Letters to the Editor  |   March 2011
Author Affiliations
  • Mark S. Cantieri, DO
    Chairman, Standards Review Committee, Commission on Osteopathic College Accreditation
Article Information
Gastroenterology / Medical Education / Osteopathic Manipulative Treatment / Being a DO / Graduate Medical Education
Letters to the Editor   |   March 2011
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 177-178. doi:
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 177-178. doi:
I recognize, as does Dr McCombs, that the clinical education of our third-year and fourth-year osteopathic medical students with regard to the use of osteopathic manipulative treatment needs to be improved. I addressed this deficiency in my Northup Lecture in March 2007.1 In addition, I have functioned as a clinical inspector for the Committee on College Accreditation Training, which reports to the American Osteopathic Association's (AOA) Commission on Osteopathic College Accreditation (COCA). Many of us who have served as clinical inspectors have expressed the opinion that the previous standard 6.3 “had no teeth.” 
In 2006, COCA began a concerted effort to revise its standards. A Standards Review Committee (SRC), chaired by Humayun (Hank) Chaudhry, DO, was created. I served on the original SRC and, subsequently, became its chair in 2008. The SRC met through the fall of 2009 and revised multiple standards, including 6.3, the standard referred to in Dr McCombs' letter. Early in 2010, these revisions were distributed for public comment to several recipients, including the AOA, the American Association of Colleges of Osteopathic Medicine, every college of osteopathic medicine, and every specialty college. In April 2010, a public forum was held, and all the recipients of the revised standards were invited to attend to discuss the revisions. At this forum, the AOA, the American Academy of Osteopathy, and the American College of Osteopathic Family Physicians supported the revisions to standard 6.3. The revised standard 6.3 was passed by COCA at its next meeting, and it went into effect in July 2010.2 
It is my opinion that—although the revised standard 6.3 is not perfect—it does give clinical inspectors much better parameters to use on site visits. The question for those of us on the SRC is how the standard can be further improved. Input is needed from concerned educators and other individuals. We hope that the previously mentioned groups as well as other groups (such as the Educational Council on Osteopathic Principles, Student Osteopathic Medical Association, and Undergraduate American Academy of Osteopathy) will discuss this issue and offer input to the SRC. Directors of medical education and directors of residency programs also need to address this crucial issue. 
Concerned osteopathic physicians need to apply to COCA to become clinical inspectors—especially those DOs with a passion for seeing osteopathic manipulative treatment used. For its part, COCA needs to reassess its reimbursement rate for clinical inspectors if it wants to expand the ranks of individuals conducting inspections. An honorarium of $150 per day hardly offsets the overhead expenses that are ongoing in a osteopathic physician's office while the doctor is out performing an inspection. 
Finally, osteopathic physicians who wish to see improvements in standards need to let the president-elect of the AOA know that they desire to serve on committees of the AOA—including COCA, where changes to standards can be made. 
Cantieri MS. Teaching Osteopathic principles in an allopathic environment: osteopathic guerrilla warfare. Am Acad Osteopath J. 2007;17:12-14.
Commission on Osteopathic College Accreditation. Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures. Chicago, IL: American Osteopathic Association; 2010.