At the November 2003 meeting of the ECCOPT, ERAS® submitted a proposal that the Committee reviewed in detail. Recommendation was made and approved by the Council on Postdoctoral Training and forwarded to the Bureau of Professional Education for its approval as well. 

The AOA Board of Trustees granted final approval at its meeting in February 2004. 

In May 2004, the AOA and the AAMC entered into an agreement for the purpose of advancing the philosophy and practice of osteopathic medicine. ERAS® will open to the osteopathic medical community to help facilitate applications and applicants' supporting documents for internship and residency positions in osteopathic graduate medical education (OGME) training programs. 

ERAS® is a service that transmits internship applications, letters of recommendation, deans letters/Medical Student Performance Evaluations, medical school transcripts, Comprehensive Osteopathic Medical Licensing Examination (COMLEX–USA) transcripts, and other supporting credentials from the student and the designated dean's office to internship program directors using the Internet. 

ERAS® is made up of MyERAS® (the Web site where students create their internship application), the Dean's Office Workstation (DWS), the Program Directors Workstation (PDWS), and the ERAS® PostOffice (ERASPO).¹ 

Some advance planning will facilitate the smooth introduction of ERAS® at the college or hospital level. Now is the time to plan for the resources necessary to implement ERAS®, eg, new computers, Internet access, etc. The AAMC has provided a timeline (Table 1) to help identify what needs to be done at each stage. 

At least one fairly new Windows based computer, connected to the Internet, is needed for each user to access and run ERAS®. Minimum and suggested specification for personal computers (PCs) are available on the ERAS® Web site at www.aamc.org/eras. The Web site will also provide a link for program staff, and access to the technical support area. 

The best way to install ERAS® is on a network, with multiple staff viewing the same data. Not only does this method allow for easy sharing of information, but it also allows staff to take advantage of nightly network backups. If an institution is not able to install ERAS® on a network, it should consider how it will back up the application data and documents and should consider purchasing a Zip or Jazz drive. Or, if purchasing a new PC, these students should consider including one with the ability to burn CDs. These are good options for individual users. 

An Internet connection is required to access the ERAS® PostOffice. Most internship programs have access to the Internet through their institution's connection. Institutions that double-click on a browser on their PCs and see a web page do not need to worry. However, if an institution does not have such a connection available, then the OGME program will need to consider how it will access the Internet to download application files. 

Although the ERAS® software is very easy to use and is accompanied by detailed manuals on the entire ERAS® process, many OGME programs like to plan for training of key staff. Special training sessions for osteopathic internship programs will be held in conjunction with the Association of Osteopathic Directors and Medical Educators (AODME) meeting, May 11–15, 2005, at the Hilton El Conquistador Hotel in Tucson, Ariz, and will be free of charge to registered participants. Please check the AODME Web site for conference details and fees at http://www.aodme.org/. Regular ERAS® training will be held in cities around the United States in July and August. The costs are $150 for a half-day session, and attendance normally involves additional costs for travel and overnight accommodations for attendees. 

Each training program will be charged a $250 ERAS® fee. This fee covers the listing of the program in the MyERAS® web site for applicants, the provision of the ERAS® Program Directors Workstation Software (PDWS), and the delivery of application materials via the ERASPO. It also includes year-round support from the friendly and competent ERAS® Helpdesk on all aspects of using ERAS®. 

Sometime in November 2004, each program will receive advance information on how ERAS® works, giving answers to the most frequently asked questions about the use of ERAS®. In January 2005, registration for the upcoming ERAS® season begins. Internship programs can update the listing that will be displayed for applicants in the MyERAS Web site. They can also indicate what type of training is to be offered: traditional, special emphasis, or combined. During registration, internship programs also provide contact information for ERAS® administrative use, such as addresses for mailing manuals and software instructions, numbers for faxing advisories, etc. 

In May 2005, the AODME will meet with the Association for Hospital Medical Education in Tucson, Ariz. In conjunction with this meeting, ERAS® will offer PDWS training. This comprehensive half-day course will give the internship program staff all the skills necessary to successfully introduce ERAS® to their program. During the months of July and August, ERAS® Training will be offered in various US cities. Each year, this training is arranged based on anticipated demand. In 2005, training sessions are planned for Washington, DC, Chicago, Los Angeles, Atlanta, Boston, and New York. 

