The phrase "green book" has historical significance. If they printed it in gray, it would still be called the green book.

It relates to a publication -- now online -- of the Accreditation Council for Graduate Medical Education, ACGME, at www.acgme.org. A rotation is said to be green book, or simply 'green' for short, if it appears in a list of ACGME-approved programs. To be approved, the rotation must be given in a hospital which has an ACGME-accredited residency program in the associated specialty. For example, if a general surgery rotation in a particular hospital is green, that means that the hospital has a residency program in general surgery which has been accredited by ACGME.

There is only one official place where you can determine whether a rotation is green; all Internet gossip is useless in this regard. Go to https://www.acgme.org/adspublic/, and click on "Accredited Programs" on the menu in the left frame.

Ignore the field that asks for a Program Number. In the Specialty list, click the name of the rotation you are interested in. The Specialty list has subspecialties because this is actually a list of accredited residencies, but by implication if the residency is not accredited, then the rotation is not green. Therefore, for rotations you should click only the main headings, like Surgery for the surgery rotation, etc.

The State list also contains Puerto Rico and "Show All States". If you wanted to know which hospitals have a residency (hence green rotation) in surgery, you would select "Show All States", but if you were interested only in Georgia, the main Xavier rotation state, then select Georgia.

Note that Puerto Rico has a dual licensing system. They will accept either the Steps or their own licensing exams, which may be taken in English.

There is confusion over whether all or some of a student's rotations must be green in order for the student to be licensed. The confusion is because the rules vary from state to state. Some states require all cores to be green; others couldn't care less. Also, some residency programs require that the rotation in that residency -- if there is one -- must be green.

You must wade through the licensing maze by yourself; don't expect professional quality guidance from the school. There are private agencies that do this sort of thing, but they're expensive.

Atlanta Medical Center, the main rotation place for Xavier, is not green for Pediatrics or Psychiatry, both core rotations.

I have a recent email from our chief academic officer to the effect that all ACGME rotations require a passing grade in Step 1 before being allowed to do the rotation, and that it will be "very hard" to complete all clinical rotations in one hospital. Both of these assertions are contrary to my understanding of how things worked when I was admitted one year ago. For example, on the page Xavier University "XUSOM" School of Medicine under the heading "Clinical Rotations", it clearly says -- after filtering out the typographical error -- that there is an option of completing all rotations in one place. None of the rules or options are adequately explained, which by now should surprise no one, as that site is like the crazy relative one keeps in the attic to avoid embarrassment.

To take all rotations in one hospital, and to avoid having to take Step 1 to do them, one could choose to do all non-green rotations, and forgo licensing in jurisdictions which insist on that color.

There is no disclosed degree requirement that one must complete green rotations, or even pass Step 1, to graduate. If any such rule should be forthcoming, it cannot be applied to currently enrolled students. ECFMG rules (that's another group, which administers the Steps) allow students to take the Steps after graduating; this does not require any permission or intervention by the school, except for supplying a transcript.

If you want to practice in another country, all of whom (except Canada) require neither the Steps nor green rotations, you could simply do all non-greens in the U.S. and a residency in another country. Guatemala is such a place, which, BTW, is approved by California as a residency site (well, the hospital in Guatemala City, to be more precise).

Other countries, like Belize, will grant a license based solely on the MD degree. No Steps, no greens. After working a few years, many U.S. jurisdictions will grant a license based on experience. Again, no Steps, no greens.

IOW, there are many tortuous and circuitous ways of obtaining U.S. licenses if the Step/green system does not appeal to you, but you must navigate those waters alone.

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Forum Moderator - Xavier Aruba

Great post, but I believe there is a way to do all green rotations at one location under the family practice (FP) umbrella. Jackson Park Hospital (JPH) in Chicago which is the another rotation site for Xavier has an ACGME family medicine program. Since a family medicine residency requires its students to rotate in several areas in medicine many states consider rotations done through JPH as green.

Technically these rotations are considered blue and if you plan on practicing in TX,PA and i think OK these states will give you trouble come license time. These states require rotations to be green by specialty which as fossildoc stated require an ACGME residency program at that particular site.

Another good point i've heard is that just because a rotation is green doesn't mean it translates to a good learning experience so do your research and choose wisely.

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Chris

life experience - define your locus of control, don't let it define you.