Allopathic Residency Programs Research Articles

Osteopathic Students Have Decreased Match Rates in Orthopaedic Surgery Compared with Allopathic Students.

Orthopaedic surgery continues to be one of the most competitive specialties to match into as a medical student, particularly for osteopathic medical students. Therefore, in this study, we sought to examine the prevalence of osteopathic students (DO) matching into orthopaedic surgery at traditional Accreditation Council for Graduate Medical Education (ACGME) accredited programs (former allopathic residency programs) in recent years. A retrospective review of National Residency Match Program annual reports and Association of American Medical Colleges's Electronic Residency Application Service Statistic reports were performed to determine the number of applications and match rates among osteopathic (DO) and allopathic (MD) medical students into orthopaedic surgery from 2019 to 2023. Data on the degree type of current residents at all ACGME-accredited residency programs were identified. During the analyzed study period of 2019 to 2023, there were 3,473 (74.5%) allopathic students and 571 (59.9%) osteopathic students who successfully matched into orthopaedic surgery. This match rate for allopathic students was 74.5% compared with 59.9% for osteopathic students. Of the 3,506 medical students who hold postgraduate orthopaedic surgery positions at former allopathic programs over the past 5 years, only 58 (1.7%) hold an osteopathic degree. Of the 560 medical students who hold postgraduate orthopaedic surgery positions at former osteopathic programs over the past 5 years, 47 (8.4%) hold an allopathic degree. The match rate of allopathic students at former osteopathic programs is significantly higher than the match rate of osteopathic students at former allopathic programs. Osteopathic students continue to match into orthopaedic surgery at lower rates than their allopathic counterparts. In addition, there remains a consistent and low number of osteopathic students matching into former allopathic programs. Allopathic students also have a higher likelihood of matching into former osteopathic programs when compared with osteopathic students matching into previous allopathic orthopaedic surgery programs.

Perceived Value of Osteopathic Recognition.

In 2020 the Accreditation Council on Graduate Medical Education (ACGME) became the sole accrediting body for osteopathic and allopathic residency programs, with an option for programs to apply for Osteopathic Recognition (OR) to distinguish their training in osteopathic principles and practice. There is limited research regarding this transition. The goal of our study was to assess the perceived value of OR and perceived difficulty of obtaining OR for family medicine residency programs. We performed analyses regarding the difficulty of obtaining OR status and the value of OR and Osteopathic Principles and Practice (OPP) using questions on the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey. Of the 280 program directors (PD) responding, 69 (24.6%) had OR status, 126 (45.0%) were considering applying or would apply if needed resources were available, and 85 (30.4%) were not considering OR. Of the 73 PDs reporting on experience with the OR process, 28 (38.4%) found it "very smooth," 30 (41.1%) found it "a little bumpy," and 15 (20.5%) found it "very bumpy"; 87.0% of PDs (60 of 69) with OR felt it had value in recruiting DO students and 31.8% (22/69) in recruiting MD students; 86.9% of programs with OR status perceived OPP to be somewhat or very valuable in enhancing patient satisfaction compared to 77% of those considering OR and 44.7% not considering OR. Program directors perceive value in OR status for recruiting and in osteopathic practice for patient care. Since 75.4% of responding program directors have or are interested in achieving OR status, further research is needed on its benefits and barriers.

On the Eve of Integration: Community and Affiliated Residency Programs Pave the Way Towards the Assimilation of Osteopathic Surgery Residents

The 2020 match integrated former osteopathic and allopathic residency programs under single Graduate Medical Education accreditation. We describe the composition of general surgery residency programs prior to the 2020 integration and provide a baseline to monitor future progress. Retrospective, cross-sectional data provided by the Association of American Medical Colleges for the 2018 academic year were analyzed. Descriptive analyses were used to summarize the characteristics of residents by program type and program location. Logistic regression was used to estimate factors associated with the presence of osteopathic (DO) residents. An alpha of 0.05 defined statistical significance. Data were collected and analyzed at a United States osteopathic medical school. All civilian surgery residencies that approved the 2018 Program Survey. Out of 285 programs, the percentages with at least one DO resident were significantly different among university (44.0%), university-affiliated (62.7%) and community (78.4%) programs (p < 0.001). DO residents made up 41.4% of community residents, 13.3% of university-affiliated residents, and 2.8% of university residents (p < 0.001). A significant regional difference was observed, as DO residents made up 16.9% of residents in the central region, compared to 10.4% in the northeast, 7.0% in the south and 8.9% in the west (p = 0.004). The logistic regression analysis found that the presence of DO residents at a program was significantly related to the type of program (Affiliated vs University OR = 3.1, 95% CI 1.5-6.5; Community vs University OR = 5.2, 95% CI 1.9-14.4) and the presence of DO faculty (OR = 2.7, 95% CI 1.6-4.8) (all p < 0.05). We observed significant differences in the presence of DO residents in different program types. As surgical education transitions to single accreditation, this study identifies opportunities for greater integration between osteopathic and allopathic surgery training programs.

