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AOA Communication  |   April 2012
Evolving Role of Osteopathic Postdoctoral Training Institutions
Author Affiliations & Notes
  • Maura Hughes, BA
    From the Department of Education at the American Osteopathic Association (AOA) in Chicago, Illinois
  • Address correspondence to Maura Hughes, BA, Manager, Osteopathic Postdoctoral Training Institutions Inspections, AOA Department of Education, 142 E Ontario St, Chicago, IL 60611-2864. E-mail: mhughes@osteopathic.org  
  •    Editor's Note: This JAOA theme issue on osteopathic medical education includes annual updates from the American Osteopathic Association's departments of accreditation and education. Last year's article on Osteopathic Postdoctoral Training Institutions can be accessed online at http://www.jaoa.org/content/111/4/258.full.
     
Article Information
AOA Communication   |   April 2012
Evolving Role of Osteopathic Postdoctoral Training Institutions
The Journal of the American Osteopathic Association, April 2012, Vol. 112, 204-210. doi:10.7556/jaoa.2012.112.4.204
The Journal of the American Osteopathic Association, April 2012, Vol. 112, 204-210. doi:10.7556/jaoa.2012.112.4.204
Abstract

All osteopathic graduate medical education programs approved by the American Osteopathic Association are required to be part of an Osteopathic Postdoctoral Training Institution (OPTI). The author reviews recent activities related to OPTI operations, including OPTI accreditation and academic sponsorship changes, revisions to the OPTI Accreditation Handbook, the 2011 OPTI Workshop, and the 2011 OPTI Annual Report. The author also reviews the OPTI accreditation process, cites common commendations and deficiencies for reviews completed from 2008 to 2011, and compares OPTI responses from the 2009 and 2011 OPTI annual reports.

The Osteopathic Postdoctoral Training Institution (OPTI) system, established by the American Osteopathic Association (AOA) in 1995, has grown considerably as a method for providing structure to osteopathic graduate medical education (OGME). Each OPTI is a community-based training consortium composed of at least 1 college of osteopathic medicine (COM) and 1 hospital accredited by the AOA Bureau of Healthcare Facilities Accreditation, the Joint Commission, or another recognized health care facility accrediting entity.1 Additional hospitals and ambulatory care facilities may also join this core partnership. Since July 1999, OPTI partnerships are required for institutions conducting AOA-approved osteopathic postdoctoral training programs.2 The AOA currently has 20 accredited OPTIs (Figure). 
Figure.
Locations of the 20 Osteopathic Postdoctoral Training Institutions (OPTIs) in the United States.
Figure.
Locations of the 20 Osteopathic Postdoctoral Training Institutions (OPTIs) in the United States.
Recent Activities
During the past year, the AOA Council on Osteopathic Postdoctoral Training Institutions (COPTI), under the leadership of its chairperson, D. Keith Watson, DO, became the final decision-making body of OPTIs, held the 2011 OPTI Workshop, and initiated the 2011 OPTI Annual Report. All OPTIs also assumed roles as academic sponsors of OGME programs. In response to this increased responsibility on the part of OPTIs, the COPTI proposed revisions to OPTI accreditation standards, asking for feedback from the OPTIs. 
OPTI Accreditation Change
In January 2011, the Education Policy and Procedure Review Committee III (EPPRC III) made recommendations to the AOA Board of Trustees for improving the policies and procedures that govern and direct the education enterprise of the AOA.3 Included in these recommendations was that the COPTI be the final decision-making body to accredit OPTIs, with the Bureau of Osteopathic Education Appeal Committee acting as the respective appellant body. The AOA Board of Trustees approved these recommendations at its 2011 midyear meeting in February. The COPTI's new responsibilities became effective July 1, 2011, and its first final accreditation decision was made at its July 27, 2011, teleconference. 
