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Editorial  |   April 2017
Changes in Osteopathic Medical Education: The Journey Continues
Author Notes
  • From William Carey University College of Osteopathic Medicine in Hattiesburg, Mississippi. Dr McClain is the medical education associate editor of The Journal of the American Osteopathic Association. 
  •  *Address correspondence to Elizabeth K. McClain, PhD, EdS, MPH, William Carey University College of Osteopathic Medicine, Box 207, 498 Tuscan Ave, Hattiesburg, MS 39401-5461. E-mail: emcclain@wmcarey.edu
     
Article Information
Medical Education / Graduate Medical Education
Editorial   |   April 2017
Changes in Osteopathic Medical Education: The Journey Continues
The Journal of the American Osteopathic Association, April 2017, Vol. 117, 208-210. doi:10.7556/jaoa.2017.037
The Journal of the American Osteopathic Association, April 2017, Vol. 117, 208-210. doi:10.7556/jaoa.2017.037
Osteopathic medical education has embarked on an exciting journey of change. However, change is never comfortable. As we prepare the next generation of physicians, we are faced with a task that is both invigorating and daunting. We as medical educators must maintain a solid educational foundation, keeping abreast of the rapid advances in science and in the delivery of health care. We are tasked with teaching, assessing, and establishing entrustment in medical students through Entrustable Professional Activities for graduate medical education (GME). As our world of health care becomes more complex, we must focus not only on health and disease but also on human connections. We must consider the complexity of population health without overlooking the individual. As we do this, we must also remain mindful of our well-being and that of our students. This annual osteopathic medical education theme issue of The Journal of the American Osteopathic Association explores these topics. 
Interprofessional Education and Population Health
Although overall health in the United States has improved over the past 30 years, the Agency for Healthcare Research and Quality consistently reports that differences in patients’ income and ethnicity affect disparities in quality and timeliness of care, access to care, and patient outcomes.1 One increasingly popular approach to address health care disparities is interprofessional collaboration. 
Over the past 2 decades, interprofessional education (IPE) has become an integral teaching component to better understand population health, cultural competency, health literacy, and social determinants of health (SDOH). Medical education is expected to provide opportunities for interprofessional engagement, but it can be challenging to find time and space in an already dense curriculum. In an attempt to address this concern, both the American Association for Colleges of Osteopathic Medicine (AACOM) and the American Association of Medical Colleges (AAMC) have incorporated the Prevention and Population Health Curriculum Framework into published medical student competency documents, thus articulating expected knowledge and skill development for medical school graduates.2-4 
How can IPE approaches be implemented to improve awareness of SDOH? Duffy et al5 explored this question using a transdisciplinary approach with the inclusion of students in the masters of public health (MPH) program on the IPE teams. Students who participated in the IPE program with an MPH student were twice as likely to be aware of the influence of SDOH. However, only nonclinical students were significantly more likely to report the importance of SDOH for the plan of care.5 This study supports an inherent value in the IPE model. However, it also opens the door for additional research using IPE models to transition medical students from personal awareness to public action regarding psychosocial factors of health. 
Blended Learning
As educators, we are constantly pursuing the most effective teaching methods. We are tasked with teaching a vast breadth and depth of material, clinical skills, and clinical decision making while ensuring at least minimal competency and entrustment. We are continually evaluating different approaches to assess positive effects on student knowledge acquisition and application. In 2010, the US Department of Education published an extensive meta-analysis to appraise the evidence surrounding blended learning.6 Students performed better in online learning compared with face-to-face instruction when online learning was integrated with elements of blended learning, including teacher interaction, extra time, and engaged learning.6 
Langenau et al7 investigated blended learning (online plus face-to-face components) vs standard learning (no online component) in a third-year clinical pediatrics rotation. Students in both settings demonstrated similar scores in knowledge application. However, student survey responses reflected the practicality and effectiveness of the integrated online learning with face-to-face preceptor learning as a helpful balance.7 Additional exploration on this topic might further address adult learning theory and the establishment of a social contract. 
Graduate Medical Education
As we move to a single accreditation system for GME, many questions arise regarding the current status of programs accredited by the American Osteopathic Association (AOA) and osteopathic recognition through the Accreditation Council for Graduate Medical Education (ACGME). Buser et al9 illuminate the history, policies, and future directions of the single accreditation system. Important updates to the Comprehensive Osteopathic Medical Licensing Board Examinations-USA are provided by Gimpel et al,10 and Weiting et al11 provide specialty board certification updates. In line with continued GME efforts, we have experienced momentum and needed growth in osteopathic GME.12 Six states and the District of Columbia demonstrated a greater than 50% increase in total number of trainees, and 14 other states recorded growth in the number of training programs. The 2 specialty programs demonstrating the most growth were family medicine and internal medicine.12 This finding is especially encouraging considering that primary care has been identified as a physician workforce aggregate shortage category.8 
Along with GME growth and the transition process, residency placement is increasingly important. VanOrder et al13 investigated the residency interview process across 83 osteopathic and dually accredited programs and specialties. This study identified preferred interview approaches and highly regarded candidate qualities such as ethical behaviors, honesty, self-motivation, and ability to work in a team effectively. Interestingly, no criterion standard was identified that directly corresponded to residents’ performance or program directors’ satisfaction.13 
Promotion and maintenance of osteopathic distinctiveness through osteopathic recognition and osteopathic-focused curricula is incredibly important to the future of the osteopathic medical profession. And, among third-year medical students, 70% reported that an ACGME program with osteopathic recognition was more appealing than one without osteopathic recognition.14 Does familiarity with osteopathic medicine affect program directors’ perceptions of residency candidates? Hempstead et al15 investigated this question and found that residency programs with formal OMT curricula ranked the academic preparation of osteopathic residents higher than did programs without. In addition, program directors of dually accredited programs rated the clinical preparedness of osteopathic residents higher when compared with program directors of programs with ACGME-only accreditation.15 Points of discussion for further inquiry include: Does exposure and familiarity with OMT curricula reduce preconceived biases against osteopathic medicine? Will osteopathic recognition through the ACGME positively affect our future osteopathic residents by exposing other health care professionals to OMT and osteopathic medicine? 
