Free
Medical Education  |   February 2006
Osteopathic Postdoctoral Training Institutions
Author Notes
  • From the Department of Education, American Osteopathic Association, Chicago, Ill. 
  • Address correspondence to Jonathan B. Webb, Department of Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail:jwebb@osteopathic.org 
Article Information
Medical Education
Medical Education   |   February 2006
Osteopathic Postdoctoral Training Institutions
The Journal of the American Osteopathic Association, February 2006, Vol. 106, 70-75. doi:10.7556/jaoa.2006.106.2.70
The Journal of the American Osteopathic Association, February 2006, Vol. 106, 70-75. doi:10.7556/jaoa.2006.106.2.70
Web of Science® Times Cited: 1
The Osteopathic Postdoctoral Training Institution (OPTI) program has flourished since the American Osteopathic Association (AOA) established it in 1995 as a system to structure and accredit osteopathic graduate medical education (OGME). Each OPTI is a community-based training consortium composed of at least one AOA-accredited college of osteopathic medicine and one AOA-accredited hospital. Additional hospitals and ambulatory care facilities may also form partnerships within an OPTI. 
Each of the 17 OPTIs is required to undergo a site survey on a regular basis to determine the institution's quality and compliance with AOA standards. The results of this site survey are used to determine the length of the OPTI's continuing accreditation. For example, if an OPTI is considered to be standard compliant and is functioning close to the expected level of quality, it may be granted a 4-year continuing accreditation. The next site survey of that institution would take place at the end of that 4-year period. Conversely, if an OPTI is deficient in various standard areas and is not operating at the expected level of quality, it may be granted only a 1-year continuing accreditation and will have to be inspected again at the end of that year. Five years is the maximum length of accreditation that can be granted to an OPTI, according to AOA guidelines. 
At publication, each of the OPTI sites has been visited by AOA inspectors at least twice since site surveys began in 1997 (Figure 1). The average length of accreditation granted has increased with each new cycle of site surveys, indicating increased compliance with AOA standards. The average length of accreditation granted in the initial site survey cycle was 2.3 years. In the most recent site survey cycle, an average accreditation length of 3 years was granted to OPTIs. 
Analysis of Compliance with Standards
In an attempt to further improve upon OPTI performance and elevate the level of service provided to the OPTIs' hospital and ambulatory care facility partners, the AOA Committee on Osteopathic Postdoctoral Training Institutions (COPTI) has analyzed OPTI compliance with AOA standards. At the 2005 Annual OPTI Workshop held in Tucson, Ariz, in May, the findings of this analysis were presented and discussed. 
In the AOA COPTI analysis, results from the two most recent OPTI site survey cycles were examined for each OPTI. In the prior survey cycle, 12 OPTIs were granted 2 years' continuing accreditation, while only one OPTI received 4 years' continuing accreditation. In the most recent survey cycle, seven OPTIs received 4 years' continuing accreditation. 
Similar progress was found in the AOA COPTI analysis in regard to cited deficiencies of OPTIs in meeting standards of compliance. In the prior survey cycle, nine OPTIs were cited for four or more deficiencies in meeting standards, while only one OPTI had no cited deficiencies. In the most recent survey cycle, four OPTIs had four or more cited deficiencies, and six OPTIs had no cited deficiencies. It is clear that OPTI compliance with AOA standards is steadily improving. 
The AOA COPTI analysis determined that OPTIs most frequently failed to meet standards within the organization, administration, and finance section of the standard requirements. Fifty-four percent of the OPTI deficiencies cited during the prior survey cycle were in this section, and 40% of the OPTI deficiencies cited during the most recent survey cycle were in this section (Figure 2). In addition, 24% of the cited OPTI deficiencies in the prior survey cycle pertained to the standards section on faculty and instruction, and 27% of the cited OPTI deficiencies in the most recent survey cycle were in this same section (Figure 2). 
From the prior to the most recent survey cycle, a shift occurred in the most frequently cited deficient individual standards. The prior survey cycle found a lack of compliance primarily in the submission of institution bylaws and development of educational program policies (Table 1). The most recent survey cycle found increased deficiencies in standards regarding the integration of osteopathic principles and practices in teaching services (Table 2). Standards regarding the presence of OGME committees, the meeting of research requirements, and the development or evaluation of faculty in OPTIs were consistently deficient in both survey cycles. 
