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 C anada, although they have developed independently in the two countries, hav e similar objectives and accreditation requirements. Both have become incre asingly focused over the past several decades on the importance of educatio nal programmes structured to provide graded professional responsibility wit h appropriate guidance and supervision to residents according to their leve l of training, ability and experience. The Canadian model used by the Royal College of Physicians and Surgeons of Canada is a centrist one, with accre ditation decisions on all programmes in all specialties being vested in a s ingle, multidisciplinary accreditation committee. The American model develo ped by the Accreditation Council for Graduate Medical Education is a distri butive one, with accreditation decisions being vested in each specialty Res idency Review Committee. In both models, accreditation is based on a system of periodic on-site visits during which both faculty and residents are int erviewed by a surveyor to provide the accrediting body with a first-hand ev aluation of the extent to which each accredited programme meets the standar ds of accreditation. While they are similar in purpose, there are significa nt differences in the operation of the two systems.