OPTI Academic Sponsorship
The AOA Board of Trustees also approved the EPPRC III recommendation to recognize OPTIs as the academic sponsors of all AOA-approved OGME programs.1,3 As academic sponsors, OPTIs are responsible for ensuring that training programs are following specialty standards and standards outlined in AOA Basic Documents for Osteopathic Postdoctoral Training.1 In addition, OPTIs are accountable for compliance of base institutions (eg, hospitals) with AOA policies including contracts, the AOA Intern/Resident Registration Program (ie, AOA Match), quality performance, trainee evaluations, participation in on-site program reviews, corrective action plans, internal reviews, and core competencies. The OPTIs will not take over base institution responsibilities such as financial support for trainees and programs, AOA Match participation, and administrative support. All programs must implement OPTI academic sponsorship no later than July 1, 2012.1 
Revised OPTI Accreditation Standards
Based on the new responsibilities of COPTI and the OPTIs, the COPTI revised “Section IX. Standards for Accreditation of OPTIs” in AOA Basic Documents for Postdoctoral Training. The COPTI and the Council on Osteopathic Postdoctoral Training reviewed these proposed standards in July 2011. The AOA published the proposed standards on its Web site for the 45-day public commenting period. The COPTI reviewed each public comment and made amendments based on the feedback. At its 2012 midyear meeting, the AOA Board of Trustees approved the revisions to the OPTI Accreditation Standards (Resolution B-6—Revisions to the AOA Basic Documents for Postdoctoral Training—Section IX: OPTI Standards; http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-6-Basic-Documents-Section-IX-OPTI-Standards-BOE-COPT-COPTI.pdf). These standards will be effective on July 1, 2012. 
2011 OPTI Workshop
The 2011 OPTI Workshop, which was held in Baltimore, Maryland, focused on assisting OPTIs in operations and updating OPTIs on reports from EPPRC III and the OPTI study conducted by Michael Hamm and Associates, as previously described.7 The workshop also included presentations on OPTIs' corrective action plans, OPTIs' roles in compliance of program standards, and OPTIs' relationships to the AOA Program and Trainee Review Council. The OPTIs also participated in an open forum to discuss COPTI's proposed “OPTI Mission and Vision Statements.” 
OPTI Annual Report
The OPTI Annual Report is a survey that queries OPTIs on a series of operational issues. In 2009, the AOA revised the format of the OPTI Annual Report to make the data easily transferable to electronic databases, improving the AOA's electronic data-reporting capabilities.4A comparison of the 2009 annual report data and 2011 annual report data is provided later in the present article. 
OPTI Accreditation Process
At its 2012 midyear meeting, the AOA Board of Trustees approved Resolution B-7 (Revisions to the OPTI Accreditation Handbook that were submitted by COPTI). The revisions are available online at http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-7-OPTI-Accreditation-Handbook-BOE-COPT-COPTI.pdf. These revisions, effective July 1, 2012, include changes to the OPTI self-study, the duration of site visits, and the length of OPTI continuing accreditation. In the following paragraphs, I will describe the process that will go into effect in July. Information regarding the current OPTI accreditation process is available in the 2011 medical education issue of the JAOA—Journal of the american Osteopathic Association.7 
The AOA and COPTI provide a fair and balanced approach to the review process. The Council conducts the following 3 types of reviews: (1) provisional site reviews, which are conducted for OPTIs seeking accreditation; (2) full site reviews, which are structured on the accreditation cycle; and (3) focused site reviews, which are required when an OPTI has a status of “Accreditation with Notice (Private)” or “Accreditation with Probation (Public).”5 A focused site review may also be called by the COPTI when there is a substantive change within the OPTI. The AOA notifies OPTIs at least 1 year before a full site review. In addition, the OPTI receives notification that a self-study will be due 60 days before the scheduled review. The OPTI and the AOA work together to find a mutually agreeable date, and the AOA sends a second letter to the OPTI confirming the review date. 
The AOA provides resources to OPTIs that are preparing for the self-study and on-site review, including the OPTI Accreditation Reviewer Crosswalk6; the AOA's OPTI Accreditation Handbook,5 which includes a list of required documentation for the self-study; and staff assistance on the construction of the self-study.7 The self-study includes an introduction to the OPTI, including historical overview, mission and objectives, recent accomplishments, and current concerns. In this section, the OPTI must also include a discussion of the OPTI's efforts and activities to establish collaboration among partner COMs and hospitals to promote a continuum of education from predoctoral to postdoctoral training. Next, the OPTI describes how it currently meets each standard in “Section IX. Standards for Accreditation of OPTIs“ of the AOA Basic Document for Postdoctoral Training. The OPTI should include documentation verifying compliance and identify any deficiencies. 
