In preparing for the summit, the steering committee, which included representatives from the AOA BOT, AACOM, and the American Osteopathic Directors of Medical Education (AODME), was charged with the following: 

In addition, more than 80 issues were forwarded to the committee by the AACOM Board of Deans and the Society of Medical Educators, the AOA House of Delegates and BOT, the AODME, and the Osteopathic Medical Educators Council (now the Bureau of Osteopathic Medical Educators),¹³ as well as the recommendations published in the osteopathic medical education study.¹² The steering committee deliberated extensively to consolidate the more than 80 topics into 25 rank-ordered items that fell into the following four themes: (1) workforce,^7,8,14,15 (2) recruitment,^16,17 (3) funding,^10,18-20 and (4) quality^21-24 (Figure 1). 

To determine who would participate in the summit, the steering committee selected a broad cross-section of the osteopathic profession's constituent groups: students and residents, medical educators from both osteopathic undergraduate medical education and OGME, chairs of the AOA Department of Education committees, officers of the Commission on Osteopathic College Accreditation (COCA), and public members (eg, chief executive officers of hospitals, public advisors to AOA accreditation bodies). Inclusion was based primarily on functional roles that individuals held in their respective organizations. Despite the committee's best attempts at inclusiveness, invitations were limited to meet budgetary and logistic constraints and encourage collaboration among attendees.¹³ 

The steering committee researched relevant topics related to primary areas of concern and then created and distributed a reading list of articles, many of which are referenced in the present piece. These resources were selected to highlight salient features and provide a common background for discussion. In addition, both the AOA Department of Education and AACOM provided substantive data for use and review where and when it was available. 

The inaugural OHF MES—later known as MES I—was held January 26, 2006, through January 29, 2006, in Chicago, Ill. Presentations on physician workforce, osteopathic recruitment, and OGME funding were given by nationally recognized experts. After each presentation, the 70 participants were divided into groups of seven to eight people to deliberate on the challenges relevant to the respective topics and to propose statements for the summit to adopt as consensus statements. Each breakout session was moderated by a trained external facilitator overseen by a steering committee member. For each major topic, the groups were “remixed” to provide maximum dialogue among individuals and to promote a collegial exchange of ideas.¹³ 

For the topic of quality in medical education, participants met in separate focus groups to describe their particular viewpoints about the definition of quality as it relates to osteopathic medical education. Key phrases and concepts defined in these sessions will be used in a large, multisite survey to better understand how students, residents, and even the public view the quality of our medical education programs. Pilot surveys are currently being tested for statistical validation. 

A total of 65 recommended consensus statements were forwarded for deliberation and further discussion during the final MES I session.²⁵ The final session was conducted according to ground rules established by the steering committee early in the planning phases. An electronic audience response system (Turning Point; Turning Technologies LLC, Youngstown, Ohio) was used to tally audience responses (ie, “yes” or “no”) on each individual statement. A 75% consensus vote was required for adoption of the statement as a “Summit Consensus Statement.” If an individual statement did not meet 75% on the first vote, alternate language was incorporated to best meet participants' recommended changes. A second vote was then taken with the incorporated changes. If a 75% vote was not reached, the statement was moved to a “parking lot” for further study or referral to subsequent summits. 

The 2006 OHF Medical Education Summit: Consolidated Consensus Statements²⁵ reflects all 65 statements considered by summit participants. Sixty-one of the statements reached a consensus level of 75% on either the first or second attempt. This striking number of approved consensus statements has proved invaluable to the profession during the past 24 months. Questions concerning opening new COMs, quality standards, and other “boiling points” have been answered, and actions have been predicated on the consensus points determined by this process. Critics will rightfully argue that many of these statements are “no-brainers.” Nonetheless, they stand as a public declaration of a common professional will around key issues. 

The 61 approved statements were regrouped in preparation for the second medical education summit, and a tracking system has been devised to follow action plans. The ongoing MES I progress report, which is being prepared for Web posting (Joyce L. Obradovic, MA, RDH, oral communication, January 2008), will extensively reference documents and accomplishments to date. Figure 2 outlines the progress on several of the consensus statements within the context of these accomplishments.²⁶ Additional substantive plans have been put into action since the June 2007 report,²⁷ and many of them have origins or links to the consensus statements beyond what has been previously reported. 

Now we can move to meaningful and purposeful decisions for critical questions in which agreement has not yet been reached. The following statements reflect the four unresolved issues²⁵: 

These questions were added to the topics and issues to be deliberated during the second medical education summit. 

Because the four statements that did not reach consensus were substantially related to OGME, the Medical Education Summit II (MES II) Steering Committee was charged with assessing issues related specifically to OGME. As a result, the research completed by the steering committee and the reading materials provided to attendees before the summit focused on literature and data relating to OGME and its milieu. As it did with the first summit, the steering committee again restricted participants, this time to approximately 100 members of the profession in official capacities representing all stakeholders in OGME issues, including students, residents, and new “physician-in-practice” leaders. Of the MES I participants, only those directly involved in OGME were invited to participate in MES II. 

