Editorial  |   March 2009
Osteopathic Medical Education in 2009: Sails Set for Improved Healthcare?
Author Notes
  • Address correspondence to Stephen C. Shannon, DO, MPH, President, American Association of Colleges of Osteopathic Medicine, 5550 Friendship Blvd, Suite 310, Chevy Chase, MD 20815-7231. E-mail: 
Article Information
Medical Education / Graduate Medical Education
Editorial   |   March 2009
Osteopathic Medical Education in 2009: Sails Set for Improved Healthcare?
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 125-127. doi:10.7556/jaoa.2009.109.3.125
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 125-127. doi:10.7556/jaoa.2009.109.3.125
Osteopathic medical education (OME) is constantly changing to meet the evolving needs of the profession and the nation's healthcare system in which it exists. Although the benefits of some recent modifications have been debated,1-3 the growth of the profession is undeniable, as evidenced in the contributions4-9 to this year's OME theme issue of JAOA—The Jo urnal o f the American Osteopathic Association. 
Growth in our profession is driven by increased student enrollment. Not only are there growing numbers of colleges of osteopathic medicine (COMs)—currently totaling 28 campuses10—but many of the existing schools have increased their class sizes.4,11 
Admitting the “right” applicants to COMs has always been a key factor in defining our profession. With growth in our colleges4 and changes in the graduate medical education (GME) environment,5 the student selection process helps shape the nature of the osteopathic medical profession, now and in the future. 
Between 1995 and 2006, I had the extraordinary privilege of serving as dean of the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Me. During those years, I was responsible for the academic program of the college, including the admissions process for potential osteopathic medical students. 
As at other COMs, UNECOM has an admissions staff and committee charged with selecting students who have the academic abilities to endure the challenging curriculum, the character to succeed as a physician, and the particular personal qualities and background that are essential for a good osteopathic physician (DO). 
We sought individuals who had demonstrated such character traits as leadership, self-knowledge, and ethics, as well as those that would be caring and compassionate. We looked for individuals likely to graduate with a patient-centered, holistic, preventive, and hands-on approach to their clinical respons i bilities. We also wanted individuals who would be most likely to choose a primary care specialty and to practice in New England.12 
Of course, all these traits did not always coexist in the same individual. There were many academic achievers, as determined by Medical College Admission Test (MCAT) scores and grade point averages (GPAs). These applicants had completed rigorous undergraduate (and often graduate) work and would likely succeed against the rigors of biochemistry, gross anatomy and neuroanatomy, microbiology, pathology, physiology, and the other biomedical sciences. As shown in several studies,13-15 these individuals are likely to do well in the clinical sciences, achieve high scores at the end of their second-year board examinations, and—though sometimes less assuredly—survive their core and elective clinical requirements to graduate 4 years later. 
There were also individuals who had strong backgrounds in caring environments (eg, volunteer work), leadership skills, and experience in clinical or manual therapy treatment. Most importantly, they often demonstrated a driving passion to become a DO, either conveyed during their interviews with the admissions committee or simply through applying only to COMs. They had a clear vision of their future, with solid goals and well thought-out paths. However, these applicants sometimes lacked the demonstrated ability to overcome the academic and standardized examination hurdles necessary to succeed in medical school. 
At UNECOM, as at all COMs, the work of the admissions committee was to select applicants who had the right combination of academic abilities, values, experiences, and character to produce a graduate that fit all the goals of the college's mission. For UNECOM, this goal was to produce quality osteopathic primary care physicians for New England.12 
Academic traits are simple to measure by MCAT scores and GPA: a top ranking more or less assures academic success and high licensing examination scores.13-15 The pressure to drive admissions decisions by these numbers was (and continues to be) strong because they are used to quantify the quality and competitiveness of a COM's students and educational program. 
Although not always explicitly stated, these standardized measures are important gauges of success for myriad evaluators, including prospective students, faculty, board members, and administrators as well as external groups including legislative bodies for state-sponsored schools, accrediting agencies,16,17 and US News & World Report.18 
Other aspects of the selection process were more difficult and subjective: reviewing the testimony of advisors, mentors, or physicians; assessing the applicant's activities, achievements, and personal statements; and evaluating all this information with the admissions committee. 