On July 1, 2005, MyERAS, the applicant Web site, opens for osteopathic medical students to register and start work on their application. On July 15, 2005, The ERASPO opens for the osteopathic internship application season. Applicants may transmit their applications to internship programs; schools and the National Board of Osteopathic Medical Examiners may transmit supporting documents; and osteopathic internship programs may begin downloading application materials (Ms Moira Edwards, assistant vice president for Residency and Fellowship Application Services). 

In 2003, there were 2628 current graduates of colleges of osteopathic medicine (COMs). Table 2 reflects a 1% increase from 2602 COM graduates in 2002. Similarly, the number of approved internship positions increased from 2473 positions in 2002 to 2659 in 2003, nearly an 8% increase. 

The AOA Match provides osteopathic medical students with a means to secure osteopathic internship positions before graduation. Table 3 reflects the variation in student participation in the AOA Intern Registration Program (the Match) by COMs. Forty-eight percent of the 2670 COM graduates (represents the class of 2003 plus 42 from previous years) matched in the 2003 AOA Intern Registration Program. More than 75% of the graduates from Lake Erie College of Osteopathic Medicine, Michigan State University College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine, and the University of Medicine and Dentistry of New Jersey–School of Osteopathic Medicine matched in the AOA Match. Participation in the Match program is generally lower in those COMs residing in states with fewer osteopathic graduate medical training opportunities. Of those students who matched, approximately 89% of the participants matched to their first choice (Table 4). 

A total of 63% of the 2003 COM graduates who matched chose a traditional rotating internship, as shown in Table 5,6. Approximately 27% of the matched graduates chose family practice, internal medicine, or emergency medicine. 

Table 6 reflects the number of AOA-approved internship training positions by state. Approximately 70% of AOA-approved internship training positions reside in Florida, Michigan, New Jersey, New York, Ohio, and Pennsylvania. This percentage represents a slight decline in the proportion of internship positions offered in those six states, from approximately 75% down to 70%. The number of approved internship positions increased in 25 states, whereas the number of approved internship positions decreased in just 8 states. Seven states began offering osteopathic internships again, after lapsing during the last academic year, and three states began offering internship programs after having lapsed for the past several years. 

Beginning with the 2000–2001 Match, COM graduates have been able to register for programs that link internships to AOA-approved second-year residency programs. With the 2003–2004 Match, every specialty offered in either specialty-tracked internships or traditional internships linked with a chosen specialty were represented. Of the 866 linked internship and residency positions offered in 2003–2004, as compared with 785 in 2002–2003, 73% were filled. These figures indicate 10% more linked positions offered versus the number offered the previous year, with a similar percentage filled compared with last year. COM graduates are most receptive to this combined offering because it provides stability and security for subsequent training years. 

Table 7 provides information on osteopathic residency training positions. In the 2003–2004 academic year, there were 549 AOA-approved residency programs, representing a 5.2% increase over the 522 approved programs in the 2002–2003 academic year. In academic year 2003 2004, there were 2327 residents in AOA-approved training, representing an 8% decrease from the 2532 residents in training during 2002–2003. 

The AOA has established mechanisms by which osteopathic physicians may obtain approval for Accreditation Council for Graduate Medical Education (ACGME) training. This approval is key for those osteopathic physicians seeking licensure in states requiring an osteopathic internship or for those desiring osteopathic board certification. Between 2001 and June 2004, a total of 548 osteopathic physicians petitioned the AOA for approval of their first year of ACGME postgraduate training compared with 344 through June 2003, a 60% increase. 

Graduate medical training is continually faced with complex changes within the learning environment of our interns and residents. Growth and reintroduction of osteopathic internship programs into geographic regions, unavailable to graduates during the previous academic year, indicate advancement toward providing osteopathic graduate medical training opportunities for all COM graduates and in all areas of the United States. The AOA continues to work collaboratively with a wide range of stakeholders in the OGME arena to provide quality training opportunities to graduates of our COMs.