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Letters to the Editor  |   May 2014
Osteopathic Graduate Medical Education: New Research Standards Needed
Author Affiliations
  • Howard M. Shulman, DO
    Midwestern University Osteopathic Postdoctoral Training Institution (MWU/OPTI); Osteopathic Graduate Medical Education Committee; Midwestern University/Arizona College of Osteopathic Medicine, Glendale
  • Kimbal Cooper, PhD
    Biomedical Sciences, Midwestern University, Glendale, Arizona
  • William Devine, DO
    Midwestern University Multispecialty Clinic Plus One Residency; Midwestern University Osteopathic Training Institute, Glendale, Arizona
  • Marc Trzeciak, DO
    Valley Consortium for Medical Education, Doctors Medical Center, Orthopedic Residency, Modesto, California
  • Umema Burney, DO
    Internal Medicine Resident, Verde Valley Medical Center, Flagstaff, Arizona
  • Wai Phan Chan, DO
    Dermatology Resident, Sierra Vista Regional Health Center, Arizona
  • Adrian Gomez, DO
    Emergency Medicine Resident, Kingman Regional Medical Center, Arizona
  • Joseph Humpherys, DO
    Orthopedic Resident, Valley Consortium for Medical Education, Doctors Medical Center, Modesto, California
  • Hadi Safavi, DO
    Family Medicine Resident, Sierra Vista Regional Health Center, Arizona
  • Miho Yoshida, DO
    Midwestern University Multispecialty Clinic Plus One Residency, Glendale, Arizona
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   May 2014
Osteopathic Graduate Medical Education: New Research Standards Needed
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 336-339. doi:10.7556/jaoa.2014.068
The Journal of the American Osteopathic Association, May 2014, Vol. 114, 336-339. doi:10.7556/jaoa.2014.068
To the Editor: 
The American Osteopathic Association (AOA) Council on Research, in their 2013-22 Research Stategic Plan for the Osteopathic Medical Profession1 and their subsequent article in The Journal of the American Osteopathic Association (JAOA),2 has called for setting research standards, vigorously encouraging research, and enforcing research standards at every college of osteopathic medicine (COM) and osteopathic postdoctoral training institution (OPTI). In light of this challenge, our group embarked on a review of the current state of research requirements in both osteopathic and allopathic graduate medical education (GME). 
We compiled and reviewed the following items:
  1.  
    all current specialty postdoctoral research basic standards approved by the Council on Osteopathic Postdoctoral Training (COPT) (available at http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Pages/default.aspx)
  2.  
    the Common Program Requirements3 of the Accreditation Council for Graduate Medical Education (ACGME)
  3.  
    the 2013-22 Research Strategic Plan for the Osteopathic Medical Profession1
  4.  
    The Basic Documents for Postdoctoral Training,4 and specifically the mission statement for postdoctoral training regarding research
  5.  
    the special report published in the September 2013 issue of the JAOA, titled “2013-2022 Strategic Plan for Research: A Role for Everyone in Promoting Research in the Osteopathic Medical Profession”2
  6.  
    the recent JAOA letter to the editor from Robert A. Cain, DO, “Relighting the Fire in Our Bellies”5
  7.  
    “Defining Scholarly Activity in Graduate Medical Education”6 in the December 2012 issue of the Journal of Graduate Medical Education
On the basis of our work, we have concluded that individual specialty-specific research requirements exist in the specialty-specific basic standards but not in the AOA's The Basic Documents for Postdoctoral Training4 or to any degree in the ACGME's Common Program Requirements.3 By incorporating information from the aforementioned documents with our own ideas, we propose that such overriding research standards be adopted for inclusion The Basic Documents for Postdoctoral Training and the Common Program Requirements. Our proposal includes separate standards for internships and residencies and fellowships, as outlined in the remainder of our letter. 
Residents and Interns: Research and Scholarly Activity
  1.  
    Each research project must demonstrate its relevance to osteopathic medicine.
  2.  
    The project must be approved by and overseen by the program director with input from faculty members.
  3.  
    The research topic must be pertinent to the specialty of the intern or resident.
  4.  
    Each program will have a written research curriculum for each year of the internship or residency.
  5.  
    The internship or residency curriculum must be in conjunction with The Basic Documents for Postdoctoral Training and the internship or residency specialty-specific basic standards research requirements.
  6.  
    Each program and its OPTI shall provide administrative and institutional review board support for the research project, including ready access to mentoring, literature searching, editing, statistical assistance, and presentation production.
  7.  
    Each intern or resident will complete 1 approved project for each year of internship or residency.
  8.  
    A resident cannot do a single type of approved project more than once during his or her residency.
  9.  
    Residents will provide a narrative description of the scholarly activity (eg, research paper, poster, community education/service) with documentation as necessary. This narrative should be more detailed than the narrative provided in the program directors annual evaluation of the resident and should be signed by the program director. Scholarly activity will be filed and subject to review by site visitors during their review of a program for continuing approval.
  10.  
    The base institution should allocate adequate time and educational resources to facilitate intern or resident involvement in research and scholarly activity.
Fellows: Research and Scholarly Activity
  1.  
    Each research project must demonstrate its relevance to osteopathic medicine.
  2.  
    The project must be approved and overseen by the program director with input from faculty members.
  3.  
    The research topic must be pertinent to the specialty of the fellow.
  4.  
    Each program will have a written research curriculum for each year of the fellowship.
  5.  
    The fellowship curriculum must be in conjunction with The Basic Documents for Postdoctoral Training and the fellowship specialty-specific basic standards research requirements.
  6.  
    The base institution should allocate adequate time and educational resources to facilitate the fellow's involvement in research and scholarly activity.
  7.  
