During the past year, the AOA Council on Osteopathic Postdoctoral Training Institutions (COPTI)—led by former chairperson, D. Keith Watson, DO, and current chairperson, Lorenzo Pence, DO—hosted the 2012 OPTI Workshop and initiated the revision of the OPTI Annual Report. Further, COPTI implemented 2 new, substantial changes: a 5-year accreditation cycle and revised OPTI accreditation standards.¹ 

The 2012 OPTI Workshop, “Academic Sponsorship: OPTImizing Performance Improvement,” was held in Louisville, Kentucky. Fifty-nine OPTI leaders, representing all AOA-accredited OPTIs, participated in discussions about academic sponsorship, quality metrics, process improvement, and integration of osteopathic principles and practice (OPP) into OGME programs. Leaders of OPTIs also assessed the newly approved “Section IX: Standards for Accreditation of OPTIs”¹ and provided feedback to the COPTI on the implementation and evaluation of each standard. The event concluded with a symposium on preparing for an OPTI site visit, which was addressed to the point of view of both the inspection team and the OPTI. 

Since 1999, all OPTIs have been required to complete the OPTI Annual Report, which queries OPTIs on a series of operational issues. As the role of the OPTI has expanded to include academic sponsorship, so too does it become prudent to track OPTI responses and the impact that an OPTI's operational structure has on OGME program quality.² Such information will enable the AOA and the COPTI to provide additional detailed data on OPTI operations and the effect of these operations on program quality. In short, these data will continue to be used to answer the question, “Where are OPTIs going?”³ 

To answer this question, a subcommittee of COPTI members and other OPTI leaders are revising the OPTI Annual Report. This subcommittee is entrusted with creating fewer, more effective questions, which would provide meaningful measures of a successful OPTI. The subcommittee includes representatives from the COPTI and the OPTI Council of the Association of Osteopathic Directors and Medical Educators, an OPTI advocacy group. New questions will be available for public comment and will be presented at the April 23, 2013, OPTI Workshop in Baltimore, Maryland, for feedback from OPTI leadership. The OPTI Annual Report will be modified by the subcommittee if necessary and receive final approval by the COPTI at its July 31, 2013, meeting. Each OPTI receives its annual report each August and must complete and return it to the AOA no later than October 1. The COPTI reviews the data each year at its fall meeting. 

In January 2011, the Education Policy and Procedure Review Committee III made recommendations to the AOA Board of Trustees (BOT) with the intent of improving the policies and procedures that govern and direct the education enterprise of the AOA.⁴ These recommendations recognized OPTIs as the academic sponsors of all AOA-approved OGME programs.^1,4 As previously mentioned,⁵ the responsibility of OPTIs greatly increased with this role, which became effective July 1, 2012. Also, in 2013 the OPTI Mission and Vision Statements were approved to define the OPTIs' purpose, primary objectives, and values. 

As academic sponsors, OPTIs are responsible for ensuring that OGME training programs are following specialty standards and standards outlined in AOA Basic Documents for Osteopathic Postdoctoral Training.¹ In addition, OPTIs are accountable for compliance of base institutions (eg, hospitals) with AOA policies, including reviewing and overseeing contracts, the AOA Match program, quality performance, trainee evaluations, and on-site program reviews, as well as monitoring corrective action plans, internal reviews, and core competencies.⁵ The OPTIs will not, however, oversee base institution responsibilities such as financial support for trainees and programs, AOA Match participation, and administrative support.⁵ 

The Hamm Report on OPTI Effectiveness, conducted by Michael Hamm and Associates and previously described by Duffy,⁶ called for a clear mission and vision concept for OPTIs. The OPTI Mission and Vision statements were drafted and discussed at 3 COPTI meetings and at the 2011 and 2012 OPTI Workshops; the statements were also approved by the Council on Osteopathic Training (COPT) and the Bureau of Osteopathic Education (BOE). The OPTI Mission and Vision Statements were approved by the AOA BOT at its 2013 midyear meeting (Figure 3). 

In matters relating to OPTI governance, the COPTI is the final accrediting body for OPTIs and is the first body to approve revisions to OPTI accreditation standards, policies, and administrative guidelines. 

Since July 1, 2011, COPTI has been the final decision body for OPTI accreditation.⁵ Provisional approval, continuing approval, and corrective action plan and progress report approval are under the authority of COPTI. Information regarding OPTI continuing approval and the new 5-year accreditation cycle can be found in the 2012 annual osteopathic medical education theme issue of The Journal of the American Osteopathic Association (JAOA).⁵ 

An organization wishing to become an AOA-approved OPTI must provide a letter of intent, a completed OPTI application (1 A of the OPTI Accreditation Handbook⁷), and a feasibility study. The feasibility study must encompass an overview and history of the OPTI formation concept and process and offer a self-study report responding to all the standards located in sections A and B (Table 1).¹ After COPTI approval of the application and feasibility study is complete, a provisional accreditation site visit is scheduled. Provisional site visits take 1 day, focus on sections A and B of the OPTI Standards, and require 1 reviewer. The OPTI Inspection Crosswalk for provisional accreditation completed by the site reviewer is evaluated by the full COPTI at the next COPTI meeting, and, if approved, provisional accreditation is granted to the OPTI. A full site visit must occur within 1 year, but an extension may be granted if the OPTI provides reasonable rationale for deferment.⁷ 