Table 1
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.18Participating institutions must submit bylaws5 (29)
1.3 Policy and guidelines essential for quality educational program 5 (29)
1.53Faculty and program evaluation5 (29)
1.23 Standards of research must be met 4 (24)
1.36Update publications4 (24)
1.41 Must have OGME committee 4 (24)
1.31Conflict of interest statement must be signed3 (18)
1.32 Develop educational plan/planning procedures 3 (18)
1.39Must have budget and financial plan2 (12)
1.46 Sufficient faculty to meet educational objectives 2 (12)
1.51OPTI designate postdoctoral faculty at affiliated sites2 (12)
1.54 Integrate OPP into all teaching services 2 (12)
1.57Documention/evaluation of intern and resident progress2 (12)
1.64
Appoint medical librarian
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions.
Table 1
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.18Participating institutions must submit bylaws5 (29)
1.3 Policy and guidelines essential for quality educational program 5 (29)
1.53Faculty and program evaluation5 (29)
1.23 Standards of research must be met 4 (24)
1.36Update publications4 (24)
1.41 Must have OGME committee 4 (24)
1.31Conflict of interest statement must be signed3 (18)
1.32 Develop educational plan/planning procedures 3 (18)
1.39Must have budget and financial plan2 (12)
1.46 Sufficient faculty to meet educational objectives 2 (12)
1.51OPTI designate postdoctoral faculty at affiliated sites2 (12)
1.54 Integrate OPP into all teaching services 2 (12)
1.57Documention/evaluation of intern and resident progress2 (12)
1.64
Appoint medical librarian
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions.
×
Table 2
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.23 Standards of research must be met 4 (24)
1.41 Must have OGME committee 4 (24)
1.5Faculty development program4 (24)
1.54 Integrate OPP into all teaching services 3 (18)
1.59Intern and resident representation on OGME committees3 (18)
1.62 Integrate OPP in all programs 3 (18)
1.18 Participating institutions must submit bylaws 2 (12)
1.36 Update publications 2 (12)
1.42Develop internal review process2 (12)
1.53
Faculty and program evaluation
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions. Boldface indicates standards on “most frequently cited” deficiencies list for both site survey cycles.
Table 2
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.23 Standards of research must be met 4 (24)
1.41 Must have OGME committee 4 (24)
1.5Faculty development program4 (24)
1.54 Integrate OPP into all teaching services 3 (18)
1.59Intern and resident representation on OGME committees3 (18)
1.62 Integrate OPP in all programs 3 (18)
1.18 Participating institutions must submit bylaws 2 (12)
1.36 Update publications 2 (12)
1.42Develop internal review process2 (12)
1.53
Faculty and program evaluation
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions. Boldface indicates standards on “most frequently cited” deficiencies list for both site survey cycles.
×
Figure 1.
The American Osteopathic Association's Osteopathic Postdoctoral Training Institutions, listed by dates scheduled for resurveys.
Figure 1.
The American Osteopathic Association's Osteopathic Postdoctoral Training Institutions, listed by dates scheduled for resurveys.
Figure 2.
Percentages of Osteopathic Postdoctoral Training Institution deficiencies in meeting American Osteopathic Association standards of compliance, by standards section, as indicated in the most recent and the prior site survey cycles.
Figure 2.
Percentages of Osteopathic Postdoctoral Training Institution deficiencies in meeting American Osteopathic Association standards of compliance, by standards section, as indicated in the most recent and the prior site survey cycles.
Plans to Address Deficiencies
Discussions regarding the best practices for addressing these cited deficiencies took place in the OPTI Workshop breakout groups in Tucson. Participants focused on the deficiencies pertaining to faculty development, OGME committee activity, and research. Suggestions were offered for meeting the standards related to these deficiencies. In addition, concerns were expressed regarding possible obstacles to meeting the standards. The OPTI Clearinghouse (available through http://www.do-online.org) was proposed as an appropriate method for sharing more detailed models of those OPTI programs that have effectively complied with AOA standards. 
The group comments were shared with all of the workshop participants and will form the basis for further discussion at the 2006 Annual OPTI Workshop, scheduled to be held in Savannah, Ga, on April 4, 2006. Additional workshop topics will include defining the role of the OPTI versus the role of the individual partner institutions, determining how OPTIs can better assist their partner institutions in meeting AOA requirements, and identifying how OPTIs can continue to improve upon their services to the osteopathic medical community. 
