Special Communication  |   July 2011
26 Steps Into the Future—A Year of Presidential COM Visits
Author Notes
  • Dr Nichols was the 2010-2011 president of the American Osteopathic Association. She is the dean of the Midwestern University/Chicago College of Osteopathic Medicine (MWU/CCOM) in Downers Grove, Illinois. 
  • Address correspondence to Karen J. Nichols, DO, 555 31st St, MWU/CCOM, Downers Grove, IL 60515-1235. E-mail: 
Article Information
Medical Education
Special Communication   |   July 2011
26 Steps Into the Future—A Year of Presidential COM Visits
The Journal of the American Osteopathic Association, July 2011, Vol. 111, 442-444. doi:
The Journal of the American Osteopathic Association, July 2011, Vol. 111, 442-444. doi:
Come get your picture taken with this student,” instructed Clinton E. Adams, DO, dean of the Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP), during my recent visit to the school. A beautiful second-year osteopathic medical student, one of many I encountered in the past 12 months, comes over and we stand together for a photograph. “Here is the book she has written”: Bow Ties, Butterflies & Band-Aids by Lindsey VanDyke. My thoughts immediately questioned, “Written... so young?” 
I read the book on the flight home from WesternU/COMP. It is an amazing story of a courageous young woman who has battled cancer 3 times and is finally fulfilling her long-held dream of being a physician. Not just any physician—an osteopathic physician. Lindsey's story, so well told, speaks of remarkable challenges that might have stopped a lesser person or at least redirected her onto a less demanding road. Yet instead, the struggles she has conquered have given her a clear picture of the importance of “going for the gold” and not settling for less. 
To me, Lindsey's story sounds like the history of the osteopathic medical profession and its struggles to bring a new approach to medicine: to “go for the gold” in health. I say health and not healthcare because our patients don't want healthcare; they want health. 
Thus, I bring us to the point of this essay. During my year as president of the American Osteopathic Association (AOA), I visited all 26 of our colleges of osteopathic medicine (COMs) in 32 locations. Throughout my travels, I sought to learn how we—our COMs—teach the delivery of health, the similarities and differences in how we teach it, and whether different venues, ages of the COMs, and relationships make a difference in how we teach and how students learn. After a year of studying those questions and reflecting on my visits, here is what I have learned. 
Colleges of Osteopathic Medicine, Through and Through
The development of our schools is segmented. There are the 5 legacy schools, which were established between 1892 and 1916. The first burst of expansion started in 1969 and ended in 1990; it was followed by the second burst, which occurred from 1992 through 2001. We have now moved from “burst” to “geyser.” With 26 schools in 32 locations and several more in development, our profession is national in scope. While most of our earlier schools were free-standing, the trend has moved toward more affiliations with larger institutions. Tax status has also entered the mix of the different variables seen in our COMs. The accreditation of the modern era's first-ever forprofit medical school, which is osteopathic, brought attention to that school. However, I found that regardless of a COM's tax status, osteopathic medical students exhibit the same pride in the profession and dedication to the tenets of Andrew Taylor Still, MD, DO. 
Facilities at COMs vary greatly. From a converted department store in downtown Harlem, New York, with a policeordered 3-foot-wide main entrance or a revitalized military base with buildings dating back to the Civil War, to brand-new buildings standing alone in the grass or integrated into large university campuses, our schools do not look very much alike on the outside. On the inside, though, there is a great deal of similarity, with classrooms, libraries (some with actual books!), osteopathic manipulative treatment laboratories, and clinics. Inside our COM walls, we actually do look very much alike. 
Faith-based connections for our COMs represent another evolution of our schools. We have COMs located in institutions of higher education that represent Baptist, Jewish, and Roman Catholic religious beliefs. There is a wonderful concordance between the faith-based emphasis on the sacred nature of the human being and the same emphasis osteopathic medicine places on the body's ability to heal itself. The religious backgrounds are clear (eg, the blowing of the shofar at Touro University California, College of Osteopathic Medicine's white coat ceremony), but all COMs are open and welcoming to students of all backgrounds. While this concordance reinforces our tradition of being a patient-focused profession, it has also introduced challenges in ensuring nondiscrimination for all students, a requirement for accreditation of a COM.1 The American Osteopathic Association Commission on Osteopathic College Accreditation is doing an admirable of job balancing this equation. 
Another important difference is that of public vs private status. While the majority of our COMs are still privately constituted, the development of publicly affiliated COMs has opened a new door to state support of osteopathic research and other resources. This is a major boon to the profession. While the funding for public COMs is much more robust than for private COMs, the vagaries of state budgets and legislative priorities provide a variable pressure not previously associated with osteopathic medical education. 
