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Editorial  |   January 2017
Keeping Osteopathic Medicine Osteopathic in a Single Accreditation System for Graduate Medical Education
Author Notes
  • From the Interim Clinical Dean at Touro College of Osteopathic Medicine in New York, New York, Dr Levine started more than 140 residency positions at 3 different hospitals in Hudson County, New Jersey, as the director of medical education and served as the family medicine residency director. He is a past-president of the American Osteopathic Association. 
  •  *Address correspondence to Martin S. Levine, DO, 230 W 125th St, New York, NY 10027-4402. E-mail: martin.levine@touro.edu
     
Article Information
Medical Education / Graduate Medical Education
Editorial   |   January 2017
Keeping Osteopathic Medicine Osteopathic in a Single Accreditation System for Graduate Medical Education
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 4-6. doi:10.7556/jaoa.2017.001
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 4-6. doi:10.7556/jaoa.2017.001
Web of Science® Times Cited: 1

Keywords: graduate medical education, osteopathic recognition, single accreditation system

Nearly one and a half years into the transition to the single accreditation system for graduate medical education (GME),1 more than 700 programs currently accredited by the American Osteopathic Association (AOA) have applied or are in the process of applying for accreditation through the Accreditation Council for Graduate Medical Education (ACGME). With a few years left before all osteopathic GME (OGME) and ACGME programs are accredited by the ACGME, the AOA expects many more of the remaining 500 programs to complete the application process within the allotted time frame.2 
As part of the agreement between the ACGME, the AOA, and the American Association of Colleges of Osteopathic Medicine to ensure a route for continued distinctive osteopathic training, all programs (osteopathic and allopathic) can apply for osteopathic recognition. Unfortunately, only about 14% of AOA programs that have achieved initial ACGME accreditation have applied for osteopathic recognition. 
Osteopathic Distinctiveness
Allopathic institutions value the role that osteopathic distinctiveness plays in the quality and future of the nation’s health care system. (Indeed, 17% of osteopathic recognition applications are from ACGME programs.) The osteopathic medical profession embodies essential aspects of quality patient care—touch, communication, empathy, and holistic care. The majority of osteopathic physicians, or DOs, practice in primary care specialties, predominantly in family medicine,3 and thus serve as their patients’ first contact of care. 
We, the members of the osteopathic medical profession, are also largely dedicated to serving the underserved. Our newest osteopathic medical schools are opening in rural and underserved areas, from Dothan, Alabama, to Las Cruces, New Mexico, where students are expected to stay and practice after training. Existing colleges of osteopathic medicine (COMs) have demonstrated that their graduates can improve the population health of a region, as they have in Appalachia.4 
Our research base for the effectiveness of osteopathic manipulative treatment is growing and will only continue to do so with the increase in funding provided by the AOA and osteopathic foundations to various research priorities.5 Osteopathic physicians are instilled with a whole-person approach to care—considering the interrelationship of body, mind, and spirit—in their medical school training. Perhaps this understanding influenced the findings of Calabrese et al6 and Kimmelman et al7: unlike allopathic medical students’ empathy levels, osteopathic medical students’ empathy levels did not drop from their first to third year of medical school. 
Pursuit of Osteopathic Recognition
All of these aspects of osteopathic medicine are valuable, but to keep trainees on the osteopathic path in a single GME accreditation system, OGME programs must seek osteopathic recognition. Will DOs and MDs who train in ACGME programs without osteopathic recognition have an opportunity to become highly skilled primary care physicians and specialists? Absolutely. However, it is that extra training in the whole-person perspective that sets osteopathic physicians apart, even in osteopathic residency programs.8 If osteopathic recognition isn’t sought, DO residents will miss that training, and what does that mean for the future of our profession? Perhaps more importantly, what does that mean for population health globally? 
It is clear that we as a profession and the public need OGME programs to pursue osteopathic recognition after starting the ACGME accreditation process. So why haven’t they? Perhaps program directors view it as too time consuming. The fact is that the osteopathic recognition application is shorter, and much of the information requested is similar to what program directors have already provided to the AOA. Data from the ACGME application is automatically populated into the osteopathic recognition application, and no application fee or site inspection is required. 
