Over the past 2 decades, there has been a growing body of literature detailing disparities in health and health care, especially in rural areas. As population health care needs increase, the health care workforce shortage continues to be a focal point of discussion among stakeholders in policy, education, and residency training. In addition, the need for increased diversity of health care teams provides another area of concern. Osteopathic medical schools and osteopathic educators have been tasked to explore innovative approaches to increase student body diversity and address interest in rural and underserved areas. This educational discussion has targeted a continued need for increased diversity in rural medicine and an increase in the number of primary care providers to address health disparities. The discussion has also expanded the concept of collaborative practice from interprofessional education in the classroom setting to include students at all levels in the clinical learning environment.^1-3 Interprofessional education and collaborative practice has been cited throughout medical education and health professions literature for more than half a century.⁴ In its conceptual framework, interprofessional education provides a mechanism to facilitate collaborative teamwork and future collaborative practice for health care teams. Throughout this progression, medical educators have grappled with the introduction and application of competencies, milestones, and, more recently, entrustable professional activities to teaching and learning in the clinical environment.⁵ Educators have been challenged to identify methods of assessment while establishing and ensuring continuous skill development and entrustment that translates to the clinical learning environment. 

In fall 2017, the National Collaborative for Improving the Clinical Learning Environment (NCICLE) held its first multiday symposium to engage active interprofessional discussions.⁶ The symposium provided a forum to articulate ideas among key stakeholders from across the country and across health professions. This national discussion embraces a shared learning environment inclusive of patients, learners, hospitals, health systems, and academic centers. As NCICLE evolves this conversation, its goals are to continue investigating the development of key milestones. For example, NCICLE milestones will look to best define and measure skills that drive an effective optimal clinical learning environment as we address sustainable approaches to achieve change in a shared clinical environment in which lifelong learning focuses on patient safety.⁶ 

This annual medical education theme issue of The Journal of the American Osteopathic Association highlights efforts to increase diversity in medical school. The issue also explores factors that influence residency program decision making, assesses student perceptions of collaborative practice in the clinical environment, provides an update on the single accreditation system for graduate medical education, and assesses faculty and residents' value of osteopathic recognition. 

How do we increase the diversity of our students? The osteopathic medical profession is not alone in addressing this concern. The demographic discrepancy between the US population composition and that of professionals in science, technology, engineering, and mathematics (STEM) has been an ongoing point of concern for education policy.^7,8 When considering intent to enter STEM professions, similar proportions of students identifying as African American, Hispanic, Native American, and white expressed interest prior to college entry.⁸ However, upon graduation, the proportion of students interested in pursuing STEM shifted to represent a much larger percentage of students who identified as white. This discrepancy translates to underrepresentation of other ethnic and racial groups in the health care professions relative to their proportion of the US population.⁹ Educational exposure, preparation, and attitude toward STEM may affect students as early as middle school.⁸ Atance et al¹⁰ addressed the importance of pipeline programs as an option for early intervention. The authors assessed the success of a brief summer program for high school students in a medically underserved area. The resulting gains in biomedical science concepts, as well as increased positive attitude toward disciplines of health and science, suggest that brief educational exposure can positively influence youth, with the goal of addressing the physician shortage in underserved areas in this particular case. 

As we consider the physician shortage, it is also important to better understand factors that affect a medical student's choice of medical specialty and residency training program. Since the 1990s, researchers have investigated variables that influence medical specialty choice.^11-13 Common factors identified include future income, prestige, medical educator influence, design and location of training program, lifestyle considerations, and practice location.^14-16 The study by Dogbey et al¹⁷ further explored critical points in medical education that influence residency program decision-making. Their main findings support previous research, including program characteristics, geographic location, and work-life balance as influences on residency choice. However, the article also challenges medical educators to not only consider innovative training approaches but to also be mindful of mentorship during the clinical rotations that may have a greater impact on future decision-making in residency. 

Competency-based education has provided a framework for interprofessional education. However, the question of meaningful measurement of competency development is at the forefront when we look toward collaborative practice. The study by Carpenter et al¹⁸ explored learner perceptions of interprofessional education in the simulated clinical learning environment. Interprofessional collaborative practice in the clinical environment and the integration of milestones and entrustable professional activities has been proposed as the next step in this framework because both provide a mechanism to bridge the classroom to the clinical learning environment. The article by Linsenmeyer et al¹⁹ explores the importance of assessment of entrustable professional activities and provides a user-friendly validated resource of measurement tools available to assess learner readiness for clinical activities. 

We have passed the midpoint of the 5-year transition period (2015 to 2020) to a single accreditation system for GME under the Accreditation Council for GME (ACGME). As of February 5, 2018, 69% of all programs accredited by the American Osteopathic Association (AOA) have achieved or have submitted applications for ACGME accreditation.²⁰ Buser et al²⁰ provide an update on and discussion of this transitional period, addressing how AOA programs are transitioning to ACGME accreditation status and how these changes may affect osteopathic medical students and residents. As we move forward with the single accreditation system, it is important for osteopathic medical educators to gain an understanding of how osteopathic training will evolve within graduate medical education. One AACOM study found that 68% of third-year osteopathic medical students reported that osteopathic recognition increased the appeal of a residency program.²¹ In the article by Hempstead et al,²² the value of osteopathic recognition in residency training for residents and faculty was explored further. More than 90% of respondents felt that OMT benefitting patients was important. The majority of respondents ranked the ability to work with DO faculty as important. 

Over the past 5 years, an increase in the number of active AOA board certifications has been reported.²³ Between 2016 and 2017, there was a 7% increase in osteopathic physicians certified by the AOA, representing a combined total of 36,982 active certifications. This increase reflects the growth of the profession and the increased number of trained osteopathic physicians in the face of predicted physician shortages.²³ 

As we continue to search for new approaches in teaching, learning, and leadership, the osteopathic medical profession must anticipate changes in interprofessional education in the clinical learning environment. It must embrace the interest in osteopathic manipulative medicine by structuring support for mentorship and hands-on training of residents as we mold the future of our professional in a unified accreditation system. In addition, it must seek to increase diversity among physicians by reaching out to youth early on through pipeline programs. And, as an increasing number of students seek non–primary care residencies, it is important to remember the roots of osteopathic medicine in primary care.