Proposed Scoring System
In light of the increased OPTI compliance with AOA standards, an important question remains unanswered: Are OPTIs simply complying with minimal standards, or are they functioning in the optimal intended capacity? In order to address this question, the AOA COPTI—under direction of the AOA's Bureau of Osteopathic Education—has begun to identify measurable outcomes for the OPTIs that better reflect compliance rates with optimal standards. The evaluation tool being designed by COPTI is a type of scoring system that will help gauge whether each OPTI is providing a quality product to its partners. This proposed scoring system would also help make the OPTI evaluation process more uniform than it presently is. The expected implementation date of the OPTI scoring system remains undetermined. 
Conclusion
The AOA's OPTI program is striving to provide a high quality, seamless continuum of osteopathic medical education and training for osteopathic graduate medical students. The data from the site surveys indicates that the OPTI program is steadily evolving and progressing. The AOA intends to further improve upon the existing OPTI framework through continued self-analysis and sharing of best practices. 
Figure 1.
The American Osteopathic Association's Osteopathic Postdoctoral Training Institutions, listed by dates scheduled for resurveys.
Figure 1.
The American Osteopathic Association's Osteopathic Postdoctoral Training Institutions, listed by dates scheduled for resurveys.
Figure 2.
Percentages of Osteopathic Postdoctoral Training Institution deficiencies in meeting American Osteopathic Association standards of compliance, by standards section, as indicated in the most recent and the prior site survey cycles.
Figure 2.
Percentages of Osteopathic Postdoctoral Training Institution deficiencies in meeting American Osteopathic Association standards of compliance, by standards section, as indicated in the most recent and the prior site survey cycles.
Table 1
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.18Participating institutions must submit bylaws5 (29)
1.3 Policy and guidelines essential for quality educational program 5 (29)
1.53Faculty and program evaluation5 (29)
1.23 Standards of research must be met 4 (24)
1.36Update publications4 (24)
1.41 Must have OGME committee 4 (24)
1.31Conflict of interest statement must be signed3 (18)
1.32 Develop educational plan/planning procedures 3 (18)
1.39Must have budget and financial plan2 (12)
1.46 Sufficient faculty to meet educational objectives 2 (12)
1.51OPTI designate postdoctoral faculty at affiliated sites2 (12)
1.54 Integrate OPP into all teaching services 2 (12)
1.57Documention/evaluation of intern and resident progress2 (12)
1.64
Appoint medical librarian
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions.
Table 1
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.18Participating institutions must submit bylaws5 (29)
1.3 Policy and guidelines essential for quality educational program 5 (29)
1.53Faculty and program evaluation5 (29)
1.23 Standards of research must be met 4 (24)
1.36Update publications4 (24)
1.41 Must have OGME committee 4 (24)
1.31Conflict of interest statement must be signed3 (18)
1.32 Develop educational plan/planning procedures 3 (18)
1.39Must have budget and financial plan2 (12)
1.46 Sufficient faculty to meet educational objectives 2 (12)
1.51OPTI designate postdoctoral faculty at affiliated sites2 (12)
1.54 Integrate OPP into all teaching services 2 (12)
1.57Documention/evaluation of intern and resident progress2 (12)
1.64
Appoint medical librarian
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions.
×
Table 2
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.23 Standards of research must be met 4 (24)
1.41 Must have OGME committee 4 (24)
1.5Faculty development program4 (24)
1.54 Integrate OPP into all teaching services 3 (18)
1.59Intern and resident representation on OGME committees3 (18)
1.62 Integrate OPP in all programs 3 (18)
1.18 Participating institutions must submit bylaws 2 (12)
1.36 Update publications 2 (12)
1.42Develop internal review process2 (12)
1.53
Faculty and program evaluation
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions. Boldface indicates standards on “most frequently cited” deficiencies list for both site survey cycles.
Table 2
Most Frequently Cited AOA Standards in Which OPTIs Were Deficient—Prior Site Survey Cycle (N=17) *

AOA Standard Number

Content

OPTIs Cited for Deficiencies, No. (%)
1.23 Standards of research must be met 4 (24)
1.41 Must have OGME committee 4 (24)
1.5Faculty development program4 (24)
1.54 Integrate OPP into all teaching services 3 (18)
1.59Intern and resident representation on OGME committees3 (18)
1.62 Integrate OPP in all programs 3 (18)
1.18 Participating institutions must submit bylaws 2 (12)
1.36 Update publications 2 (12)
1.42Develop internal review process2 (12)
1.53
Faculty and program evaluation
2 (12)
 *AOA indicates American Osteopathic Association; OGME, osteopathic graduate medical education; OPP, osteopathic principles and practices; OPTI, Osteopathic Postdoctoral Training Institutions. Boldface indicates standards on “most frequently cited” deficiencies list for both site survey cycles.
×