Many program directors have reported that completing the application process led to improvements in their programs.9 Furthermore, the AOA now offers free support to any program willing to take that leap by contacting singleGME@osteopathic.org. 
Sustaining Competitiveness
As we transition to the single accreditation system, we must also consider the requirements and expectations of existing ACGME programs. By 2020, all osteopathic medical students will be competing with allopathic and international medical students for training positions. Faculty and leadership in the profession must ensure that osteopathic medical students are competitive. Sure, that includes grade point averages and scores on licensing examinations, but we can’t neglect the need to get students involved in scholarly activity. Participation in research, which is often a major factor used by program directors in selecting applicants, is a major component of ACGME accreditation. 
Call to Action
Now is the time for OGME programs to step up and apply for ACGME accreditation and osteopathic recognition. Here are some key steps that OGME programs can take: 
  • ■ Before doing anything, learn about the ACGME application process at ACGME.org.
  • ■ Enlist help from your OGME colleagues. Reach out to singleGME@osteopathic.org for free professional guidance and support.
  • ■ Begin the ACGME accreditation application, and refer to the ACGME’s instruction guide (http://www.acgme.org/Portals/0/PDFs/Application_Guide.docx). Recognize that although it may take 2 to 3 months to complete the application, most of the items align with information that was required for AOA accreditation. Submit the application only after each item has been answered.
  • ■ Commit to providing distinct osteopathic training by applying for osteopathic recognition. Learn more about osteopathic recognition by reading the Osteopathic Recognition Application Guide (http://www.acgme.org/Portals/0/PFAssets/ProgramResources/OR_Application_Instructions.pdf) and by viewing the webinar “Osteopathic Recognition: Understanding the Application and Common Pitfalls” at http://aodme.org/cme/aodme-webinars/november-17th-2016/.
It is up to all of us to make sure that osteopathic medicine is embedded in the fabric of the US medical education system. For those who are not OGME program directors, I urge you to reach out to your institutions and push them to pursue osteopathic recognition. Our students are the future of the osteopathic medical profession. They are bright, engaged, and enthusiastic about the opportunity to be osteopathic physicians, and they want to pursue programs with osteopathic recognition.10 The need is great. Let’s not let them down. 
References
The single GME accreditation system. American Osteopathic Association website. http://www.osteopathic.org/inside-aoa/single-gme-accreditation-system/Pages/default.aspx. Accessed October 19, 2016.
Accreditation Council for Graduate Medical Education (ACGME) – Public. ACGME website. https://apps.acgme.org/ads/Public/Reports/Report/18. Accessed November 1, 2016.
2015 Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 2015. http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2015-OMP-report.pdf. Accessed October 17, 2016.
Leibold C, Shubrook JH, Nakazawa M, Drozek D. Effectiveness of the complete health improvement program in reducing risk factors for cardiovascular disease in an Appalachian population. J Am Osteopath Assoc. 2016;116(2):84-91. [CrossRef] [PubMed]
Samano K. DOs, researchers awarded $1 million to conduct osteopathic research. The DO. June 22, 2016. http://thedo.osteopathic.org/2016/06/dos-researchers-awarded-1-million-to-conduct-osteopathic-research/. Accessed October 19, 2016.
Calabrese LH, Bianco JA, Mann D, Massello D, Hojat M. Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students. J Am Osteopath Assoc. 2013;113(12):898-907. doi:10.7556/jaoa.2013.068 [CrossRef] [PubMed]
Kimmelman M, Giacobbe J, Faden J, Kumar G, Pinckney CC, Steer R. Empathy in osteopathicmedical students: a cross-sectional analysis. J Am Osteopath Assoc. 2012;112(6):347-355. [PubMed]
Snow RJ, Levine MS, Harper DL, McGill SL, Thomas G, McNerney JP. A clinical assessment program to evaluate the safety of patient care. In: Henrikson K, Battles JB, Marks ES, et al, eds. Advances in Patient Safety: From Research to Implementation. Rockville, MD: Agency for Healthcare Research and Quality; 2005. Vol 4: Programs, Tools, and Products.
Raymond R. ‘Right away, people noticed’: residency director on ACGME application. The DO. February 15, 2016. http://thedo.osteopathic.org/2016/02/right-away-people-noticed-residency-director-on-acgme-application/. Accessed October 19, 2016.
Osteopathic recognition matters: medical students value the ‘DO difference.’ The DO. October 28, 2016. http://thedo.osteopathic.org/2016/10/osteopathic-recognition-matters-medical-students-value-the-do-difference/. Accessed November 1, 2016.