Assignment of reviewers begins once review dates have been set; the OPTI approves the assigned reviewers. The site team consists of 4 members (3 inspectors and 1 AOA staff member). At least 1 osteopathic physician reviews the clinical OPTI standards. Individuals who serve as OPTI reviewers are involved with OGME or COMs and are required to attend training, which is held every other year at the OPTI Workshop. Review team members sign a conflict of interest form before each visit. Starting July 1, 2012, the duration of the site visit must be agreed upon in advance by the chief academic officer of the OPTI and the review team leader. 
Prior to the full site review, the assigned review team reviews the self-study, the most recent site visit report, and the past annual reports of the OPTI. The team then meets by means of a teleconference to discuss the submitted documentation and to ensure logistical support is covered. The team also reviews a draft copy of the review schedule and recommends any necessary changes. The OPTI should organize the documents clearly and concisely according to OPTI standards to ensure that the review team has quick access to materials. 
Full site reviews typically last 1½ days. The full site review includes time for a review of OPTI documents and interviews with OPTI staff, directors of medical education, program directors, and trainees. During the on-site visit, the review team cites each standard as not met, met, or met with excellence for each of the 8 standard sections (Table 1). Starting July 1, 2012, the OPTI Accreditation Reviewer Crosswalk will include the following 2 types of standards: “Must Meet” standards (indicated with “**“ in the revisions to AOA Basic Documents for Postdoctoral Training and OPTI Accreditation Reviewer Crosswalk) and “regular” standards. The 6 “Must Meet” standards identified by the COPTI are considered essential to OPTI function and continuing approval (Table 2). 
Table 1.
Definitions of the 8 AOA OPTI Standard Sections
AOA OPTI Standard Section Definition
A Prerequisites for accreditation
B Organization, governance, and finance
C Program evaluation
D Research standards
E Faculty and instruction
F Intern and resident status and services
G Curriculum
H Facilities
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
  Source: AOA Basic Documents for Postdoctoral Training.1
Table 1.
Definitions of the 8 AOA OPTI Standard Sections
AOA OPTI Standard Section Definition
A Prerequisites for accreditation
B Organization, governance, and finance
C Program evaluation
D Research standards
E Faculty and instruction
F Intern and resident status and services
G Curriculum
H Facilities
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
  Source: AOA Basic Documents for Postdoctoral Training.1
×
Table 2.
“Must Meet” OPTI Standardsa
Standard Number Description
A.9.1 OPTI shall be a formalized entity.
A.9.2 OPTI shall have at least 1 member hospital; all hospitals must be accredited or licensed.
A.9.3 OPTI shall include membership of at least 1 COM accredited by AOA COCA.
A.9.5 All member institutions of the OPTI must have an affiliation agreement with the OPTI.
A.9.7 OPTI shall academically sponsor a minimum of 2 AOA-approved residency programs, at least 1 of which is in the following specialties: family medicine, general internal medicine, obstetrics and gynecology, general surgery, or general pediatrics.
B.9.13 OPTI shall complete and forward to the AOA an annual report on a schedule set by COPTI but no later than October 1.
  a Effective July 1, 2012.
  Abbreviations: AOA, American Osteopathic Association; COCA, Commission on Osteopathic College Accreditation; COM, college of osteopathic medicine; COPTI, Council on Osteopathic Postdoctoral Training Institutions; OPTI, osteopathic postdoctoral training institute.
  Source: Resolution B-6 [M/2012]—Revisions to the AOA Basic Documents for Postdoctoral Training—Section IX: OPTI Standards. http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-6-Basic-Documents-Section-IX-OPTI-Standards-BOE-COPT-COPTI.pdf.
Table 2.
“Must Meet” OPTI Standardsa
Standard Number Description
A.9.1 OPTI shall be a formalized entity.
A.9.2 OPTI shall have at least 1 member hospital; all hospitals must be accredited or licensed.
A.9.3 OPTI shall include membership of at least 1 COM accredited by AOA COCA.
A.9.5 All member institutions of the OPTI must have an affiliation agreement with the OPTI.
A.9.7 OPTI shall academically sponsor a minimum of 2 AOA-approved residency programs, at least 1 of which is in the following specialties: family medicine, general internal medicine, obstetrics and gynecology, general surgery, or general pediatrics.
B.9.13 OPTI shall complete and forward to the AOA an annual report on a schedule set by COPTI but no later than October 1.
  a Effective July 1, 2012.
  Abbreviations: AOA, American Osteopathic Association; COCA, Commission on Osteopathic College Accreditation; COM, college of osteopathic medicine; COPTI, Council on Osteopathic Postdoctoral Training Institutions; OPTI, osteopathic postdoctoral training institute.
