Osteopathic postdoctoral education

Osteopathic postdoctoral education is still in transition. With a projected modest decline in the number of graduates and continued increase in the number of intern positions, the profession can now accommodate all graduates in osteopathic internships. Changes have been made in the intern program curriculum and in procedures for approval of residency training to be more responsive to the current healthcare environment and needs of osteopathic graduates. The AOA Department of Education will continue to monitor and report on the impact of these changes.     

Osteopathic graduate medical education

Several aspects of osteopathic graduate medical education have gained momentum in recent years. Although the number of 2006 osteopathic graduates dropped slightly compared with the previous year, 2007 graduates totaled 3103, surpassing 3000 for the first time in osteopathic history. A total of 1196 (41%) and 1267 (40%) graduates and previous graduates participated and matched in the American Osteopathic Association (AOA) "Match" program in 2006 and 2007, respectively. With post-Match scramble data, the number of osteopathic graduates and previous graduates in AOA-approved internship positions rose to 1525 (53%) and 1663 (52%) for 2006 and 2007, respectively. Likewise, the number of filled osteopathic residency positions for the 2006-2007 academic year increased by 5%. In light of these increases, the authors compare AOA data with data from the American Council of Graduate Medical Education regarding osteopathic physicians in allopathic residencies. A brief summary of the restructured traditional osteopathic internships, which will go into effect July 1, 2008, is also provided.     

Osteopathic distinctiveness in osteopathic predoctoral education and its effect on osteopathic graduate medical education

The number of colleges of osteopathic medicine (COMs), osteopathic medical students, and osteopathic physicians in practice has been consistently growing since the 1960s. In recent years, the growth of the profession has been exponential. Despite this growth, graduates of COMs are increasingly choosing allopathic residencies. The authors believe that this trend may stem from a lack of focus on osteopathic principles and practice in COMs, as well as geographic and specialty limitations of available osteopathic residency positions. The present article will briefly examine the history of AOA accreditation and the current accreditation process and the current state of osteopathic predoctoral education and postdoctoral training. The authors call on osteopathic physicians to help bring osteopathic distinctiveness to osteopathic predoctoral education by mentoring and volunteering at COMs. In addition, the authors urge the osteopathic profession to increase the number of osteopathic residencies to account for the number of and distribution of osteopathic medical school graduates.     

AOA membership and board certification of residency graduates: comparison of three programs accepting osteopathic physicians--implications for graduate medical education

The purpose of this study was to determine membership status in the American Osteopathic Association (AOA) and osteopathic board certification status for osteopathic physicians completing osteopathic, allopathic, and dually accredited residency programs. Rates of AOA membership and osteopathic board certification of osteopathic graduates from a dually accredited residency were compared to rates of osteopathic graduates of an allopathic residency in the same training facility. These same two parameters were compared between the dually accredited residency and an osteopathic residency. Osteopathic graduates from the dually accredited residency had significantly higher rates of AOA membership and osteopathic board certification when compared with the osteopathic graduates of an allopathic residency. Moreover, no significant difference existed between the rates of these two measures for osteopathic resident graduates from the dually accredited residency when compared with graduates of an osteopathic residency. Implications of the results are discussed.     

Osteopathic graduate medical education

For the 2004-2005 academic year, as in preceding years, the number of graduates from colleges of osteopathic medicine (COMs) and the number of osteopathic medical internship positions approved by the American Osteopathic Association (AOA) continued to increase, by 2% and 1%, respectively. However, student participation in the AOA's Intern/Resident Registration Program dipped by 5% to a total of 44% for the class of 2005. Notwithstanding, a striking majority (1120 [91%]) of participating 2005 COM graduates were matched to their first choice training program--most often in traditional osteopathic rotating internships (63%). Next in popularity for osteopathic medical graduates were internships in family practice (11%), internal medicine (9%), and emergency medicine (5%). As a model for training, the traditional osteopathic rotating internship has undergone extensive revision in the past year as a result of extensive collaboration among the AOA's Council on Postdoctoral Training and each of the 23 osteopathic specialty colleges. The restructured plan will go into effect as of July 1, 2008.     

