In the past 3 years, since the September 2003 launch of the new Trainee Information, Verification, and Registration Audit (TIVRA) system—and in line with the American Osteopathic Association's (AOA) original projections—there has been a steadily increasing level of compliance from osteopathic internship and residency programs reporting required data to the AOA's division of postdoctoral training. The most recent and dramatic increase in these compliance levels appears to be the direct result of several osteopathic postdoctoral training institutions (OPTIs) introducing assistive software—either proprietary or self-designed—to their consortia, enabling more rapid and accurate processing of the data required by the TIVRA system.
Annual data on osteopathic graduate medical education (OGME) is also reported based on the AOA's Intern/Resident Registration Program (ie, the “Match”). When compared with the data reported for the class of 2003 in THE JOURNAL's Osteopathic Medical Education 2004 issue,
1 there has been a 5% increase in the number of graduates from colleges of osteopathic medicine (COMs) in the class of 2004. Concurrently, there has been an increase of 2.5% for approved internships available to these graduates during this time.
So-called match rates through the AOA's Intern/Resident Registration Program have remained relatively steady at 48%, with 93% of participating COM graduates being matched to their first choice training program. For match participants, the majority (65%) seek and obtain traditional rotating internships, followed by internships in family practice (10%), internal medicine (10%), and emergency medicine (6%).
The AOA division of postdoctoral training launched the TIVRA system in September 2003 to replace the previous paper-based protocol for osteopathic internship and residency programs, all of which were required by the AOA to (1) submit signed intern and resident contracts to the AOA; (2) verify the status of all osteopathic medical interns, residents, and fellows who have completed training in the previous academic year; and (3) update AOA records with any program changes. Without this vital information from osteopathic internship and residency programs, the AOA is unable to finalize the certification process for osteopathic trainees. One additional advantage of the new system over the old paper-based system is that TIVRA allows the AOA to track the educational progression of osteopathic trainees from the moment they enter an internship or residency program.
Strong, accurate, and verifiable OGME data is critical to the osteopathic medical community, which relies on the regular and accurate reporting of this information. The AOA's division of postdoctoral training provides statistics—based directly on TIVRA data—that are used by the Association for the following purposes:
to define the osteopathic medical profession in terms of potential workforce strength,
to document trends in the various medical specialties,
to record internship and residency program “fill rates,”
to allow the Association to anticipate future shortages of OGME programs, and
to report on OGME positions funded through the Center for Medicare and Medicaid Services (CMS).
Finally, because it is not in the purview of the AOA to track allopathic training data for COM graduates, the OGME data available to the division of postdoctoral training allows the Association to make more accurate assumptions about the number of physicians who have opted to receive their residency training through programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
In fact, low compliance rates with TIVRA reporting methods have had a direct impact on the “hassle factor” for osteopathic physicians. For example, some specialties (eg, family practice) allow their residents to take certifying examinations 6 months prior to graduation. However, when the internship and residency programs have not verified training completion for physicians, board certification certificates cannot be released. In addition, with regard to AOA advocacy efforts, data accuracy is needed when the AOA lobbies Capital Hill for issues concerning OGME (M.J. Hardy, JD, oral communication, January 2006).
Accurate reporting of TIVRA data from the osteopathic internship and residency programs ensures the AOA's ability to represent the vitality and growth of the profession accurately. In the past, incomplete reporting on the part of osteopathic internship and residency programs may have underrepresented the strength of OGME in the United States, leading the programs themselves—as well as their constituents (eg, specialty colleges and COMs)—to make inaccurate conclusions based on the data presented by the AOA.
For these reasons, the AOA determined that it was essential to establish a target date for osteopathic internship and residency programs to achieve a level of 100% compliance with TIVRA reporting methods. On the inception of TIVRA, the goal for compliance was set at 2007—and every year subsequent. As of publication, the division of postdoctoral training is pleased to announce that this goal seems well within reach.
At the end of 2003, the AOA had 746 approved internship and residency programs, for a combined total of 7567 approved internship and residency positions. Out of those 746 internship and residency programs, however, the AOA noted a compliance rate of 45% for TIVRA reports.
The AOA had 782 approved internship and residency programs in 2004, representing a total of 7817 approved positions. For that year, the AOA noted a compliance rate of 59% for the required TIVRA reports.
In 2005, the AOA had 843 approved internship and residency programs, for a total of 8370 positions. For the 843 programs approved, the division of postdoctoral training recorded a TIVRA compliance rate of 93%.
The division of postdoctoral training believes that the 34% increase in compliance rates seen in 2005 was due mainly to the diligence of two OPTIs: the OPTI partners of the Centers for Osteopathic Research and Education in Athens, Ohio, and the Statewide Campus System/Michigan State University College of Osteopathic Medicine (MSUCOM) OPTI in East Lansing. Both consortia were able to make use of systems for data importation that reduced the amount of manual entry required by consortia partners to provide comprehensive records to the AOA through TIVRA. As noted, one OPTI purchased proprietary software with data fields that match the data collected by TIVRA, while the other chose to design and create their own software to serve the same purpose.
Since its inception in 2003, the TIVRA system has undergone annual revisions aimed at improving usability and the overall quality of the data collected. Past improvements have included:
a help guide,
a toll-free telephone help line,
an e-mail address for end-user support,
data validation features,
a Copy function to reduce manual input,
a TIVRA report, and
additional import functions for some users.
Future versions of TIVRA are currently under development to assist the end-user's ability to import the most current OGME data.
Although the division of postdoctoral training introduces updates and improvements to TIVRA each year to assist end users, it is the hope of the AOA that more OPTIs will seek to serve their partners in the role of facilitators in 2006, leading to a similar increase in their OPTI compliance levels in the TIVRA program.