  Source: Resolution B-6 [M/2012]—Revisions to the AOA Basic Documents for Postdoctoral Training—Section IX: OPTI Standards. http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-6-Basic-Documents-Section-IX-OPTI-Standards-BOE-COPT-COPTI.pdf.
×
At the end of each review, the review team and the OPTI have an exit conference. The goal of the exit conference is to provide a general review of the OPTI site visit and to outline the process of AOA accreditation. The review team can provide initial findings to the OPTI, but they must stress that the findings are subject to change. 
After the OPTI review, AOA staff work with the team to finalize a first draft of the site report. Once approved by the team, AOA staff forward the report to the OPTI for an optional written response. In instances in which the OPTI disagrees with the findings of the report, the OPTI has 15 business days to submit a written response to the AOA Division of Postdoctoral Training. The OPTI response must be based on errors in fact and provide all supporting documentation. 
Once the OPTI sends its response to the initial site report to the AOA, AOA staff forward the response to the review team. The team meets by teleconference, reviews the initial findings and the OPTI response, and makes any necessary changes to the report. After the team finalizes their report, the COPTI reviews the report at its next scheduled meeting. 
The COPTI considers team reports and OPTI responses during COPTI meetings, which occur 3 times per year. The review team report and OPTI response are confidential and reviewed during the executive session of the COPTI. During the meeting, the COPTI hears testimony from OPTI representatives and the review team leader. The COPTI determines final action regarding approval of the site visit report. With COPTI now acting as the final decision-making body to accredit OPTIs, final action no longer needs to be approved by the Bureau of Osteopathic Education. 
After the COPTI meeting, the COPTI secretary mails a letter to the OPTI outlining the continuing approval, commendations, and deficiencies. Enclosed with the letter is a copy of the approved site report for the OPTI's record. The OPTI may appeal the COPTI's decisions regarding accreditation to the Bureau of Osteopathic Education Appeal Committee. 
Starting July 1, 2012, OPTIs' continuing approval will be based on a 5-year term accreditation. This new accreditation model will streamline OPTI accreditation awards and allow OPTIs to focus on quality measures rather than individual points in the previous scoring rubric. Under the new accreditation model, all OPTIs will receive a continuing approval of 5 years. For each standard cited as deficient in the site visit report, the OPTI must submit a corrective action plan and progress report 6 months after its inspection. The COPTI will review each corrective action plan and progress report and determine whether the OPTI has met the deficient standard. 
Any OPTI that is deficient in 2 “Must Meet” standards at the time of its site visit will automatically receive a status of “Accreditation with Notice (private).” All “Must Meet” standards must be corrected within 12 months, and all regular standards must be corrected within 24 months. If “Must Meet” standards or regular standards are not met within the proscribed time frame, the OPTI will be given the status of “Accreditation with Notice (Private).” “Accreditation with Notice (Private)” requires that a focused site visit occur within 12 months and is confidential. The AOA and OPTI will still publically describe the OPTI as accredited. If any standard remains unmet after the focused site visit, the OPTI will be given the status of “Accreditation with Probation (Public),” and another focused site visit must occur within 12 months. If any standard still remains unmet after the focused site visit, the COPTI will take action to withdraw the accreditation of the OPTI. An OPTI that has lost its accreditation may reapply and must meet at least 70% of all accreditation standards, including all standards designated as “Must Meet.” Any COPTI action of “Accreditation with Notice (Private),” “Accreditation with Probation (Public),” or “Withdrawal of Accreditation” will be reported to the Bureau of Osteopathic Education, the Council of Postdoctoral Training, the Program and Trainee Review Council, and AOA Commission on Osteopathic College Accreditation for their records. 
OPTI Commendations
Reviewers of OPTI sites score results for AOA basic standards according to 3 categories: “not met,” “met,” or “met with excellence.” Institutions do not receive extra points for standards that are “met with excellence.” However, they do receive commendations for those standards. The COPTI may award multiple commendations to a single OPTI. Table 3 summarizes the commendations and deficiencies given in the last 4 years. 
Table 3.
Commendations and Deficiencies Given to OPTIs for Compliance With AOA OPTI Standards, 2008 to 2011 (N=20)
Commendations or Deficiences, No. Standard Sectionsa
A B C D E F G H Total
Commendations 3 2 1 8 7 1 6 3 31
Deficiencies 3 29 26 17 8 8 9 1 101
  a Definitions of standard sections are found in Table 1.
