Characteristics, roles, and responsibilities of the Designated Institutional Official (DIO) position in graduate medical education

In 1998, the Accreditation Council for Graduate Medical Education (ACGME) added the stipulation that each institution providing graduate medical education (GME) have a Designated Institutional Official (DIO). Little is known about the effect of new accreditation requirements on GME practice and outcomes. The authors conducted a cross-sectional survey designed to provide descriptive data about DIOs and to validate a DIO Responsibility Scale (DIORS). DIOs were identified by the ACGME. The following delivery strategy was used to administer the survey from January 2004 to May 2004: prenotice letter; survey with self-addressed, stamped return envelope and cover letter; thank-you/reminder postcard; and replacement survey with new cover letter and self-addressed, stamped return envelope. Completed surveys were received from 243 of 363 DIOs (66.9%). Responses indicated wide ranges in DIO titles, report titles, time spent accomplishing responsibilities, DIO-specific salaries, credentials, and Graduate Medical Education Committee reporting arrangements. DIOs reported confusion or overlap between DIO and program director roles (72.0%), decreasing funding for GME (50.6%), and inadequate support staff (25.1%). The 11-item DIO Responsibility Scale demonstrated a Cronbach alpha of .86 and a statistically significant relationship to five variables selected to establish construct validity. The wide variability in DIO characteristics found in this study supports the premise that the DIO role is underdeveloped. The authors established the reliability and validity of the DIORS, which now may be used in future research of the DIO role. The data from this study may be used by DIOs and institutions to develop the role further, improve DIO performance, and create more useful job descriptions.