The final article of this issue considers the most important aspect of medicine: humanism. Key habits that affect humanism and potentially reduce physician burnout are seeking a connection with patients and achieving work-life balance. These habits have positive effects on patients and physicians alike.16 Both AACOM and the AAMC have directed focus on a broad spectrum of factors influencing humanism, including mental health and well-being, physician burnout, mindfulness, resilience, and empathy. Programs that promote humanism encourage students to identify and practice effective skills in patient observation and connections, but skills are not always measureable through traditional approaches. Baltonado, a third-year osteopathic medical student, and Cymet17 present a well-articulated journey through humanism and medicine. They encourage us to be reflective and creative and challenge us to maintain or reestablish our joy in medicine through humanistic engagement with our patients. 
Call to Action
As we continue our journey through ACGME accreditation and begin to look more deeply into the value of what it means to truly be osteopathic, how can we effectively promote and integrate osteopathic tenets with osteopathic recognition for osteopathic medical graduates as well as allopathic medical graduates who demonstrate interest in the osteopathic tenets? We are challenged not only to encourage and teach humanism in medicine, but also to demonstrate practices that promote humanism in our own lives. We are encouraged as educators to address new learning modalities to promote engagement and application of knowledge and skills. As we navigate the future of osteopathic medical education, let us envision change, explore collaborative practices, and test innovative approaches to promote what makes us osteopathic. 
References
Quality and quality disparities. Agency for Healthcare Research and Quality. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/key2.html. Published April 2015. Accessed February 22, 2017.
About. The Clinical Prevention and Population Health Curriculum Framework website. http://www.teachpopulationhealth.org/about.html. Accessed March 6, 2017.
American Association of Colleges of Osteopathic Medicine, in conjunction with all U.S. Osteopathic Medical Schools. Osteopathic Core Competencies for Medical Students. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; 2012. http://www.aacom.org/docs/default-source/insideome-2012/corecompetencyreport2012.pdf?sfvrsn=0. Accessed March 6, 2017.
Maeshiro R, Johnson I, Koo D, et al Medical education for a healthier population: reflections on the Flexner Report from a public health perspective. Acad Med. 2010;85(2):215. doi:10.1097/ACM.0b013e3181c885d8 [CrossRef]
Duffy PA, Ronnebaum JA, Stumbo TA, Smith KN, Reimer RA. Does including public health students on interprofessional teams increase attainment of interprofessional practice competencies? J Am Osteopath Assoc. 2017;117(4):244-252. doi:10.7556/jaoa.2017.042
Means B, Toyama Y, Murphy R, Bakia M, Jones K; Center for Technology in Learning. Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies. Washington, DC: US Dept of Education, Office of Planning, Evaluation, and Policy Development; 2010. https://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf. Accessed February 20, 2017.
Langenau EE, Lee R, Fults M. Blended learning educational format for third-year pediatrics clinical rotation. J Am Osteopath Assoc. 2017;117(4):234-243. doi:10.7556/jaoa.2017.041
HIS, Inc. The Complexities of Physician Supply and Demand: Projections From 2013 to 2025: Final Report. Washington, DC: American Association of Medical Colleges; 2015.
Buser BR, Swartwout J, Lischka T, Biszewski M, DeVine K. Single accreditation system update: gaining momentum. J Am Osteopath Assoc. 2017;117(4):211-215. doi:10.7556/jaoa.2017.038
Gimpel JR, Horber D, Sandella JM, Knebl JA, Thornburg JE. Evidence-based redesign of the COMLEX-USA series. J Am Osteopath Assoc. 2017;117(4):253-261. doi:10.7556/jaoa.2017.043
Wieting JM, Weaver JL, Kramer JA, Morales-Egizi L. Appendix 2: American Osteopathic Association specialty board certification. J Am Osteopath Assoc. 2017;117(4):268-271. doi:10.7556/jaoa.2017.045
Martinez B, Biszewski M. Appendix 1: osteopathic graduate medical education, 2017. J Am Osteopath Assoc. 2017;117(4):262-267. doi:10.7556/jaoa.2017.044
VanOrder T, Robbins W, Zemper E. Residency program directors’ interview methods and satisfaction with resident selection across multiple specialties. J Am Osteopath Assoc. 2017;117(4):226-232. doi:10.7556/jaoa.2017.040
Survey results: appeal of ACGME-accredited programs with osteopathic recognition among third year osteopathic medical students. American Association of Colleges of Osteopathic Medicine. http://www.aacom.org/docs/default-source/single-gme-accreditation/or-survey-may-2015.pdf?sfvrsn=8. Accessed February 21, 2017.
Hempstead LK, Shaffer TD, Williams KB, Arnold J. Attitudes of family medicine program directors toward osteopathic residents under the single accreditation system. J Am Osteopath Assoc. 2017;117(4):216-224. doi:10.7556/jaoa.2017.039
Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014;89(9):1252-1258. doi:10.1097/ACM.0000000000000405 [CrossRef] [PubMed]
Baltonado J, Cymet T. Can the humanities humanize health care? J Am Osteopath Assoc. 2017;117(4):273-275. doi:10.7556/jaoa.2017.046