoracic X

Anesthesiology Clinical Informatics X

Anesthesiology Critical Care X

Anesthesiology Hospice and Palliative Medicine X Regional Anesthesiology and Acute Anesthesiology X Pain Medicine Anesthesiology Pain Medicine X

Anesthesiology Obstetric Anesthesiology X

Anesthesiology Pediatric Anesthesiology X

Dermatology Dermatopathology X Micrographic and X Dermatologic Subspecialty programs are dependent with exceptions granted by the Emergency Clinical Informatics X Medicine Review Committee. Subspecialty programs are dependent with exceptions granted by the Emergency Emergency Medicine Emergency Medical Services X Medicine Review Committee. Subspecialty programs are dependent with exceptions granted by the Emergency Emergency Medicine X Medicine Review Committee. Subspecialty programs are dependent with exceptions granted by the Emergency Emergency Medicine Pediatric Emergency Medicine X Medicine Review Committee. Subspecialty programs are dependent with exceptions granted by the Emergency Emergency Medicine X Medicine Review Committee. Subspecialty programs are dependent with exceptions granted by the Emergency Emergency Medicine Undersea and Hyperbaric Medicine X Medicine Review Committee. Clinical Informatics X

2 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Family Medicine Geriatric Medicine X

Family Medicine Hospice and Palliative Medicine X

Family Medicine Sports Medicine X subspecialty programs are residency dependent. However, the Internal Medicine Adult Congenital Heart Disease X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Advanced Heart Failure and Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a Transplant subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Cardiovascular Disease X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Clinical Cardiac Electrophysiology X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Clinical Informatics X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Critical Care Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the , Diabetes and Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a Metabolism subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Geriatric Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution.

3 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine and Medical Oncology X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Hospice and Palliative Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Infectious Disease X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Interventional Cardiology X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Pulmonary Disease X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Pulmonary Disease Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a and Critical Care Medicine subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. Internal Medicine subspecialty programs are residency dependent. However, the Internal Medicine Transplant X Review Committee for Internal Medicine will consider exceptions for a subspecialty program that is based in a specialized institution. and Clinical Informatics X Genomics

4 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Medical Genetics and Medical Biochemical Genetics X Genomics Medical Genetics and Molecular Genetic X Genomics Endovascular Surgical Neurological Surgery X Brain Injury Medicine X

Neurology X Endovascular Surgical Neurology X Neuroradiology Neurology Neurodevelopmental Disabilities X

Neurology Neuromuscular Medicine X

Neurology Sleep Medicine X

Neurology Vascular Neurology X

Neurology Pain Medicine X 1) There must be at least one other ACGME-accredited program in the and Female Pelvic Medicine and Sponsoring Institution. 2) The learning environment must demonstrate a strong X Gynecology Reconstructive Surgery commitment to clinical education and research. 3) The program director and faculty must demonstrate clinical and scholarly expertise. 1) There must be at least one other ACGME-accredited program in the Obstetrics and Sponsoring Institution. 2) The learning environment must demonstrate a strong X Gynecology commitment to clinical education and research. 3) The program director and faculty must demonstrate clinical and scholarly expertise. 1) There must be at least one other ACGME-accredited program in the Obstetrics and Sponsoring Institution. 2) The learning environment must demonstrate a strong Maternal-Fetal Medicine X Gynecology commitment to clinical education and research. 3) The program director and faculty must demonstrate clinical and scholarly expertise.

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1) There must be at least one other ACGME-accredited program in the Obstetrics and Reproductive Endocrinology and Sponsoring Institution. 2) The learning environment must demonstrate a strong X Gynecology Infertility commitment to clinical education and research. 3) The program director and faculty must demonstrate clinical and scholarly expertise. Ophthalmic Plastic and Subspecialty programs are dependent with exceptions granted by the X Reconstructive Surgery Ophthalmology Review Committee. Orthopaedic Surgery Adult Reconstructive Orthopaedics X

Orthopaedic Surgery Foot and Ankle Orthopaedics X

Orthopaedic Surgery X

Orthopaedic Surgery Musculoskeletal Oncology X

Orthopaedic Surgery Orthopaedic Sports Medicine X

Orthopaedic Surgery Orthopaedic Surgery of the Spine X

Orthopaedic Surgery Orthopaedic Trauma X

Orthopaedic Surgery Pediatric Orthopaedics X

Otolaryngology Neurotology X

Otolaryngology Pediatric Otolaryngology X

Submit specialty-specific application to ED, along with rational and information as Blood Banking/Transfusion Pathology X to how resident training will occur without having an ACGME-accredited Medicine pathology program at the institution.