To best assess the effectiveness and functionality of an OPTI's effect on OGME, the COPTI makes revisions to OPTI accreditation standards, policies, and administrative guidelines. Revisions to the OPTI accreditation documents often start when a change is made to the responsibility of OPTIs by the AOA BOT, the BOE, or the COPT. For example, when the AOA BOT approved the policy that placed OGME programs under the guidance of OPTIs, the COPTI formed a special OPTI Standards Subcommittee to revise the OPTI Accreditation Standards,¹ the AOA's OPTI Accreditation Handbook,⁷ and the OPTI Inspection Crosswalk.⁸ Other revisions to OPTI accreditation documents may be brought on by feedback from OPTI leadership at the OPTI workshops, OPTI correspondence, or other OPTI advocacy groups. 

Like other postdoctoral training policy and specialty standard revisions, OPTI accreditation document revisions, once approved by the COPTI, must receive approval from the COPT. After approval by the COPT, the approved revisions are posted to the AOA website for a 45-day public comment period. The AOA's Department of Education staff announces in their e-newsletter that policies are available for public comments. Any comments are reviewed by members of the COPTI and the COPT, who will make any necessary amendments. Once the comments are reviewed, the COPTI- and COPT-approved documents go to the BOE. Once approved by the BOE, the documents receive final review and approval from the AOA BOT. The changes to the standards are then posted online as “effective date pending” and will be effective for all OPTIs on July 1 of the following year. 

Most recently, “Section IX: Standards for Accreditation of OPTIs” in AOA Basic Documents for Postdoctoral Training¹ and the OPTI Accreditation Handbook⁷ were extensively revised to reflect the new academic sponsorship responsibilities of OPTIs. The AOA published the proposed standards on its website for the 45-day public comment period; all comments were reviewed by COPTI, and amendments were made on the basis of the feedback. The OPTI Inspection Crosswalk⁸ was revised to include the revisions to the standards and also to include the new Pilot OPTI Performance Improvement Program. The OPTI accreditation standards and cross-walk now include 2 types of standards: “Must Meet” standards (indicated with ** in the revisions to AOA Basic Document for Postdoctoral Training and OPTI Inspection Crosswalk) and “regular” standards. The 6 “Must Meet” standards identified by the COPTI that must be met are considered essential to OPTI function and continuing approval (Table 2). These standards became effective on July 1, 2012; the first review of an OPTI under the new standards will occur in January 2013. Additional information about the new OPTI accreditation process is available in the JAOA's 2012 osteopathic medical education theme issue.⁵ 

Reviewers of OPTI sites score results for OPTI accreditation standards according to 3 categories: “not met,” “met,” or “met with excellence.” An OPTI does not receive extra points for standards that are “met with excellence.” However, they do receive commendations for those standards. The COPTI may award multiple commendations to a single OPTI. Table 3 summarizes the commendations and deficiencies given in the past 5 years. 

In the 22 full OPTI reviews conducted from 2008 to 2012, OPTI accreditation standards were scored as “met with excellence” 31 times (Table 3). Three OPTIs received the distinction of being awarded a “blue ribbon” status—a perfect score on the review. In the 22 reviews conducted from 2008 to 2012, COPTI awarded commendations most often in research (Standard Section D) and faculty and instruction (Standard Section E). 

The OPTI Accreditation Standards revisions to include academic sponsorship into the OPTI requirements made an editorial revision to Standard D.9.2. Standard E.9.3 was chosen as a standard for the Pilot OPTI Performance Improvement Program and is shown in the 1. 

In the 22 full OPTI reviews completed from 2008 to 2012, COPTI cited 119 deficiencies, or OPTI accreditation standards found as “not met” (Table 3), with multiple deficiencies cited to a single OPTI. The COPTI cited deficiencies most often in organization, governance, and finance (Standard Section B) and program evaluation (Standard Section C). 

Each standard was amended in last year's OPTI Accreditation Standards revisions to ensure clarity for COPTI, the OPTIs, and the site reviewers. Standard B.9.15 now requires an OPTI to commit financial resources and to define a financial plan and budget that is linked to its strategic plan, mission, goals, objectives, and outcomes. Standard C.9.4 was removed because it was not achieving the expected outcome that COPTI intended. Standard C.9.8 is currently being rewritten to more clearly define the expectation of the standard; that is, all OPTI-initiated programming provided to member institutions—whether related to research, OPP, curriculum, or faculty development—is to be evaluated. Standard D.9.5 now requires that OPTIs provide specific budgeted funding for OPTI-wide or program-specific research for its trainees. 

The role of OPTIs in OGME substantially changed in 2012. As OPTIs are inspected in accordance with the revised standards and using the Pilot OPTI Performance Improvement Program, the data collected from the new OPTI annual reports, OPTI inspections, and program inspections will continue to highlight OPTI functions that are effective or that need improvement. This information will lead to greater understanding of how OPTIs can best sponsor and improve OGME programs.