Usually the outcome was good, as evidenced by an attrition rate of only 5% from matriculation to graduation.19 Students who had the experiences, character, and life stories with proven academic abilities entered a program designed to enable them to emerge as DOs with the skills, traits, and competence to advance into GME. These are the kind of graduates who GME program directors heavily recruit and who achieve successful Match rates through the American Osteopathic Association Intern/Resident Registration Program and the National Resident Match Program.5,20 
The success of COMs in producing such desirable graduates is a common story,21 though original research to support this impression is lacking—and, I believe, sorely needed. However, I have had the experience of being one of many DOs in academic settings who have been asked by allopathic colleagues (with a degree of envy) something along the lines of: “What is it about osteopathic medical schools that produces the kind of graduates you generate?” Sometimes this question refers to DOs being more likely to choose careers as primary care physicians and to practice in rural areas.22,23 But, more frequently, I think it has to do with the high level of competence, patient-centeredness, and excellent communication skills that many of our graduates exhibit in their residency training and subsequent clinical careers. Of course, OME itself is a part of that process, but so is the selection process—admitting the right applicants. 
Some voices in allopathic medicine24-26 are advocating for changes that would make their recruitment and selection process and some aspects of their training look more like those of COMs. For example, with growing attention on the desired traits for US physicians in our changing healthcare system,27 there are calls to reduce reliance on MCAT scores and GPAs and instead emphasize service and emotional intelligence in admissions criteria to improve patient-centered care.24-26 Likewise, changes in medical education, such as an increase in out-of-hospital, community-based clinical education, are recommended to improve communication skills.24-26 
Many of the traits that osteopathic medicine heralds as fundamental to its training model (eg, teaching students the philosophy of treating the whole patient) are in fact simply fundamental to being a good physician. The osteopathic medical profession should be proud of its tradition of focusing on preventive, patient-centered care. But DOs do not “own” this philosophy—and we should not be surprised that others are now highlighting a need to emphasize a more holistic approach to patient care.24 
If there is “competition” in this regard, it should be targeting how best to produce the kind of physician the US healthcare system needs, especially as we reinvent that system and refocus it on primary care medicine. 
This OME issue includes the data snapshot that is needed to evaluate the trends in the continuum of education for DOs. Annual updates regarding several aspects of OME are also provided, including COM accreditation and growth,4 GME data for graduates in residencies approved by the American Osteopathic Association or the Accreditation Council for Graduate Medical Education,5 developments regarding Osteopathic Postdoctoral Training Institutions,7 and key reports on the status of continuing medical education8 and osteopathic specialty certification.9 Also, for the first time, this OME theme issue of the JAOA includes data on osteopathic residents in dually accredited and parallel postdoctoral training programs.6 
Although the data in these articles will enable us to continue to chart our course amidst a time of tremendous change, there is much left to discover about OME and the physicians our profession is producing. Several questions come to mind: 
  • Are osteopathic medical students and graduates different from their allopathic counterparts? If so, how?
  • Are these differences meaningful in terms of patient care and clinical outcomes?
  • Are any outcome differences observed that can improve the US healthcare system?
  • How can we improve all aspects of the OME continuum, from recuitment and admissions to osteopathic internships and residency programs—and beyond, to certification and continuing medical education?
A number of topics related to OME have been proposed for next year's OME issue, as described in the call for papers on page 124. I invite all members of the osteopathic medical community, especially those directly involved in OME, to submit studies that will advance our profession. For example, one suggested topic is a report on clinical training of osteopathic medical students, interns, and residents. Another topic asks for studies related to OGME, particularly those that describe trends or factors related to specialty selection. 
In addition, I encourage you to raise the questions generated by the information in this issue and to ask for any data that are lacking. Only then can we make informed decisions about issues that affect the future of not only our profession but also the nation's healthcare system. 
 Dr Shannon is a member of the Editorial Advisory Board for JAOA—The Journal of the American Osteopathic Association. He has served as the guest editor for the JAOA's annual theme issue on osteopathic medical education since 2006.
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