Compliance Validation

COMPLIANCE_VALIDATION Skill

Comprehensive ACGME compliance validation, historical analysis, and violation remediation for medical residency scheduling. This skill provides systematic audit workflows, trend analysis, and actionable remediation strategies.

When This Skill Activates

• Pre-deployment validation - Before publishing any schedule
• Regulatory audits - Monthly/quarterly ACGME reporting
• Violation investigation - When compliance issues are detected
• Historical analysis - Trend analysis over multiple blocks
• Remediation planning - Fixing identified violations
• Program review preparation - Annual ACGME site visits
• Post-swap validation - After schedule swap execution

Overview

This skill implements a three-phase compliance approach:

1. AUDIT - Systematic checking of current or historical schedules 2. ANALYZE - Pattern identification and trend analysis 3. REMEDIATE - Violation fixing with minimal disruption

Unlike the general acgme-compliance skill (which provides reference knowledge), this skill focuses on systematic execution of compliance workflows.

Key Phases

Phase 1: Audit

• Load schedule data from database
• Run all Tier 1/2 constraint validators
• Generate comprehensive violation report
• Classify violations by severity (CRITICAL, HIGH, MEDIUM, LOW)
• Identify affected personnel

Phase 2: Analyze

• Aggregate violations across time periods
• Identify recurring patterns (same rule violated repeatedly)
• Calculate compliance metrics (% compliant blocks, violation rate)
• Generate trend charts (violations over time)
• Root cause analysis (why violations happen)

Phase 3: Remediate

• Prioritize violations (Tier 1 ACGME first, then institutional)
• Generate remediation strategies for each violation
• Impact assessment (how fix affects other constraints)
• Execute fixes with transaction rollback support
• Verification (re-run validation after fix)

Constraint Tiers

All constraints are classified into tiers for prioritization:

Tier 1: ACGME Regulatory (CRITICAL)

Must fix immediately - regulatory violations

• 80-Hour Rule: Maximum 80 hours/week averaged over 4 weeks
• 1-in-7 Rule: One 24-hour period off every 7 days
• Supervision Ratios: PGY-specific faculty supervision
• Duty Period Limits: Maximum continuous duty hours
• Availability: No assignments during absences

Tier 2: Institutional Hard Constraints (HIGH)

Must fix before deployment - operational requirements

• FMIT Coverage: Weekly faculty rotation
• Night Float Headcount: Exactly 1 resident
• NICU Friday Clinic: Required clinic day
• Post-Call Blocking: Required recovery time
• Credential Requirements: Slot-type invariants

Tier 3: Soft Constraints (MEDIUM)

Should fix if possible - preferences

• Call spacing: Avoid back-to-back call weeks
• Weekend distribution: Fair distribution
• Clinic day preferences: PGY-specific clinic days

Tier 4: Optimization Goals (LOW)

Nice to have - quality improvements

• Workload balance
• Continuity of care
• Learning opportunities

Workflows

This skill provides specialized workflows in the Workflows/ directory:

Key Files

Core Validation Code

backend/app/services/constraints/acgme.py       - ACGME constraint validators
backend/app/validators/advanced_acgme.py        - Enhanced validators (24+4, NF limits)
backend/app/scheduling/constraints/acgme.py     - Constraint service integration

Database Schema

backend/alembic/versions/003_add_acgme_audit_fields.py  - Audit trail schema
backend/app/models/assignment.py                        - Schedule assignments
backend/app/models/person.py                             - Faculty/resident data
backend/app/models/block.py                              - Time blocks

Tests

backend/tests/validators/test_advanced_acgme.py         - Unit tests
backend/tests/integration/test_acgme_edge_cases.py      - Integration tests
backend/tests/performance/test_acgme_load.py            - Load testing

Output Format

All compliance reports must follow this structure:

╔══════════════════════════════════════════════════════════════════╗
║  ACGME COMPLIANCE AUDIT REPORT                                   ║
║  Schedule: Block 10 (2026-03-12 to 2026-04-08)                  ║
║  Generated: 2025-12-26 15:30:00                                  ║
║  Validator: COMPLIANCE_VALIDATION Skill                          ║
╠══════════════════════════════════════════════════════════════════╣
║  OVERALL STATUS: [COMPLIANT / WARNING / VIOLATION]              ║
╠══════════════════════════════════════════════════════════════════╣
║                                                                  ║
║  TIER 1: ACGME VIOLATIONS (Critical)                            ║
║  ────────────────────────────────────────────────────────────    ║
║  [List violations with person, date, specifics]                  ║
║                                                                  ║
║  TIER 2: INSTITUTIONAL VIOLATIONS (High)                        ║
║  ────────────────────────────────────────────────────────────    ║
║  [List violations]                                               ║
║                                                                  ║
║  TIER 3: SOFT CONSTRAINT WARNINGS (Medium)                      ║
║  ────────────────────────────────────────────────────────────    ║
║  [List warnings]                                                 ║
║                                                                  ║
║  SUMMARY METRICS                                                 ║
║  ────────────────────────────────────────────────────────────    ║
║  Total Violations: 3 (Tier 1: 2, Tier 2: 1)                     ║
║  Affected Personnel: 5 (3 residents, 2 faculty)                 ║
║  Compliance Rate: 94.2% (33/35 constraints passed)              ║
║                                                                  ║
║  RECOMMENDED ACTIONS                                             ║
║  ────────────────────────────────────────────────────────────    ║
║  1. [Specific remediation step]                                  ║
║  2. [Specific remediation step]                                  ║
║  3. [Specific remediation step]                                  ║
║                                                                  ║
╚══════════════════════════════════════════════════════════════════╝

Error Handling

Database Connection Issues

# Always use try-catch with rollback
try:
    db = SessionLocal()
    result = validate_schedule(db, schedule_id)
    db.commit()
except Exception as e:
    db.rollback()
    logger.error(f"Validation failed: {e}")
    raise
finally:
    db.close()

Missing Data

If data is missing (no assignments, no residents), report clearly:

⚠️  VALIDATION INCOMPLETE: No assignments found for Block 10
   Possible causes:
   - Schedule not yet generated
   - Wrong date range
   - Database migration incomplete

Constraint Failures

If a constraint validator fails (not just violations, but crashes):

❌ VALIDATOR ERROR: 80HourRule constraint failed to execute
   Error: Division by zero in _calculate_rolling_average()
   Action: Check that blocks exist in date range

MCP Tool Integration

Primary Tools

validate_acgme_compliance          - Run full ACGME validation
get_schedule                       - Retrieve schedule data
check_utilization_threshold_tool   - Verify 80% utilization
run_contingency_analysis          - N-1 coverage check

Remediation Tools

execute_swap                       - Fix violations via swaps
get_swap_candidates               - Find compatible swap partners
validate_swap_compliance          - Ensure swap maintains compliance

Escalation Matrix

References

• See Reference/acgme-rules-detailed.md for complete ACGME citations
• See Reference/compliance-glossary.md for terminology definitions
• See Workflows/ for step-by-step audit procedures

Development Notes

When adding new constraints: 1. Add validator to backend/app/services/constraints/acgme.py 2. Register in ACGMEConstraintValidator.constraints list 3. Add unit test in backend/tests/validators/ 4. Update this skill's reference documentation 5. Classify as Tier 1/2/3/4 for prioritization

When fixing violations: 1. Always create database backup first 2. Use transaction rollback if fix fails 3. Re-run validation after fix 4. Document fix in audit trail 5. Update historical compliance metrics