    Each program and its OPTI shall provide administrative and institutional review board support for the research projects, including ready access to mentoring, literature searching, editing, statistical assistance, and presentation production.
  8.  
    Each fellow will do 1 approved project for each year of fellowship.
  9.  
    The fellow must submit a research or scholarly paper each year during their fellowship to the JAOA or another appropriate scientific journal for publication.
  10.  
    The fellow must submit 1 scientific paper for presentation at a suitable state, national, or international meeting once during their fellowship, and that presentation should be approved by the program director.
  11.  
    An original scientific study can be conducted over several years or throughout the entire fellowship as long as goals are met annually and the paper is completed before the fellow completes training. The format of the paper will be determined by the instructions to authors listed on the journal's website.
  12.  
    The fellow must present his or her research paper to the program faculty in the first 6 months of his or her last year of fellowship training.
Types of Research Allowed
Clinical Research
Examples of clinical research include, but are not limited to, an original scientific paper, poster session, literature review, case study, or new procedure report. For a scientific paper, the requirements would be as follows:
  1.  
    The AOA requires all residents to demonstrate the ability to synthesize and apply medical research data in their training. Writing an original scientific research paper is 1 method to evidence this training. Through this process, the resident may improve cognitive skills and learn to manage and communicate medical information more effectively.
  2.  
    An original scientific paper can be completed over several years or throughout the entire residency as long as goals are met annually and the paper is completed before the resident completes training. The format of the paper would be determined by the instructions to authors listed on the journal's website.
  3.  
    The scientific paper must be suitable for publication and submitted to the JAOA or another appropriate scientific journal.
  4.  
    Scholarly activity must be approved by the program director and a narrative of the activity must be completed and submitted. Credit will be allocated among the resident authors according to the program director's recommendation.
For a poster session, the requirements would be as follows:
  1.  
    Poster sessions are an in-depth exchange of information on a one-to-one basis, providing a medium for unusual or multiple clinical case presentations prepared with photographs and laboratory or radiologic information. Documentation of this activity requires a photograph of the poster session and written statement that the poster was exhibited by the resident who prepared the poster. A resident's folder for this activity should also include a written description of at least 250 words of the objective, methods, and summary of outcomes of the clinical case presented.
  2.  
    The poster must be submitted for presentation at a state, national, or international meeting.
Community-Based Effort
For all community-based activities, written documentation of the resident's community-based efforts will be available and kept in the resident's file. Examples of community-based activities include quality improvement programs, community education, and community service. 
In quality improvement programs, residents may select a specific health improvement or disease prevention issue or need within a community. The resident must identify a population of interest within a community, summarize the problem and the population, review the current literature, perform a needs assessment, and design, implement, and evaluate an intervention to address the issue or need. 
Community education may consist of a well-planned lecture to a locally recognized community group or a presentation at a state, national, or international level. Community service may consist of implementing a program and subsequently delivering medical care to an underserved or impoverished area or population. Medical mission trips would fall into this category. 
Medical Education Quality Initiative
Residents who wish to pursue medical education research projects must identify a process or program need, review the current literature, perform a needs assessment, and design, implement, and evaluate the proposed improvement project. An example of a Medical Education Quality Initiative would include, but would not be not limited to, preparing 3 lectures to be given in 3 different venues to the house staff, evaluating the resident's effectiveness as a lecturer, and testing the knowledge retained by the attendees. Written documentation of the resident's community-based efforts will be available and kept in the resident's file. 
Practice Improvement Outcome
For research related to a practice improvement outcome, the resident should obtain a grant for a scientific project or scholarly activity and should serve 1 year on the program's institutional review board. In addition, practice improvement outcomes may include, but are not limited to, designing and completing a project for presentation at grand rounds focusing on the root-cause analysis of a systems error occurring in the care of the patient. Another example might be for the resident to review a published clinical practice guideline using an evidence-based approach and audit office charts to compare treatment, screening, or diagnostic testing of patients with the recommendations of the guideline. 
Implementing Change
Although these standards would be included in The AOA Basic Documents for Postdoctoral Training, each specialty college would continue to define the scope of research performed in their programs selected from the ones listed. The osteopathic medical profession should then recommend that these or similar standards be incorporated in the ACGME's Common Program Requirements. 
We believe that only by setting high standards for our trainees can we instill in the next generation of osteopathic and allopathic physicians the rigor and values that have made our profession great and expand the quality and quantity of osteopathic medical research. 
References
AOA Council on Research. 2013-22 Research Strategic Plan for the Osteopathic Medical Profession. Chicago, IL: American Osteopathic Association; 2013.
Degenhardt BF, Standley PR. 2013-2022 strategic plan for research: a role for everyone in promoting research in the osteopathic medical profession. J Am Osteopath Assoc. 2013;113(9):654-659. doi:10.7556/jaoa.2013.029. [CrossRef] [PubMed]
Common Program Requirements. Chicago, IL: Accreditation Council for Graduate Medical Education; 2011. http://www.acgme.org/acgmeweb/Portals/0/dh_dutyhoursCommonPR07012007.pdf. Accessed April 1, 2014.
The Basic Documents for Postdoctoral Training. Chicago, IL: American Osteopathic Association; 2013. http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/aoa-basic-document-for-postdoctoral-training.pdf. Accessed April 1, 2014.
Cain RA. Relighting the fire in our bellies. J Am Osteopath Assoc. 2013;113(8):598-599. doi:10.7556/jaoa.2013.020. [CrossRef] [PubMed]
Grady EC, Roise A, Barr Det al. Defining scholarly activity in graduate medical education. J Grad Med Educ. 2012;4(4):558-561. doi:10.4300/JGME-D-12-00266.1. [CrossRef] [PubMed]