Pathology Clinical Informatics X

Pathology Chemical Pathology X

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Pathology X

Submit specialty-specific application to ED, along with rational and information as Pathology Dermatopathology X to how resident training will occur without having an ACGME-accredited pathology program at the institution.

Submit specialty-specific application to ED, along with rational and information as Pathology X to how resident training will occur without having an ACGME-accredited pathology program at the institution.

Pathology X

Pathology X

Pathology Molecular Genetic Pathology X

Pathology X

Submit specialty-specific application to ED, along with rational and information as Pathology Pediatric Pathology X to how resident training will occur without having an ACGME-accredited pathology program at the institution.

Submit specialty-specific application to ED, along with rational and information as Pathology Selective Pathology X to how resident training will occur without having an ACGME-accredited pathology program at the institution.

Subspecialty programs are dependent with exceptions granted by the Pediatrics X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Child Abuse Pediatrics X Review Committee for programs based in specialized institutions.

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Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Clinical Informatics X Review Committee for programs based in specialized institutions.

Developmental-Behavioral Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics X Pediatrics Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Hospice and Palliative Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Neonatal-Perinatal Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Cardiology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Critical Care Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Emergency Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Endocrinology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Gastroenterology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Hematology/Oncology X Review Committee for programs based in specialized institutions.

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Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Infectious Diseases X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Medical Toxicology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Nephrology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Rheumatology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Sports Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Pediatric Transplant Hepatology X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Pediatrics Pediatrics Sleep Medicine X Review Committee for programs based in specialized institutions.

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Brain Injury Medicine X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

9 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Neuromuscular Medicine X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Spinal Cord Injury Medicine X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Pediatric Rehabilitation X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Sports Medicine X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

Subspecialty programs are dependent with exceptions granted by the Physical Physical Medicine and Pain Medicine X Medicine and Rehabilitation Review Committee for programs based in specialized Rehabilitation institutions.

Plastic Surgery Craniofacial Surgery X

Plastic Surgery Hand Surgery X

Preventive Medicine Clinical Informatics X

Preventive Medicine Medical Toxicology X

Preventive Medicine Undersea and Hyperbaric Medicine X

Psychiatry Addiction X

Psychiatry Brain Injury Medicine X

10 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Subspecialty programs are dependent with exceptions granted by the Psychiatry Psychiatry Child and Adolescent Psychiatry X Review Committee. Psychiatry Forensic Psychiatry X

Psychiatry Geriatric Psychiatry X

Psychiatry Hospice and Palliative Medicine X

Psychiatry Psychosomatic Medicine X

Psychiatry Sleep Medicine X

Radiation Oncology Hospice and Palliative Medicine X Subspecialty programs are dependent with exceptions granted by the Radiology-Diagnostic Abdominal Radiology X Review Committee. Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic Clinical Informatics X Review Committee. Endovascular Surgical Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic X Neuroradiology Review Committee. Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic Musculoskeletal Radiology X Review Committee. Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic Neuroradiology X Review Committee. Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic Nuclear Radiology X Review Committee. Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic Pediatric Radiology X Review Committee. Vascular and Interventional Subspecialty programs are dependent with exceptions granted by the Radiology Radiology-Diagnostic X Radiology Review Committee. Complex General Surgical Surgery X Oncology Surgery Hand Surgery X

11 09/2018 Must subspecialty programs be residency dependent? ACGME Review Subspecialty If "Yes, With Exceptions," Criteria for Residency Independence Committee Yes, With Yes, Always No Exceptions

Surgery X

Surgery Surgical Critical Care X

Surgery X

Thoracic Surgery Congenital X

Submit a letter to the Executive Director that includes: (1) educational rationale Female Pelvic Medicine and X for the fellowship to be residency independent and (2) attestation that the Reconstructive Surgery program requirements have been reviewed and the program has in place the resources needed to meet the requirements. Submit a letter to the Executive Director that includes: (1) educational rationale Urology Pediatric Urology X for the fellowship to be residency independent and (2) attestation that the program requirements have been reviewed and the program has in place the resources needed to meet the requirements.

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