Abstract
All postdoctoral training programs approved by the American Osteopathic Association are required to be part of an Osteopathic Postdoctoral Training Institution (OPTI) consortium. The author reviews recent activities related to OPTI operations, including the transfer the OPTI Annual Report to an electronic database, revisions to the OPTI Accreditation Handbook, training at the 2010 OPTI Workshop, and new requirements of the American Osteopathic Association Commission on Osteopathic College Accreditation. The author also reviews the OPTI accreditation process, cites common commendations and deficiencies for reviews completed from 2008 to 2010, and provides an overview of plans for future improvements.
The Osteopathic Postdoctoral Training Institution (OPTI) system, established by the American Osteopathic Association (AOA) in 1995, has grown considerably as a method for providing structure to osteopathic graduate medical education (OGME). Each OPTI is a community-based training consortium composed of at least 1 college of osteopathic medicine (COM) and 1 hospital accredited by the AOA Bureau of Healthcare Facilities Accreditation, the Joint Commission, or another recognized healthcare facility accrediting entity.
1 Additional hospitals and ambulatory care facilities may also join this core partnership. Since July 1999, OPTI partnerships are required for institutions conducting AOA-approved osteopathic postdoctoral training programs.
2 Nineteen OPTIs are accredited by the AOA Bureau of Osteopathic Education (BOE) (
Figure 1).
1
The Council reviews OPTIs in intervals based on type of accreditation status, ranging from 1 to 5 years. For example, an OPTI that was awarded a 3-year accreditation in 2009 will undergo a visit in 2012. The Council conducts 2 types of reviews: full site reviews, which are structured on the accreditation cycle, and focused site reviews, which are focused on one or more specific concerns within the OPTI.
The AOA and COPTI provide a fair and balanced approach to the review process. Institutions are notified at least 1 year before a full site review. In addition, they are informed that a self-study will be due 60 days before the scheduled review. Starting in fall 2010, the AOA began sending a second letter to OPTIs to confirm the review dates. Assignment of reviewers begins once review dates have been set. The AOA provides resources to OPTIs that are preparing for the self-study and onsite review, including the
Standard Crosswalk; the AOA's OPTI Accreditation Handbook,
3 which includes a list of required documentation for the self-study; and staff assistance on the construction of the self-study.
Full site reviews last 1.5 days and include interviews with OPTI staff and the review of OPTI documents. The site team consists of 4 members (3 inspectors and 1 AOA staff member). At least 1 osteopathic physician reviews the clinical OPTI standards. Individuals who serve as OPTI reviewers are involved with OGME and are required to attend training before being approved. Review team members sign a conflict of interest form before each visit.
The assigned review team reviews the self-study, the last site review report, and past annual reports of the OPTI being reviewed. The team then meets by means of a teleconference before the OPTI visit to discuss the submitted documentation and to ensure logistical support is covered. The team also reviews a draft copy of the review schedule and recommends any necessary changes. The leader of the review team and the chief academic officer of the OPTI being reviewed sign an attestation form that requires all OPTI documents to be released for review at the end of the visit. The OPTI should ensure that documents are clearly and concisely organized according to OPTI standards to ensure that the review team has quick access to materials.
During the onsite visit, the review team awards the OPTI a certain number of points (ie, number of accreditation elements met) for each of the 8 standard sections (
Figure 2), for a maximum possible score of 64 points. Depending on the total score received, the OPTI can receive an accreditation status ranging from 1 year (45-47 points) to 5 years (61-64 points). As shown in
Figure 3, OPTIs with a total score of less than 44 points are placed on public probation. If, after 1 year, an onsite inspection reveals another total score of less than 44 points, the OPTI's accreditation is withdrawn.
At the end of each review, the review team and the OPTI have an exit conference. The goal of the exit conference is to provide a general review of the OPTI site visit and to outline the process of AOA accreditation. Teams can provide initial findings to the OPTI, but must stress that the findings are subject to change.
After the OPTI review, AOA staff works with the team to finalize a first draft of the site report. Once approved by the team, the report is forwarded to the OPTI for an optional written response. In instances in which the OPTI disagrees with the findings of the report, the OPTI has 15 business days to submit a written response to the AOA Division of Postdoctoral Training. The OPTI response must be based on errors in fact and provide all supporting documentation.
Once the OPTI's response to the initial site report has been received by the AOA, it is forwarded to the site team for review. The team meets by teleconference, reviews the initial findings and the OPTI response, and makes any necessary changes to the report. The report is then forwarded to the COPTI for review. A copy of the updated report is sent to the OPTI for its records.
The COPTI considers team reports and OPTI responses during COPTI meetings, which occur 3 times a year and each comprise 3 sessions. The review of this documentation occurs in the “Accreditation Session,” where COPTI hears testimony from OPTI representatives and the review team leader. The COPTI makes a final recommendation in the “Executive Session,” without the OPTI representatives or team leader present.
The COPTI forwards its final recommendation to the BOE for final action. The BOE's decisions on actions regarding OPTI accreditation actions may be appealed to the BOE appeals committee. After the BOE meeting, a final decision letter is mailed to the OPTI that outlines the accreditation award, commendations, and deficiencies.
Once the review is complete and the final accreditation letter has been sent to the OPTI, the AOA sends an electronic survey to the OPTI to evaluate both the OPTI review process and the accreditation process. The survey, which was initiated in the summer of 2009, has questions that determine the quality of the review process. For example, the survey queries the OPTI about the review team's professionalism and the quality of the communication between the AOA and the OPTI. The findings of these evaluations help the AOA and COPTI make informed decisions regarding future improvements to the OPTI review process.
If an OPTI is cited for a deficiency, it is required to submit a corrective action plan for correction of the deficiency to COPTI. The Commission reviews the plan at its next meeting and provides feedback to the OPTI. If COPTI accepts the plan, the OPTI reports on the implementation of the plan in its annual report. If the COPTI does not accept the plan, the OPTI is required to submit a new plan or a focused site visit may be scheduled.
For 2011, COPTI is planning an initiative to revise the OPTI standards and provide several major recommendations on OPTI functioning. These recommendations will be based on the results of an OPTI study conducted by the outside consulting firm Michael Hamm and Associates. The OPTI study is jointly sponsored by the AOA and the American Association of Colleges of Osteopathic Medicine. The recommendations will also consider the number of deficiencies and commendations according to the collected OPTI review data.
In addition to initiating a more transparent review process that is founded upon effective communication and thorough procedures, the AOA will begin to collect information on individual reviewers and specific review teams in regards to the type of deficiencies and commendations cited during reviews. With this information, the AOA will be able to examine if a particular reviewer has a tendency to cite one standard over another as a deficiency, which will assist in creating more individualized reviewer training modules. The AOA continues to compile statistics on the most cited standard deficiencies and commendations. These data are being used by the AOA and COPTI to assist in the development of curricula that will improve OPTI operations.
In 2011, the OPTI Workshop will concentrate on assisting OPTIs in various operations. It will also focus on providing a clear mission and vision statement that captures the purpose and responsibilities of OPTIs. The AOA also will develop examples of various OPTI policies and procedures to assist OPTIs in meeting accreditation standards.