The steering committee performed a detailed analysis of all aspects of OGME and divided the topics into the following three components: 

The steering committee prepared question sets for each of these three topics and identified the main controversy in each topic. 

Funding for MES II, which was held November 10, 2007, through November 12, 2007, in Lombard, Ill, was generously provided by the AOA, AACOM, the OHF, the Osteopathic Founders Foundation, and the Osteopathic Institute of the South. The summit kicked off with an introduction of the issues and the pertinent history, followed by presentations by nationally recognized experts in each of these areas. These experts delivered a provocative set of point/counterpoint presentations on each controversial topic. Participants also benefited from the general reactions and overview of two noted experts: Barbara Ross-Lee, DO, and David Leach, MD. Dr Ross-Lee, the vice president of health sciences and medical affairs at the New York Institute of Technology in Old Westbury, spoke about the changes in the profession in the bigger context of our history and where the profession can go. Dr Leach, the recently retired director of the ACGME, spoke about the unique nature of the osteopathic profession in the context of the type of medical care the public needs and deserves. 

For MES II, groups were divided into a series of three breakout sessions to identify solutions and approaches, analyze barriers and facilitators, and develop action plans, respectively. Each breakout session had nine groups—seven to eight people in each group—and, like MES I, was moderated by a trained external facilitator overseen by a steering committee member. The final breakout session used the affirmed concepts to develop action plans. 

At the conclusion of the development of the action plans, the entire group prioritized those plans. Summit participants were asked to vote only for items not yet in progress. In addition, participants were clearly instructed that concepts resulting from MES II would be advisory to the two governing boards (ie, the AOA and AACOM). 

During the MES II, the following three overarching concepts were clarified and approved: 

The structural overview of MES II, in which these three concepts fall, is provided in Figure 3. After the summit adjourned, the steering committee met to further analyze and assign oversight of the recommendations. However, because there was some overlap, several action plans were combined. 

In addition, based on the number of priority votes for each area by summit participants, the concept areas were categorized by priority (ie, low vs high. All concept areas were forwarded to the appropriate bodies (ie, implementation groups already in place). By providing this information to the appropriate groups, MES II has provided affirmation of the work set in motion by MES I. 

The work product was sent to the steering committee by electronic mail for final vetting and then submitted to the AOA and AACOM for approval. The steering committee was advised that if there were differences of affirmation votes between the two association boards, the two executive committees would meet in an attempt to adjudicate any identified differences. The the AOA Executive Committee and the AACOM Board of Deans vetted the work products on December 1, 2007, and December 10, 2007, respectively. Action plans that did not achieve consensus were vetted by joint leadership on February 6, 2008. Following that approval, plans were put in place for action plan assignments and for the steering committee to provide ongoing oversight. 

It is clear that MES I set the stage for “evidence-based decisions” about policy—provided that the meaningful data requested by the participants is forthcoming from the AOA and AACOM. The groundwork has been laid to move forward with policy action plans based on consensus not previously possible. 

Like any good investigation, each summit uncovered more questions—all of which demand further refinement and study as well as additional action plans. Our progress will become more difficult with each level of questioning as we approach our individual core values and beliefs about who we are as osteopathic physicians and what our profession really means to international healthcare. Questions and decisions like these cannot be reliably answered with emotion, unreasoned judgment, or tradition. Instead, they demand robust data and information that has been thoroughly scrubbed of bias. 

The oft-repeated theme of many groups who reported their proposed statements at MES I was “we need reliable data, which are not being collected or are not available.” This point has been reinforced in conversations with Howard S. Teitelbaum DO, PhD, MPH (oral communication, June 2006), author of the well-known osteopathic medical education study.¹² To address the problem of absent data regarding osteopathic medical education highlighted during the summits, an organized entity for the conduct of educational research for the osteopathic medical profession should be created.¹² 

The first summit was successful in many ways far beyond the 61 statements that emerged as “compass points.” First, the steering committee grappled with a diverse set of topics and issues, determining which ones to deliberate and whom to invite to participate in the discussions. Second, AOA and AACOM administrative personnel came together as never before to work in tandem for a common product. Third, the educational leadership of both organizations came together in a unified way to deliberate very difficult questions with purpose and integrity. The second summit was able to build on the sound foundation of MES I and proceed to the next level of questions and issues related to OGME. 

The summits have initiated a common public articulation of educational direction on growth, promotion of tougher accreditation standards, and a purposeful path for producing highly qualified osteopathic physicians for the future. This process continues in a way that is unique to the osteopathic medical profession. Because of our size, our focus, and our commitment to the heart of what our profession has to offer, we can bring all the stakeholders and players to the table and hammer out the issues facing us. The challenge may be daunting, but our charge is worthy of the work. 

We are honored to have been asked to serve as the chairs for the summit events and are likewise humbled and proud of the accomplishments we achieved as a profession in the process.