Adapting to change: Navigating ACGME changes and the PHM workforce

Pediatric Hospital Medicine (PHM) is central to the clinical workforce that sustains pediatric inpatient care and the education of pediatric trainees. In 2025, the Accreditation Council for Graduate Medical Education (ACGME) revised pediatric residency requirements, substantially reducing the amount of inpatient training required for graduation. These changes create important implications for resident education, hospital staffing, and the organization of inpatient care. PHM has been integral in adapting to previous graduate medical education changes and is again positioned to help institutions navigate an evolving clinical and educational landscape. Hospital Medicine leaders, hospital leaders, and other partners must make the necessary changes to meet the new ACGME requirements, all while balancing several competing priorities to address the resultant patient care need gaps. Using a case-based scenario, we present a practical framework for responding to these changes. The approach includes (1) defining educational and operational goals, (2) developing and comparing alternate models, (3) negotiation through understanding and communicating the whole ask, (4) planning for implementation and its evaluation, and (5) heeding the call with action.