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
Table 3.
Commendations and Deficiencies Given to OPTIs for Compliance With AOA OPTI Standards, 2008 to 2011 (N=20)
Commendations or Deficiences, No. Standard Sectionsa
A B C D E F G H Total
Commendations 3 2 1 8 7 1 6 3 31
Deficiencies 3 29 26 17 8 8 9 1 101
  a Definitions of standard sections are found in Table 1.
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
×
In the 20 full OPTI reviews conducted from 2008 to 2011, AOA basic standards were scored as “met with excellence” 31 times (Table 3). Three OPTIs received the distinction of being awarded a “blue ribbon” status—a perfect score on the review. In the 20 reviews conducted from 2008 to 2011, COPTI awarded commendations most often in research (Standard Section D) and faculty and instruction (Standard Section E). 
The AOA basic standards that were most often awarded as “met with excellence” were Standards D 9.2 (cited 6 times) and E 9.5 (cited 4 times):
  •  
    D 9.2: “Each OPTI shall facilitate and provide research education, assistance and resources directly to interns, residents and institutions to encourage research and to meet the specialty college requirements.”1
  •  
    E 9.3: “Each OPTI and its member institutions and designated faculty, shall integrate osteopathic principles and practice (OPP) into all teaching services as appropriate and shall have designated faculty to provide OPP teaching.”1
OPTI Deficiencies
In the 20 full OPTI reviews completed from 2008 to 2011, COPTI cited 101 deficiencies, or AOA basic standards found as “not met” (Table 3), with multiple deficiencies cited to a single OPTI. The COPTI cited deficiencies most often in organization, governance, and finance (Standard Section B) and program evaluation (Standard Section C). 
Among these deficiencies, the following OPTI standards were cited as “not met” the most (ie, ⩾6 times):
  •  
    B 9.15: “Each OPTI shall define a financial plan and budget that is linked to its strategic plan, annual educational plan and outcomes, and that reflects profit/loss detailed allocations to all members.”1
  •  
    C 9.4: “The responsibility of the OGME committee shall be clearly stated. The OGME shall document its effectiveness through outcome measures consistent with the OPTI strategic plan goals.”1
  •  
    D 9.5: “The OPTI shall seek funding, either externally generated or internally budgeted funding (not only from the COM), to provide for OPTI-wide or program specific research efforts of its member faculty and residents or students.”1
2011 OPTI Annual Report
Eleven OPTIs completed the 2011 OPTI Annual Report, which consisted of an online, 46-item questionnaire that allowed OPTIs to report changes in demographics, membership composition, and operations. There were 2 versions of the report. The first version was for OPTIs that had not completed the online survey before. Responses were formatted as “Yes/No,” multiple choice, or free response. The second version was for OPTIs that had completed the online survey in previous years. This version allowed OPTIs to verify “Yes/No” for the answers they submitted in 2010. In instances in which the answer was not the same, space was available for OPTIs to provide the new response. The OPTIs that were inspected during 2011 did not submit annual reports.5 
Table 4 compares the responses from the 2009 OPTI Annual Report with the responses from the 2011 report. The sample questions and data from the 2009 OPTI Annual Report were first reported by Duffy and Martinez4 in the JAOA's 2010 medical education issue. The majority of OPTIs described having similar goals and objectives in 2009 and 2011. In addition, results of both reports showed a similar percentage of OPTIs that provided active assistance to programs that were preparing corrective action plans.4 
Table 4.
Sample Questions and Comparison of OPTI Overall Responses From the 2009 and 2011 AOA Annual Reports
Sample Question 2009 Summary Responses4 (N=13) 2011 Summary Responses (N=11)
Does your OPTI have an OPTI Administrator that is separate from the Chief Academic Officer? (yes/no)
Yes 9 11
No 4 0
Please choose the OPTI organizational structure that best describes the OPTI. (multiple choice)
501(c)(3) 4 3
LLC 0 0
Partnership 1 1
Consortium 8 7
Are the individual partner and aggregate ICCP submissions reviewed by the OPTI OGME committee to determine needed new educational or evaluation strategies? (yes/no)
Yes 9 11
No 4 0
Describe the OPTI process for monitoring OGME trainee progress toward graduation including the documentation of AOA competencies. (free form) OGME review of annual reports, monitoring of board pass rates, program inspections OPTI review at annual site visit, OGME review of annual reports and quarterly evaluations, COMLEX-USA Level 3 test results
Does the OPTI provide active assistance to programs in developing corrective action plans? (yes/no)
Yes 13 10
No 0 1
  Abbreviations: AOA, American Osteopathic Association; COMLEX-USA, Comprehensive Osteopathic Medical Licensing Examination-USA; ICCP, Institutional Core Competency Plans; OGME, Osteopathic Graduate Medical Education; OPTI, Osteopathic Postdoctoral Training Institution.
