The Designated Institutional Official: An Essential GME Role, But What Do They Actually Do?

The Designated Institutional Official (DIO) is a necessary but uncommon role in medical education. Every sponsoring institution (SI) in the USA that trains residents or fellows is required to have a DIO. Nationally, there are slightly more than 900 SIs. DIOs may oversee small-, medium-, or large-sized graduate medical education (GME) institutions. Based on size and complexity, the DIO may be the main person who orchestrates the day-to-day functions of GME or may manage a team who undertakes the work. Many of the DIO's responsibilities are prescribed by the Accreditation Council for Graduate Medical Education (ACGME), but how these responsibilities are completed is variable. At its essence, the role of the DIO is to ensure every resident and fellow receives a good educational experience and meets requirements for board certification. In addition, DIOs may take on roles as a human resource expert, as a strategic content expert for GME, as a developer of educational sites and curriculum, and a quality assurance person evaluating GME programs. The DIO role is likely to increase in scope and complexity as GME evolves, and the DIO is positioned to think strategically about larger topics pertinent to GME.