Encouraging a Little Help from Our Friends: Resident Physician Burnout & Peer Communication Curriculum.

INTRODUCTIONResident physician burnout and depression rates are increasing faster than in the non-physician workforce. To foster a supportive community where such concerns may be addressed, residents can be educated in identification and first-line support of burnout in fellow residents. The literature has not described peer roleplaying applied toward aiding fellow residents with burnout.METHODThis pilot study evaluated an educational component aimed at fostering a strong emotional and informational social support system. The curriculum used peer roleplaying to develop self-awareness and social support, improve communication skills, and teach about existing mental health resources, thereby encouraging intervention. Residents listed behavioral manifestations of burnout and dysphoria that we developed into real-life scenarios. During experiential workshops, residents roleplayed “distressed” and “helper” residents and practiced communicating empathy. To tackle mental health stigma, all were required to practice expressing distress and seeking help. Residents completed a pre-roleplaying questionnaire, curriculum satisfaction questionnaire, and reflection essay.RESULTSAll 42 Internal Medicine and Transitional Year residents (69% male, 93% international medical graduates) participated. Resident-reported comfort, competence, confidence, and knowledge increased, as did positive appraisals of the clinical teaching environment representing a safe atmosphere. Six themes were cited in >25% of essays: knowledge of communication techniques, knowledge of approach tactics or strategies, knowledge of hospital resources, commitment to helping colleagues, importance of burnout, and belief this training produced a better understanding of oneself.CONCLUSIONAs first-witnesses of resident physician distress, peers occupy an underutilized, yet crucial preventive and supportive role in burnout and mental health intervention, especially during times of shared crises such as the coronavirus pandemic. Creating roleplays from personal experiences facilitated meaningful discussion of burnout and dysphoric emotions. Roleplaying offered a low-cost, effective method to destigmatize and encourage discussion of burnout, educate on signs and symptoms, and learn available resources to offer an afflicted colleague in osteopathic and allopathic residency programs.

Evaluating the Influence of Research on Match Success for Osteopathic and Allopathic Applicants to Residency Programs.

Analyzing factors that may enhance osteopathic applicants' likelihood of matching is warranted given that United States osteopathic and allopathic residency programs will have a single accreditation system in 2020. To determine the impact of research accomplishments and experiences on osteopathic and allopathic residency matching. Analysis of variance, t test, and odds ratios were used to examine data from the National Resident Matching Program Charting Outcomes from 2016 and 2018. Relationships between match status and medical degree, specialty matching, and mean numbers of research accomplishments and experiences in the Main Residency Match were analyzed. Matched osteopathic and allopathic applicants had significantly greater numbers of research accomplishments (mean [SD], 5.18 [4.34]) than unmatched applicants (3.66 [2.87]) (P=.006). Applicants who matched (mean [SD], 2.81 [1.64]) had similar numbers of research experiences to those who did not match (2.43 [1.26]) (P=.068). Matched and unmatched allopathic applicants' research accomplishments (5.91 [3.72]) were significantly greater than that of osteopathic applicants (2.60 [2.90]) (P<.001). Significant differences also were found between the means of research experiences of matched and unmatched osteopathic (mean [SD], 1.73 [1.21]) and allopathic applicants (3.36 [1.25], P<.001). Matched and unmatched osteopathic applicants' had similar means for research accomplishments (mean [SD], 3.00 [3.64] and 2.20 [1.84], respectively; P=.242) and experiences (1.79 [1.31] and 1.66 [1.12], respectively; P=.664). By contrast, significant differences were found between the numbers of research accomplishments for matched (mean [SD], 6.97 [4.07]) vs unmatched (4.86 [3.02]) allopathic applicants (P=.007). The only subspecialty for which research experiences of osteopathic applicants correlated with matching was physical medicine and rehabilitation (OR, 2.75; 95% CI, 1.30-5.84). Research seems to have a greater influence on matching for allopathic than osteopathic applicants. Although both osteopathic and allopathic programs have standards pertaining to scholarly activity, allopathic medical schools may place a greater emphasis on research. Increasing osteopathic medical students' exposure to research is predicted to enhance their competitiveness for matching and help develop skills relevant to the practice of evidence-based medicine.

Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals.