Table 4.
Sample Questions and Comparison of OPTI Overall Responses From the 2009 and 2011 AOA Annual Reports
Sample Question 2009 Summary Responses4 (N=13) 2011 Summary Responses (N=11)
Does your OPTI have an OPTI Administrator that is separate from the Chief Academic Officer? (yes/no)
Yes 9 11
No 4 0
Please choose the OPTI organizational structure that best describes the OPTI. (multiple choice)
501(c)(3) 4 3
LLC 0 0
Partnership 1 1
Consortium 8 7
Are the individual partner and aggregate ICCP submissions reviewed by the OPTI OGME committee to determine needed new educational or evaluation strategies? (yes/no)
Yes 9 11
No 4 0
Describe the OPTI process for monitoring OGME trainee progress toward graduation including the documentation of AOA competencies. (free form) OGME review of annual reports, monitoring of board pass rates, program inspections OPTI review at annual site visit, OGME review of annual reports and quarterly evaluations, COMLEX-USA Level 3 test results
Does the OPTI provide active assistance to programs in developing corrective action plans? (yes/no)
Yes 13 10
No 0 1
  Abbreviations: AOA, American Osteopathic Association; COMLEX-USA, Comprehensive Osteopathic Medical Licensing Examination-USA; ICCP, Institutional Core Competency Plans; OGME, Osteopathic Graduate Medical Education; OPTI, Osteopathic Postdoctoral Training Institution.
×
Also of note, during the past 2 years OPTIs have generally increased review of institutional core competency plans and monitoring of OGME trainee progress toward graduation. In addition, more OPTIs reported having an OPTI administrator separate from the Chief Academic Officer in 2011 than in 2009. The addition of a separate administrator may be attributed to the increased OPTI responsibilities over the past 2 years. 
In 2009, Duffy and Martinez8 reported that highly accredited OPTIs (ie, those with 4- or 5-year accreditation awards) are more likely than lower accredited OPTIs (ie, those with accreditation awards of 3 years or less) to have higher quality postdoctoral training programs (ie, programs accredited for 4 or 5 years). As OPTIs transition into their new roles as program academic sponsors, and as additional data are collected by means of the OPTI Annual Report, it is prudent to track OPTI responses and the impact they have on program quality.8 In using such information, the AOA and COPTI will be able to provide additional detailed data on OPTI operations and their effect on program quality. In short, they will be able to continue to answer the question, “Where are OPTIs going?”9 
Conclusion
In 2011, the AOA and the COPTI saw substantial changes to the role of OPTIs in OGME. As OPTI academic sponsorship of programs becomes effective in July 2012, the data collected from OPTI annual reports, OPTI inspections, and program inspections will highlight OPTI functions that are effective or need improvement. This information will lead to greater understanding of how OPTIs can best sponsor and improve OGME programs. 
   Financial Disclosures: None reported.
 
References
American Osteopathic Association. AOA Basic Documents for Postdoctoral Training. Chicago, IL: American Osteopathic Association; 2011. http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/aoa-basic-document-for-postdoctoral-training.pdf. Accessed December 19, 2011.
Meyer CT, Portanova R, Riley Cet al. The anatomy of an OPTI: part 2. The CORE system. Ohio Osteopathic Hospital Association. Ohio Association of Osteopathic Medical Directors. Ohio Osteopathic Association [abstract]. J Am Osteopath Assoc. 1997;97(11):686. http://www.jaoa.org/cgi/content/abstract/97/11/686. Accessed December 19, 2011.
American Osteopathic Association. Report of the Education Policy and Procedure Review Committee III. Chicago, IL: American Osteopathic Association; 2011. http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2011-midyear-meeting-documents/EPPRC-report.pdf. Accessed December 19, 2011.
Duffy T, Martinez B. Examining OPTI operations with a new light. J Am Osteopath Assoc. 2010;110(3):160-167. http://www.jaoa.org/content/110/3/160. Accessed December 19, 2011.
