Free
Letters to the Editor  |   May 2006
Response
Author Affiliations
  • MICHAEL I. OPIPARI, DO
    American Osteopathic Association's Council on Postdoctoral Training Chicago, Ill
    Chairman
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   May 2006
Response
The Journal of the American Osteopathic Association, May 2006, Vol. 106, 302-303. doi:
The Journal of the American Osteopathic Association, May 2006, Vol. 106, 302-303. doi:
I read with great interest the letter from Dr Mychaskiw about osteopathic graduate medical education (GME). I found the letter to be a very negative review of the current state of GME in the osteopathic medical profession. In my role as the chairman of the American Osteopathic Association's Council on Postdoctoral Training, I feel compelled to respond. 
Dr Mychaskiw indicates that he was advised while in osteopathic medical school in the mid-1980s to “[g]o into the best residency you can find, regardless of whether it has an allopathic or osteopathic affiliation.” It is unfortunate that many of the advisers at colleges of osteopathic medicine fail to indicate that the quality of many AOA-approved internships and residencies is every bit as good or even better than many of the GME programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Having observed many reviews of ACGME-accredited programs, I know that there are just as many training programs of questionable quality accredited by the ACGME as there may be by the AOA. However, because no one has ever agreed on an objective definition of “quality” in medical education—other than meeting a set of minimum standards for accreditation—the evaluation of any program is often a personal, subjective matter. 
I am certain that Dr Mychaskiw obtained a fine academic and clinical education in his internship at the Hospital of St Raphael in New Haven, Conn, and his residency at the Yale-New Haven Hospital. However, he cannot blame all of his subsequent adverse experiences regarding the osteopathic medical profession on the AOA. His ineligibility to participate in part 3 of the examination of the National Board of Osteopathic Medical Examiners (NBOME) was the result of criteria established by the NBOME—not the AOA. Furthermore, his inability to practice in certain states resulted from his ineligibility in accordance with state licensing laws—not AOA rules or regulations. The AOA does not regulate licensing criteria in any state. 
Dr Mychaskiw refers to the “`inadequacy' of my clinical training in the eyes of the AOA.” The adequacy or inadequacy of his training is not the issue here. Every osteopathic medical student should know—or should be informed by his or her osteopathic college “adviser”—that there are established, professional criteria that must be met. The AOA, through its Council on Postdoctoral Training and its Bureau of Osteopathic Education, functions as an educational approval and accrediting agency in the same manner in which the ACGME functions. Both organizations have a responsibility to maintain the integrity of their training programs. At present, the ACGME does not recognize AOA-approved residency programs as meeting ACGME standards, and the AOA does not recognize ACGME-accredited programs as meeting AOA standards. 
As far as Dr Mychaskiw's status within the AOA, the AOA is pleased that he has chosen to maintain his membership and remain active as a DO in his state. The AOA values the professional contributions of Dr Mychaskiw and other DOs who have been trained and licensed through allopathic pathways. The AOA also looks forward to the assistance of these DOs in teaching osteopathic medical students and residents, as Dr Mychaskiw is doing in his residency program at the University of Mississippi School of Medicine. I can assure you that these DOs are certainly not, as Dr Mychaskiw charges in his letter, “invisible in the eyes of the AOA.” Rather, they are seen as important AOA members, just like any other members. In fact, a major focus of the AOA's new branding initiative is to make sure that ACGME-trained DOs feel welcome in the AOA.1 
The AOA Board of Trustees supports various policies to integrate ACGME-trained DOs into the osteopathic medical profession, including Resolution 42 (A/2000), titled “Approval of ACGME Training as an AOA-Approved Internship” (the “hardship exception”), and Resolution 56 (A/2004), titled “Certification Eligibility for ABMS-Certified DOs.” 
Resolution 42 permits ACGME-trained DOs to request internship approval from the AOA of their first ACGME-accredited year of training. If the AOA grants this approval, these DOs may request that the AOA approve their ACGME-accredited residency training. To date, the AOA has approved more than 90% of the requests made under this resolution (J.L. Obradovic, MA, RDH, oral communication, April 2006). 
Resolution 56 permits those DOs certified by member boards of the American Board of Medical Specialties (ABMS) to request eligibility to sit for the examinations of AOA certifying boards—without requiring separate AOA approval of the ACGME training. This resolution provides for an expedited process to make these DOs eligible for AOA board certification. 
I challenge Dr Mychaskiw's statement that the AOA certifying board examinations do not have validity comparable with the ABMS boards. To give one example of why this statement is inaccurate, the American College of Physicians (ACP) decided in 2003 that DOs certified by the American Osteopathic Board of Internal Medicine are eligible for ACP membership because of the comparability of the AOA and ABMS certifying board examinations for this specialty.2 Moreover, the AOA has insisted that its certifying boards go through extensive validation processes to ensure that they are comparable with ABMS boards. The fact that several acquaintances of Dr Mychaskiw were unable to pass ABMS boards after completing ACGME-accredited residencies raises questions concerning the quality of the ACGME training. 
Regarding Dr Mychaskiw's remark that osteopathic manipulative treatment (OMT) is “overemphasized by the AOA,” I acknowledge that osteopathic medicine and osteopathic philosophy encompass much more than OMT. Nevertheless, OMT is one of the fundamentals on which the osteopathic medical profession is built. I suggest that by incorporating OMT into his cardiac anesthesiology practice, just as he uses medications and gases, Dr Mychaskiw could offer even better care to his patients. 
In summary, I do not believe that Dr Mychaskiw and other ACGME-trained DOs are being ignored by the AOA. Rather, they have chosen not to partake of the many benefits that the AOA has developed for them. My words of advice are: Try the AOA. You might like it! 
Greenwald B. On the `brandwagon': AOA reaches out to all. The DO. April2006;47:34 –38.
American College of Physicians. Requirements and guidelines for membership. Available at: http://www.acponline.org/college/membership/required.htm#member. Accessed April 25, 2006.