Current threats to osteopathic graduate medical education

The Balanced Budget Act of 1997 and continuing changes put into place by the Educational Commission on Foreign Medical Graduates (ECFMG) are altering the environment for graduate medical education (GME) in ways that threaten osteopathic graduate medical education in particular. Hospital revenue is decreasing due to declines in Medicare GME and patient-care reimbursements. The new 3-year rolling average methodology for counting "house staff" makes it likely that unfilled positions will be eliminated. With osteopathic GME positions unfilled and financial resources decreasing, osteopathic medical programs may shrink further. Additionally, the ECFMG has put into place policies that may restrict the number of international medical graduates entering the United States. Approximately 25% of all allopathic GME positions in the United States are filled by international medical graduates. If this applicant pool decreases, allopathic medical programs may turn to osteopathic medical graduates as the only other available pool of individuals to fill program positions. At a time when allopathic internship positions are already unfilled and 30% of osteopathic medical graduates enter allopathic first-year programs, further inroads by allopathic programs could severely impact osteopathic GME efforts.     

Professional identification and affiliation of the 1992 graduate class of the colleges of osteopathic medicine.

This survey of the 1992 graduates of colleges of osteopathic medicine included questions regarding their identification with the osteopathic medical profession from application to medical school through residency training and practice. Findings of the study demonstrate that a large majority of graduates regard the profession positively. However, many express concerns about the limited training in advanced osteopathic manipulative skills, with several indicating a low level of confidence in integrating osteopathic techniques into clinical practice. Study respondents also assert that the osteopathic medical profession has yet to effectively project and promote its distinctiveness to the general public. These factors affect the overall identification and affiliation of the respondents to the osteopathic medical profession. Previous anecdotal and research reports suggested that a migration of graduates into nonosteopathic postgraduate training programs and the de-emphasis of osteopathic manipulative medicine in clinical training sites have created an identity crisis within the profession. These reports stimulated the undertaking of this study. Challenges to the profession addressed in this paper include: (1) requiring advanced training in osteopathic manipulative medicine after the second year of medical school; (2) creating an awareness of the need for increased professional visibility; (3) producing effective public relations strategies to portray the osteopathic medical profession accurately; and (4) generating sufficient funds to carry out these strategies.     

Dermatology: a specialty that exemplifies the osteopathic medical profession

Even though the tradition of osteopathic medicine is based in primary care, more osteopathic graduates than in the past are pursuing subspecialties within medicine. Some claim that medical specialties, such as dermatology, compromise osteopathic principles and philosophy. However, the authors contend that dermatology exemplifies the ideals expressed by Andrew Taylor Still, MD, DO, and explain how osteopathic manipulative treatment and the principles of osteopathic medicine can be applied to dermatologic disease and patient care.     

Intern orientation: obstacle or opportunity?

Orientation programs for medical interns generally bombard new physicians with a barrage of information from the hospital director of medical education, the chief executive officer, and other hospital personnel, as well as from a number of outside speakers. Advanced cardiac life-support training and social events round out the orientation program, which typically lasts 3 to 4 days. The authors propose a three-phase orientation program that begins even before the intern reports for duty and continues for an estimated 6-month period thereafter. This seemingly long-term time investment will foster good relations between employer and employee, thereby helping to encourage the intern to stay on as a resident and staff physician. Such commitment can only enhance the growth of the osteopathic medical education programs.     

Introducing osteopathic medical education in an allopathic residency

BACKGROUND: Osteopathic medical school graduates, who are entering allopathic residencies in increasing numbers, want to maintain their osteopathic manipulative medicine (OMM) skills, but such residency programs do not include osteopathic curricula. OBJECTIVES: To describe the development and implementation of an osteopathic curriculum within an allopathic family medicine residency, and to evaluate the program's success. METHODS: Osteopathic residents, with the assistance of their allopathic faculty, generated the goals, objectives, and implementation strategies for an osteopathic curriculum that consisted of an osteopathic clinic and educational activities. The modified nominal group technique was used to determine the success of the clinic, highlighting its strengths and weaknesses. Success of the educational activities was measured by the American Osteopathic Association's approval of the residents' first year of postgraduate training. RESULTS: Osteopathic residents, who staffed the clinic, reported maintenance of their OMM skills to be the greatest strength of the clinic and lack of structured didactics to be its greatest weakness. Since the curriculum was introduced in 2004, 3 residents have applied for and received the American Osteopathic Association's approval for training. CONCLUSION: In the present study, an osteopathic curriculum was successfully implemented in an allopathic family medicine residency, enabling osteopathic residents to maintain their OMM skills. In addition to exploring the curriculum's impact on allopathic colleagues, further research should investigate whether osteopathic graduates who participate in such a curriculum are more likely to practice OMM after their residency ends.     