American Osteopathic Association. OPTI Accreditation Handbook. Chicago, IL: American Osteopathic Association; 2010. http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/Documents/opti-accreditation-handbook.pdf. Accessed December 19, 2011.
American Osteopathic Association. OPTI Accreditation Reviewer Crosswalk. Chicago, IL: American Osteopathic Association; 2011. http://www.osteopathic.org/inside-aoa/Education/opti-clearinghouse/Documents/OPTI-Inspection-Crosswalk-2011.pdf. Accessed January 18, 2012.
Duffy T. Accrediting osteopathic postdoctoral training institutions. J Am Osteopath Assoc. 2011;111(4):258-262. http://www.jaoa.org/content/111/4/258. Accessed December 19, 2011.
Duffy T, Martinez B. OPTImizing osteopathic postdoctoral training institutions. J Am Osteopath Assoc. 2009:109(3):154-159. http://www.jaoa.org/cgi/content/109/3/154. Accessed December 19, 2011.
Peska DN, Opipari MI, Watson DK. Osteopathic postdoctoral training institutions: a decentralized model for facilitating accreditation and program quality. Acad Med. 2009:84(6):729-732. [CrossRef] [PubMed]
Figure.
Locations of the 20 Osteopathic Postdoctoral Training Institutions (OPTIs) in the United States.
Figure.
Locations of the 20 Osteopathic Postdoctoral Training Institutions (OPTIs) in the United States.
Table 1.
Definitions of the 8 AOA OPTI Standard Sections
AOA OPTI Standard Section Definition
A Prerequisites for accreditation
B Organization, governance, and finance
C Program evaluation
D Research standards
E Faculty and instruction
F Intern and resident status and services
G Curriculum
H Facilities
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
  Source: AOA Basic Documents for Postdoctoral Training.1
Table 1.
Definitions of the 8 AOA OPTI Standard Sections
AOA OPTI Standard Section Definition
A Prerequisites for accreditation
B Organization, governance, and finance
C Program evaluation
D Research standards
E Faculty and instruction
F Intern and resident status and services
G Curriculum
H Facilities
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
  Source: AOA Basic Documents for Postdoctoral Training.1
×
Table 2.
“Must Meet” OPTI Standardsa
Standard Number Description
A.9.1 OPTI shall be a formalized entity.
A.9.2 OPTI shall have at least 1 member hospital; all hospitals must be accredited or licensed.
A.9.3 OPTI shall include membership of at least 1 COM accredited by AOA COCA.
A.9.5 All member institutions of the OPTI must have an affiliation agreement with the OPTI.
A.9.7 OPTI shall academically sponsor a minimum of 2 AOA-approved residency programs, at least 1 of which is in the following specialties: family medicine, general internal medicine, obstetrics and gynecology, general surgery, or general pediatrics.
B.9.13 OPTI shall complete and forward to the AOA an annual report on a schedule set by COPTI but no later than October 1.
  a Effective July 1, 2012.
  Abbreviations: AOA, American Osteopathic Association; COCA, Commission on Osteopathic College Accreditation; COM, college of osteopathic medicine; COPTI, Council on Osteopathic Postdoctoral Training Institutions; OPTI, osteopathic postdoctoral training institute.
  Source: Resolution B-6 [M/2012]—Revisions to the AOA Basic Documents for Postdoctoral Training—Section IX: OPTI Standards. http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-6-Basic-Documents-Section-IX-OPTI-Standards-BOE-COPT-COPTI.pdf.
Table 2.
“Must Meet” OPTI Standardsa
Standard Number Description
A.9.1 OPTI shall be a formalized entity.
A.9.2 OPTI shall have at least 1 member hospital; all hospitals must be accredited or licensed.
A.9.3 OPTI shall include membership of at least 1 COM accredited by AOA COCA.
A.9.5 All member institutions of the OPTI must have an affiliation agreement with the OPTI.
A.9.7 OPTI shall academically sponsor a minimum of 2 AOA-approved residency programs, at least 1 of which is in the following specialties: family medicine, general internal medicine, obstetrics and gynecology, general surgery, or general pediatrics.
B.9.13 OPTI shall complete and forward to the AOA an annual report on a schedule set by COPTI but no later than October 1.
  a Effective July 1, 2012.