Different but the Same
I view our COMs from different perspectives: As the AOA's immediate past president, I am very proud of our COMs' work and dedication to promoting the profession. As a fellow dean, I am struck by the variability that leads to a very similar result (ie, the osteopathic physician). As a faculty member, I note different curricula, delivery methods, and structures with much innovation and still similar outcomes. In talking to the students for their perspectives, I find them fiercely proud of their COMs and their profession. 
For all our differences, we have certain basic commonalities. At every COM, I met students and their leaders who are uniformly proud to be a part of the osteopathic medical profession and to carry on the tradition of A.T. Still. For the most part, our students deliberately selected osteopathic medicine because they believe in the concepts on which our profession was built. In other words, we still “fish from a different stream,” as I remember Christopher T. Meyer, DO, saying years ago. For example, newly minted DO Andrew Nelson comes from an allopathic family background. When he chose to enter the WesternU/COMP family, his relatives saw the quality of the osteopathic medical education and training, and they embraced his decision and our profession. 
Another important commonality is the faculties' dedication and commitment to doing the best possible job teaching our students. Regardless of the teaching method or type of curriculum, these faculty are committed to providing the best education. 
The “COM culture” is another commonality. The most frequent expression I heard from osteopathic medical students was that they felt a strong sense of family at their respective schools. They also strongly felt the commitment to service. Whether in Harlem or Hattiesburg, Washington or Bradenton, osteopathic medical students are dedicated to learning to provide the best patient care and serving the underserved. 
Building Better Opportunities for Graduates
Because of our students' commitment to osteopathic medicine, they expressed a common concern at every one of my COM visits. They want assurance that they will have access to highquality graduate medical education, preferably osteopathic and preferably in their specialty and geographic region of choice. As one of the fastest growing health professions in the world, with predictions that the number of DOs will reach 110,000 by 2020,2 the challenges of providing adequate osteopathic graduate medical education (OGME) positions are compounded. 
The osteopathic medical profession has a moral and ethical obligation to expand OGME—and we are doing so. In my inaugural address as president of the AOA,3 I challenged specialties with 85% OGME fill rates to increase the number of training positions by 15%. The specialties are responding. From July 2010 to June 2011, we had a net gain of 15 residency programs and 334 positions, bringing our professionwide total to 8501 positions. The AOA Board of Trustees has also formalized the OGME Development Initiative into a standing bureau to continue providing assistance for facilities seeking to create or expand OGME training programs. 
Looking Forward
Midway through my presidential year, I was invited to be the keynote speaker for the Bridging Ceremony at the Midwestern University/Chicago College of Osteopathic Medicine (MWU/CCOM), the celebration of students “bridging” from their second to third year. Seeing second-year osteopathic medical student Miriam Medhkour coming over to give me a hug, I recalled the day she came to the dean's office having just learned that she had thyroid cancer. As the wife of another MWU/CCOM student and sister-in-law of a MWU/CCOM graduate, she knew she was part of a family who would aid her through this challenging time. 
I reflected again on my meeting with Lindsey VanDyke. Although Miriam and Lindsey have different backgrounds and come from different cultures, they are identical under the skin and in their profession. Lindsey's experience of making her dream come true after surviving cancer 3 times inspires me every day; the same can be said about Miriam. They demonstrate the same will and determination that has allowed this profession to carry on for 130 years after the articulation of the principles of osteopathic medicine. 
To these 2 remarkable women and to all of our osteopathic students, I have frequently quoted a phrase from Jeffrey S. Grove, DO, the current president of the Florida Osteopathic Medical Association: “This is more your profession than it is mine.” Many students have looked at me with a puzzled expression after I make that statement. After all, they are students, and I was the AOA president. I tell them, “Look at how long I have to influence the profession. Look how long you have to do the same.” Then they understand. 
The most striking realization I came to in this year of travels is this: We are still pioneers. We may have full practice rights in all 50 states, but so many more venues are just now learning what osteopathic medicine brings to the table. The expansion of student rotations into new areas of the world brings our approach to patient care to new populations. Our connection to public schools and faith-based institutions introduces us to new spheres of influence in the United States. The increase in the number of osteopathic physicians makes us a force to be reckoned with in medical education and patient care. 
We still face challenges, especially ensuring that we are graduating and training the right type of physicians today to meet tomorrow's healthcare needs. Yet the most wonderful thing I have learned from these visits to all of our COMs should be a comfort and inspiration to all those who love and practice osteopathic medicine—namely, “We're in good hands—be proud! The future is bright!” 
 Financial Disclosures: None reported.
Commission on Osteopathic College Accreditation. Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures. Chicago, IL: American Osteopathic Association; July 2011. Accessed July 6, 2011.
2010 Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 2011. Accessed July 6, 2011.
Nichols KJ. Inaugural address. Presented at: Annual Business Meeting of the American Osteopathic Association; July 17, 2010; Chicago, IL. Accessed July 6, 2011.