As osteopathic medical schools continue to proliferate across the nation, and as the ranks of DO graduates swell, the future of medicine will increasingly depend on osteopathic medical schools to provide both outstanding medical education and active engagement in scientific and medical advances. To achieve the goal that osteopathic medicine must embrace research, scientific inquiry, and the application of EBM, we propose a 3-pronged strategy that articulates specific steps in an effort to address the lack of progress despite previous calls for change.
2-5,7 The collective impact of a coordinated strategy requires the cooperation of all osteopathic medical schools as well as changes in how the accreditation standards that govern osteopathic medical schools are implemented. By adopting this strategy, we believe that it is possible to increase extramural research, programmatic funding, and the impact of the osteopathic medical profession's scholarship; enhance the predoctoral research educational experience; and ensure that the osteopathic medical profession is an active participant in creating the evidence base that defines medicine.
First, we must look within osteopathic medical schools and offer recommendations to strengthen the research agenda. Specifically, we encourage all osteopathic medical schools to (1) increase medical education curricular content relating to research methodology and the application of EBM, (2) hire more research-active faculty, (3) raise faculty research expectations, (4) invest in faculty mentoring in research, (5) embed routine data collection into affiliated health care delivery systems to support clinical research and data-driven decision making, and (6) secure the necessary commitment from administrative leadership to align incentives and infrastructure that drive the necessary culture shift. Although we believe that most practicing DOs support the notion that medical practice should be linked to scientific inquiry and that clinical practice should reflect the dictates of EBM, few may recognize the need for reform or the challenges involved in generating the necessary changes.
Nurturing a research culture within the osteopathic medical profession is a complex and difficult task. The deans and presidents of our colleges must recognize that an investment in research strengthens the profession's commitment and ability to produce the best primary care physicians. By changing how research is embedded in the fabric of our institutions, we will advance our profession's reputation and research identity.
Second, we call for the creation of regional and national research networks that bring together osteopathic medical schools and their surrounding universities and communities for cooperative inter-institutional research. It is not realistic to expect rapid expansion in the ranks of our research faculty; however, it is feasible to focus on the development of research networks, reducing the isolation of existing researchers and expanding the opportunities for faculty to become connected to research teams. In the current funding environment, the competition for federal grants is fierce, and the ability to generate a return on investment in the short term is unlikely. If existing and future osteopathic medical schools could develop close ties with, or even be housed within, major research universities, these partnerships would create a structure for advancing scholarly activity with potentially lower initial financial investment. Of the more than 200 “research universities” and 90 “doctoral/research universities” classified as “high” and “very high” in research activity by the Carnegie Classification of Institutions of Higher Education, about half are not currently affiliated with a college of medicine. By establishing partnerships through research networks, collaborative strategies can be designed for faculty development, research mentoring, shared equipment, research participant recruitment, access to new patient populations, and joint proposal development. Efforts to work collectively are not dependent on knitting together institutions with similar research profiles, but rather blending together institutions whose strengths complement one another.
The third prong of this strategic plan calls for strict adherence to the existing Commission on Osteopathic College Accreditation research requirement as it relates to research expectations and productivity for osteopathic medical schools. Accreditation Standard Seven
15 requires only that faculty have adequate time dedicated to research, it is the responsibility of our institutions to explicitly define the quantity and quality that constitutes an “adequate” research effort. And why stop at adequate? More importantly, what happens when institutions shirk this responsibility? The opportunities for research in the osteopathic medical profession are abundant. We need not be limited to research on OMM and other constructs historically tied to the profession; rather, we should expand our horizons to include the broader fields of musculoskeletal health, chronic disease, and other research with a primary care focus.
Our roadmap to recovery addresses many of the contributing factors that account for low research productivity in osteopathic medical schools, including the small numbers and inadequate research training of faculty, insufficient research investment and infrastructure, and lack of research expectations for both faculty and students (
Figure 2). The lack of generalized critical thinking and formal training in research during medical school leads to a low appreciation of and devotion to research. The osteopathic medical profession's endorsement of for-profit medical schools may exacerbate these issues if research is not prioritized, because research activity may be expected to negatively affect profitability. Regrettably, many existing osteopathic medical schools (whether for-profit or not) lack a traditional academic medical campus environment in which the school is integrated with clinical facilities and an engaged staff committed to education, patient care, and research—all critical elements that contribute to a vibrant research culture.