  Abbreviations: AOA, American Osteopathic Association; COCA, Commission on Osteopathic College Accreditation; COM, college of osteopathic medicine; COPTI, Council on Osteopathic Postdoctoral Training Institutions; OPTI, osteopathic postdoctoral training institute.
  Source: Resolution B-6 [M/2012]—Revisions to the AOA Basic Documents for Postdoctoral Training—Section IX: OPTI Standards. http://www.osteopathic.org/inside-aoa/events/midyear-meeting/Documents/2012-midyear-meeting-documents/B-6-Basic-Documents-Section-IX-OPTI-Standards-BOE-COPT-COPTI.pdf.
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Table 3.
Commendations and Deficiencies Given to OPTIs for Compliance With AOA OPTI Standards, 2008 to 2011 (N=20)
Commendations or Deficiences, No. Standard Sectionsa
A B C D E F G H Total
Commendations 3 2 1 8 7 1 6 3 31
Deficiencies 3 29 26 17 8 8 9 1 101
  a Definitions of standard sections are found in Table 1.
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
Table 3.
Commendations and Deficiencies Given to OPTIs for Compliance With AOA OPTI Standards, 2008 to 2011 (N=20)
Commendations or Deficiences, No. Standard Sectionsa
A B C D E F G H Total
Commendations 3 2 1 8 7 1 6 3 31
Deficiencies 3 29 26 17 8 8 9 1 101
  a Definitions of standard sections are found in Table 1.
  Abbreviations: AOA, American Osteopathic Association; OPTI, Osteopathic Postdoctoral Training Institution.
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Table 4.
Sample Questions and Comparison of OPTI Overall Responses From the 2009 and 2011 AOA Annual Reports
Sample Question 2009 Summary Responses4 (N=13) 2011 Summary Responses (N=11)
Does your OPTI have an OPTI Administrator that is separate from the Chief Academic Officer? (yes/no)
Yes 9 11
No 4 0
Please choose the OPTI organizational structure that best describes the OPTI. (multiple choice)
501(c)(3) 4 3
LLC 0 0
Partnership 1 1
Consortium 8 7
Are the individual partner and aggregate ICCP submissions reviewed by the OPTI OGME committee to determine needed new educational or evaluation strategies? (yes/no)
Yes 9 11
No 4 0
Describe the OPTI process for monitoring OGME trainee progress toward graduation including the documentation of AOA competencies. (free form) OGME review of annual reports, monitoring of board pass rates, program inspections OPTI review at annual site visit, OGME review of annual reports and quarterly evaluations, COMLEX-USA Level 3 test results
Does the OPTI provide active assistance to programs in developing corrective action plans? (yes/no)
Yes 13 10
No 0 1
  Abbreviations: AOA, American Osteopathic Association; COMLEX-USA, Comprehensive Osteopathic Medical Licensing Examination-USA; ICCP, Institutional Core Competency Plans; OGME, Osteopathic Graduate Medical Education; OPTI, Osteopathic Postdoctoral Training Institution.
Table 4.
Sample Questions and Comparison of OPTI Overall Responses From the 2009 and 2011 AOA Annual Reports
Sample Question 2009 Summary Responses4 (N=13) 2011 Summary Responses (N=11)
Does your OPTI have an OPTI Administrator that is separate from the Chief Academic Officer? (yes/no)
Yes 9 11
No 4 0
Please choose the OPTI organizational structure that best describes the OPTI. (multiple choice)
501(c)(3) 4 3
LLC 0 0
Partnership 1 1
Consortium 8 7
Are the individual partner and aggregate ICCP submissions reviewed by the OPTI OGME committee to determine needed new educational or evaluation strategies? (yes/no)
Yes 9 11
No 4 0
Describe the OPTI process for monitoring OGME trainee progress toward graduation including the documentation of AOA competencies. (free form) OGME review of annual reports, monitoring of board pass rates, program inspections OPTI review at annual site visit, OGME review of annual reports and quarterly evaluations, COMLEX-USA Level 3 test results
Does the OPTI provide active assistance to programs in developing corrective action plans? (yes/no)
Yes 13 10
No 0 1
  Abbreviations: AOA, American Osteopathic Association; COMLEX-USA, Comprehensive Osteopathic Medical Licensing Examination-USA; ICCP, Institutional Core Competency Plans; OGME, Osteopathic Graduate Medical Education; OPTI, Osteopathic Postdoctoral Training Institution.
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