Implementation of an osteopathic manipulative medicine clinic at an allopathic teaching hospital: a research-based experience

Mastery of osteopathic palpatory skills and the skilled delivery of osteopathic manipulative treatment is a life-long venture that demands from practitioners increasingly sophisticated manual skills. Specific receptors and neural networks within the brain allow for the gradual development of refined manual skills that parallel responsive alterations and refinements that develop with repeated experience. During clinical training, most graduates of colleges of osteopathic medicine are not given opportunities to hone their palpatory skills. This is unfortunate because there is an increasing public demand for the nonpharmacologic treatment modalities osteopathic physicians could supply. At Berkshire Medical Center in Pittsfield, Mass, a major teaching affiliate of the University of Massachusetts Medical School in Worcester, the authors assembled a team of osteopathic and allopathic physicians to found an osteopathic manipulative medicine clinic. In this article, the authors share their experience in the creation of this research-based osteopathic medical clinic.     

Results of a survey of inaugural class graduates of a college of osteopathic medicine

The purpose of this study was to determine where the graduates of an inaugural class of a college of osteopathic medicine came from, what influenced their school selection, how their osteopathic medical school experience affected them, and how they chose what and where they would study after graduation as well as where they would practice. These data have significant implications for the osteopathic profession and its future recruitment efforts into the profession and into its postgraduate programs.     

Recruiting interns and residents to an osteopathic medical training program.

As more graduates of colleges of osteopathic medicine enroll in allopathic training programs and specialty programs, medical directors of osteopathic medical institutions are faced with the challenge of maintaining a well-trained housestaff. More important, perhaps, this exodus threatens the very core of osteopathic medicine, namely, its ability to produce well-trained primary care physicians. A recruitment plan used at the Chicago College of Osteopathic Medicine and its affiliates is presented here. The plan emphasizes the importance of trainee involvement in their own education as well as the use of residents in recruiting interns and specialty residents.     

Successful implementation of new osteopathic graduate medical education programs in a community hospital: challenges and lessons learned

Development of new osteopathic graduate medical education (OGME) programs has emerged as a priority for the osteopathic medical profession. As colleges of osteopathic medicine (COMs) expand class sizes and branch campuses, and as new COMs are launched, availability of sufficient internship, residency, and fellowship positions for future COM graduates will become a challenge. Because of constraints in graduate medical education reimbursement, growth of existing training programs is limited. For hospitals that did not sponsor internship and residency programs before January 1, 1995, the Centers for Medicare and Medicaid Services offers an exception to funding restraints on expansion of training programs. However, successful development and implementation of new OGME programs remains a formidable undertaking. Moreover, because of idiosyncrasies of medical education reimbursement, successful recruitment of COM graduates into new training positions is paramount to ensure program viability. The authors describe lessons learned from the successful implementation of new OGME programs in a community hospital, and they offer recommendations for other hospitals considering such an endeavor.     

Preparing medical students for the changing healthcare environment in United States

Future graduates of medical schools in the United States will practice in healthcare environments increasingly predominated by managed care. Thus allopathic and osteopathic undergraduate and postgraduate residency training programs should begin to revise their respective curricula and conduct training in managed healthcare environments to prepare graduates for practice in managed care settings. The demand for curricular revision in medicine comes not only from prospective employers and government agencies, but from students and graduates. Educators, clinicians, and government officials have recently defined core competencies that are requisite to the education and preparation of future physicians through the work of the Council on Graduate Medical Education (COGME). This article discusses these core competencies and suggests strategies by which to implement them in undergraduate and graduate medical education.     

Testing osteopathic medical school graduates for licensure: is COMLEX-USA the most appropriate examination?

Osteopathic and allopathic physicians receive authority to practice medicine through the licensing boards of the states in which they practice. Each state has the responsibility to operate a licensing board for physicians and other medical professionals. These boards choose which examinations are acceptable to establish that a physician is licensable to practice medicine. The National Board of Osteopathic Medical Examiners (NBOME) administers the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA). To determine the views of the educational leaders of the osteopathic profession regarding licensure testing, a survey was mailed to leaders in the profession. Of the 799 surveys mailed, 341 (43%) were returned. Respondents were asked 19 questions, using a Likert scale to record responses (strongly disagree, 1; strongly agree, 5). Eighty-eight percent of respondents believed that osteopathic medicine is a distinct profession. Seventy percent of respondents felt that COMLEX-USA is the standard for testing osteopathic trainees, while 70% believed trainees should continue to be tested by a unique process. According to 72% of the respondents, the NBOME, through its testing procedures, continues to be the organization best suited to test the knowledge of osteopathic students and graduates. These results indicate that among the practicing leadership of the osteopathic profession, overwhelming support exists for the profession to retain the ability and the right to examine its own trainees from within.     

