Free
AOA Communication  |   March 2008
Osteopathic Postdoctoral Training Institutions
Author Notes
  • Address correspondence to Steven F. Schmit, EdD, Director, Division of Postdoctoral Training, American Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: sschmit@osteopathic.org 
Article Information
AOA Communication   |   March 2008
Osteopathic Postdoctoral Training Institutions
The Journal of the American Osteopathic Association, March 2008, Vol. 108, 138-139. doi:
The Journal of the American Osteopathic Association, March 2008, Vol. 108, 138-139. doi:
Abstract

The Osteopathic Postdoctoral Training Institution (OPTI) program was established by the American Osteopathic Association (AOA) in 1995 as a support and accreditation structure for osteopathic graduate medical education. Since 1999, all AOA-approved postdoctoral training programs are required to take place in OPTIs. In a continuing effort to further define standards for quality and to promote program development, the AOA's 2007 Annual OPTI Workshop focused on recommended changes to the OPTI standards document. In addition, an OPTI Inspectors Workshop was held in January 2008 to increase interrater reliability in determining whether individual OPTIs have met specific criteria.

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 COCA-accredited college of osteopathic medicine and one AOA-accredited hospital. Additional hospitals and ambulatory care facilities may also join this core partnership. Since July 1999, all AOA-approved osteopathic internships and residencies must take place in OPTIs.1 However, because the original guidelines for establishing OPTIs were minimal, each OPTI has formed as a unique entity “with different structures and different ways of operating.”1 
Currently, 17 OPTIs exist, each of which is periodically site-surveyed to determine the institution's quality and compliance with AOA accreditation standards.2,3 The results of site surveys are used to determine the length of the OPTI's continuing accreditation. For example, if an OPTI is determined to be “standard compliant” and is functioning close to the expected level of quality, it may be granted a 4-year continuing accreditation (ie, the next site survey would take place at the end of that 4-year period). Conversely, if an OPTI is deficient in various accreditation standard areas and is not operating at the expected level of quality, it may be granted only a 1-year continuing accreditation, requiring reinspection at the end of that 1-year period. Currently, if an OPTI demonstrates excellent outcomes, the maximum length of accreditation it can be granted is 5 years. As noted elsewhere,4,5 each OPTI site has been visited by AOA inspectors at least twice since site surveys began in 1997. 
Currently, the most commonly cited areas of deficiency reported after OPTI inspections relate to research. For example, one of the most common deficiencies relates to standard 1.42, which states that each OPTI must identify and list the resources and opportunities for research available to interns and residents within that OPTI.3 Two of the other most common areas of deficiency apply to standard 1.43, which requires each OPTI to provide ready access to basic science and clinical research mentorships, and standard 1.44, which states that each OPTI must identify research and methodology support services available to interns and residents.3 
Recent Activities
The Council on Osteopathic Postdoctoral Training Institutions (COPTI), under the leadership of its chairman, D. Keith Watson, DO, has embarked on several new initiatives, such as revitalizing the OPTI Annual Report. A standardized format for the report will allow the progress of each OPTI to be tracked longitudinally. Likewise, because improvement for the OPTI accreditation process depends on providing both inspectors and OPTIs the tools required to understand the standards, guidelines, and documentation necessary for verification, Dr Watson has also pushed for a revised OPTI Standards Inspectors Worksheet (ie, Standards Crosswalk). 
OPTI Standards, Refined
The AOA's 2007 OPTI Workshop was held at the Marco Island Marriott Beach Resort, Golf Club & Spa in Marco Island, Fla, on May 8, 2007. The primary goal of this workshop was to review the proposed OPTI standard changes, which were posted for public comment on the AOA Web site. A critical review of each standard and the rationale behind it were presented to the attendees. 
The workshop provided a forum for meaningful discussion and critical review of recommended changes in preparation for the final adoption of the new standards by the AOA's Bureau of Osteopathic Education and the AOA's Board of Trustees in July 2007. Although many of the changes are simply clarifying phrases or statements from the various specialty colleges, several of the approved requirements are entirely new.3 For example, OPTI directors of medical education are now required to attend an Association of Osteopathic Directors and Medical Educators conference or an AOA osteopathic medical education conference to ensure their continuing development in topics related to medical education.3 All changes can be found in Accreditation Document for Osteopathic Postdoctoral Training Institutions and the Basic Document for Postdoctoral Training Programs.3 
OPTI Inspectors Workshop
On January 9, 2008, an OPTI Inspectors Workshop was held at the Westin Kierland Resort and Spa in Scottsdale, Ariz. The workshop trained OPTI inspectors to determine whether an individual standard is met or not. It is hoped that such training will increase interrater reliability. A decision as basic as determining if a standard has been met, which is based on a clear understanding of the intent of the standard and the necessary documentation, is critical to ensuring the success of the overall inspection process. 
Conclusion
The AOA's updated accreditation standards3 became effective beginning January 2008. These standards continue to be analyzed by COPTI and the Bureau of Osteopathic Education. The Council continues to seek ways to foster excellence among the OPTIs by further refining the criteria and guidelines used by the AOA to assess program effectiveness. In addition, COPTI's objective is to encourage growth and goal-setting in terms of concrete outcomes among OPTIs and in all OGME institutions. 
Sinco P. OPTI nerve: forum spurs tough talk on standards. The DO. December(2004). ;45:54-57.
Locations of osteopathic postdoctoral training institutions (OPTIs). American Osteopathic Association Web site. July 2007. Available at: https://www.do-online.org/pdf/sir_postdocoptilist.pdf. Accessed March 10, 2008.
American Osteopathic Association. Accreditation Document for Osteopathic Postdoctoral Training Institutions and the Basic Document for Postdoctoral Training Programs. Chicago, Ill: American Osteopathic Association; 2007. Available at: https://www.do-online.org/pdf/sir_postdoctrainproced.pdf. Accessed March 10, 2008.
Obradovic JL. Osteopathic postdoctoral training institutions. J Am Osteopath Assoc. 2007;107:54-55. Available at: http://www.jaoa.org/cgi/content/full/107/2/54. Accessed March 10, 2008.
Webb JB. Osteopathic postdoctoral training institutions. J Am Osteopath Assoc. 2006;106:70-75. Available at: http://www.jaoa.org/cgi/content/full/106/2/70. Accessed March 10, 2008.