Accréditation Sans Frontières · ASF Health Standards 9.0
Standard 14 · Academic Medical Center — Teaching & Research
6 criteria · base standard
Base standard. 6 criteria, of which 2 non-negotiable. Each criterion is numbered 14.Y, with its classification and verification questions.
Criteria
- 14.1 Resident and Trainee Supervision With Verified, Graduated Autonomy (NON-NEGOTIABLE)
- 14.2 Patients Are Informed of Trainee Involvement in Their Care (CORE)
- 14.3 Research Activity Operates Under Independent Ethics Review Before Enrolment (NON-NEGOTIABLE)
- 14.4 Clinical Care and Research Participation Are Clearly Separated in Consent (CORE)
- 14.5 Conflicts of Interest Between Research and Clinical Care Are Disclosed and Managed (CORE)
- 14.6 Teaching Faculty Maintain Verified, Current Clinical Competency (STANDARD)
14.1 Resident and Trainee Supervision With Verified, Graduated Autonomy
NON-NEGOTIABLE
Each resident or trainee's current scope of independent practice is explicitly defined and documented, matched to their verified competency progression, with supervising physician involvement available at the level that scope requires — not assumed from training year or general programme level alone.
VERIFICATION QUESTIONS
- Is each trainee's current scope of independent practice explicitly documented, not inferred from training year alone?
A specific, verified scope, not an assumption that a given training year implies a given level of independence. - Is supervising physician availability matched to the trainee's actual current scope, not a generic on-call arrangement?
Appropriate availability for the specific procedure or decision a trainee is performing, not a general backup presence. - Is scope of practice reassessed and updated as competency progresses, not fixed at programme entry?
A trainee's verified competency can change meaningfully during training; scope should track actual demonstrated ability.
14.2 Patients Are Informed of Trainee Involvement in Their Care
CORE
Patients are clearly informed before or at admission that a teaching facility's care model involves residents and trainees, with an opportunity to ask questions about who is involved in their care — not a line buried in general admission paperwork that provides no understanding.
VERIFICATION QUESTIONS
- Is trainee involvement disclosed clearly and specifically, not buried in general admission paperwork a patient is unlikely to read or absorb?
Clear, specific disclosure the patient registers, not a clause among many in a signed form. - Does the patient have a practical opportunity to ask who specifically is involved in their care?
An opportunity to ask, not merely a theoretical right buried in policy. - Is the attending physician of record, distinct from any trainee, clearly identified to the patient?
The patient should know who holds ultimate responsibility for their care, separate from any trainee involved.
14.3 Research Activity Operates Under Independent Ethics Review Before Enrolment
NON-NEGOTIABLE
No patient is enrolled in a research study until that study has received approval from an independent ethics review board (IRB or equivalent), with the approval current and the enrolled patient's participation falling within the approved protocol — not research activity proceeding ahead of, or outside the scope of, that approval.
VERIFICATION QUESTIONS
- Is independent ethics board approval obtained and current before any patient enrolment, not assumed pending or informally proceeding?
Approval that is in place, not an application pending while enrolment proceeds regardless. - Is the ethics board independent of the research team being reviewed, not effectively self-reviewing?
Independence from the team whose research is under review, not a board with significant overlap or conflict. - Does each enrolled patient's actual participation fall within the approved protocol's scope?
A protocol deviation, even well-intentioned, falls outside the specific approval granted.
14.4 Clinical Care and Research Participation Are Clearly Separated in Consent
CORE
A patient understands which elements of their care are standard clinical treatment and which are research participation, with declining research participation never affecting the standard care they receive — not a blurred consent process that leaves a patient unclear what they are agreeing to.
VERIFICATION QUESTIONS
- Does informed consent distinguish standard clinical care from research participation, not present them as a single blended decision?
Clarity about which parts are standard treatment versus which are research, not a combined consent that obscures the distinction. - Is it explicitly clear to the patient that declining research participation will not affect the standard care they receive?
A patient should never feel their standard treatment is contingent on research participation. - Can a patient who initially consented withdraw from research participation at any point, with that withdrawal honoured?
Voluntariness is ongoing, not a one-time consent treated as irrevocable.
14.5 Conflicts of Interest Between Research and Clinical Care Are Disclosed and Managed
CORE
A clinician's financial or other significant interest connected to a research study is disclosed through a defined process and managed — such as separating the clinician's research role from their direct clinical decision-making for enrolled patients — not left undisclosed or disclosed without any management action following.
VERIFICATION QUESTIONS
- Is there a defined process that clinicians use to disclose a financial or other significant interest connected to a research study?
A functioning disclosure process, not a policy that exists on paper but is not used. - Once disclosed, is the conflict managed through a concrete action, not merely logged with no follow-through?
Disclosure alone provides limited protective value without a management step following it. - Is disclosure reviewed and refreshed periodically, not captured once and never revisited as circumstances change?
A conflict of interest can emerge or change after the original disclosure point.
14.6 Teaching Faculty Maintain Verified, Current Clinical Competency
STANDARD
Faculty teaching clinical skills maintain active, verified clinical competency in the skill being taught, confirmed through a defined process — not a teaching role assumed to carry current clinical competency simply from past experience or academic seniority.
VERIFICATION QUESTIONS
- Is current clinical competency, not past experience alone, verified for faculty teaching a given clinical skill?
Current, active competency verified through a process, not assumed from years of past experience or academic rank. - Is competency verification repeated on a defined schedule, not confirmed once at initial faculty appointment?
Clinical competency in a given skill can change over time; a one-time check at appointment does not reflect current status. - Is there a defined process for addressing an identified competency gap in a teaching faculty member?
Identifying a gap without a response process provides limited protective value. ————————————————————