Teaching osteopathic students technique; using research to identify good teaching practice

Higher education is a constantly changing learning environment where academic tutors utilise modern technology and developments in educational theory to enhance their lecture presentations while students are encouraged to use web based programmes to contribute to learning forums, communicate with lecturers and access lecture notes and course documentation. In contrast the teaching of osteopathic technique appears to be unchanging with little development or alteration to the tried and tested teaching methods. This commentary briefly discusses theories of learning that could underpin this teaching method and by focussing upon the recent research into the learning of motor skills recommends some practical applications that may add variety to the format, enhance the student experience and potentially raise the standards of osteopathic technique in new graduates.     

Undergraduate osteopathic medical education

This article details requests from the nation's 23 accredited colleges of osteopathic medicine (COMs) for class-size increases and the establishment of new COMs and branch campuses. Basic data on COM applicants and applications, matriculants, and graduates are also provided. Tuition, revenues, and expenditures at COMs are outlined.     

Tobacco dependence curricula in undergraduate osteopathic medical education

CONTEXT: Tobacco use has been identified as the primary preventable cause of premature deaths and disability, yet results of a previous survey show that undergraduate allopathic medical schools do not adequately address this topic. OBJECTIVE: To assess the content and extent of tobacco education and intervention skills in osteopathic medical schools' curricula. DESIGN: A mailed survey with 19 questions similar to one used for allopathic medical schools. SETTING: Nineteen osteopathic medical schools. PARTICIPANTS: Responses were obtained from each associate dean for medical education or representative. MAIN OUTCOME MEASURES: Curriculum in seven basic science and six clinical science content areas (elective or required), hours of tobacco use intervention education, and resource materials used to design curricula. RESULTS: Average number of total content areas covered was 10.2 (6 +/- 1.6 basic science areas, 4.17 +/- 1.54 clinical areas) with a range of 2 to 13. Nine (47%) schools reported covering all seven basic science areas, and one school reported covering none. Eleven (64.7%) of seventeen schools reported less than 3 hours of training in tobacco dependence treatment techniques during all 4 years. Sixty percent of schools do not require clinical training in smoking cessation techniques. Thirty-six percent require clinical training in an artificial setting without patients. None of the schools require clinical training with live patients. The schools founded after 1920 covered an average of almost twice as many content areas as those founded before 1920 (11.1 vs 6.6; P = .018). CONCLUSIONS: Most US osteopathic medical school graduates are not being adequately educated to treat nicotine dependence as recommended by the National Cancer Institute expert panel and the Public Health Service Clinical Practice Guideline. Specifically, osteopathic medical education is deficient in clinical nicotine dependence treatment during the third and fourth years.     

Competence levels in musculoskeletal medicine: comparison of osteopathic and allopathic medical graduates

BACKGROUND: Consistent with osteopathic principles and practice, the nation's colleges of osteopathic medicine (COMs) have emphasized the significance of the musculoskeletal system to the practice of medicine. The authors hypothesized that graduating COM students would, therefore, demonstrate superior knowledge and competence in musculoskeletal medicine when compared with graduates of allopathic medical schools. METHODS: The authors asked graduating COM students to complete a standardized and previously validated 25-question basic competency examination on musculoskeletal medicine in short-answer format. Originally developed and validated in the late 1990s, the examination was distributed to allopathic medical residents at the beginning of their residencies. The authors compare their results with those reported by Freedman and Bernstein for allopathic residents. RESULTS: When the minimum passing level as determined by orthopedic program directors was applied to the results of these examinations, 70.4% of graduating COM students (n=54) and 82% of allopathic graduates (n=85) failed to demonstrate basic competency in musculoskeletal medicine. Similarly, the majority of both groups failed to attain the minimum passing level established by the directors of internal medicine programs (graduating COM students, 67%; allopathic graduates, 78%). CONCLUSION: In an examination of competence levels for musculoskeletal medicine, students about to graduate from a COM fared only marginally better than did their allopathic counterparts. To ensure that all graduating COM students have attained a level of basic competence in musculoskeletal medicine, the authors recommend further study as a prelude to evaluation of the didactic and clinical curriculum at all 22 COMs and their branch campuses.