With the transition to a single accreditation system for graduate medical education, the scholarly activity among core faculty in osteopathic and allopathic residency programs has come under scrutiny. Currently, major differences in scholarly activity requirements exist between core faculty in obstetrics and gynecology residencies accredited by the Accreditation Council for Graduate Medical Education and those accredited by the American Osteopathic Association. To determine whether there is a disparity between osteopathic and allopathic physicians among authors with original research published in 4 high-impact obstetrics and gynecology journals during 4 select years. The authors reviewed Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause for the degree designation of the first and senior (last) author of each original manuscript for the years of 2000, 2005, 2010, and 2015. Data were analyzed using simple descriptive statistics and linear regression. In total, 3311 articles and 5909 authors were reviewed. Of these authors, 0.80% (47) had a DO degree. Of 1692 authors with dual advanced degrees, only 0.53% (9) had a DO degree. On subgroup analysis of each journal, 0.87% (13 of 1494) of identified authors in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were osteopathic physicians. During the years studied, no statistically significant trend could be established for first or senior author publication by osteopathic physicians over time, for all 4 journals or for any individual journal. Very few osteopathic physicians have served as either the first or the senior author in articles published in Obstet Gynecol, Am J Obstet Gynecol, Fertil Steril, or Menopause during the years studied, and no trend was seen for increased publication by osteopathic physicians in these journals over time.

Information within residency monthly evaluation forms at two institutions

ABSTRACTPeriodic review of resident performance is an important aspect of residency training. Amongst allopathic residency programs, it is expected that the performance of resident physicians which can be grouped based on the ACGME core competencies, be assessed so as to allow for effective feedback and continuous improvement. Review of monthly evaluation forms for residents in the core ACGME programs at Marshall University and the University of Toledo demonstrated a wide spread in the number of Likert questions that faculty were asked to complete. This number ranged from a low of 7 in Surgery to a high of 65 in Psychiatry (both Marshall Programs). Correlation and network analysis were performed on these data. High degrees of correlations were noted between answers to questions (controlled for each resident) on these forms at both institutions. In other words, although evaluation scores varied tremendously amongst the different residents in all the programs studied, scores addressing different competencies tended to be very similar for the same resident, especially in some of the programs which were studied. Network analysis suggested that there were clusters of questions that produced essentially the same answer for a given resident, and these clusters were bigger in some of the different residency program assessment forms. This seemed to be more the rule in the residency programs with large numbers of Likert questions. The authors suggest that reducing the number of monthly questions used to address the core competencies in some programs may be possible without substantial loss of information.

Implementation of a Resident-Led Osteopathic Manipulative Treatment Clinic in an Allopathic Residency

With the growing number of osteopathic physicians practicing in the United States and the creation of a single graduate medical education system, a continued need exists for focused education in osteopathic principles, philosophy, and treatment modalities in primarily allopathic residency programs. To create and integrate a resident-led osteopathic manipulative treatment (OMT) clinic in an allopathic residency program. After an informal needs assessment on the basis of resident survey data, a resident-led OMT clinic was created within a military allopathic family medicine residency program. A standard operating procedure, resident survey, and scheduling system were created by the residents for approval by the departmental and hospital leadership. Resident survey data pertaining to the time available to perform OMT, education, and faculty supervision of OMT were obtained before the clinic implementation and 1 year after implementation. Nine osteopathic residents were surveyed before the OMT clinic implementation to illustrate a need for continued osteopathic medical education, faculty support, and skill maintenance. Sixteen osteopathic residents were surveyed after the OMT clinic implementation. More residents indicated that the establishment of an osteopathic curriculum was important (3 of 9 in the preclinic survey vs 9 of 16 in the postclinic survey) and that the program promoted the use of OMT (0 of 9 in the preclinic survey vs 13 of 16 in the postclinic survey). A resident-led OMT clinic can be successfully implemented, maintained, and expanded in an allopathic residency program by implementing an OMT curriculum, offering elective rotations, and encouraging regular use of OMT. The current project can be used as a framework for implementing an OMT clinic.

The Allopathic Program Director's Dilemma.

The Allopathic Program Director's Dilemma.

From "Doctor of Osteopathy" to "Doctor of Osteopathic Medicine": a title change in the push for equality.

Nationally, the California merger created great solidarity among osteopathic members of state and national osteopathic associations. They rebuffed further efforts at amalgamation and championed the continuation of the DO degree. Even after the American Medical Association (AMA) opened its doors to DOs to join local and state medical associations as well as the AMA itself and gave its blessing to them entering allopathic residency programs and becoming MD board certified, the DOs stood fast for their independence. Yet some across the country wanted to become known as MDs. A few osteopathic physicians even went to federal court to claim-unsuccessfully-that state medical boards' refusal to license them or allow them to identify themselves as MDs violated their constitutional rights under the 1st and 14th Amendments. In the mid-1990s, the American Osteopathic Association (AOA) gave individual osteopathic medical colleges the option of indicating on their diplomas that the DO degree signified "Doctor of Osteopathic Medicine" rather than "Doctor of Osteopathy," a change that paralleled previous AOA policy changes regarding appropriate professional language. Nevertheless, some DOs and particularly a sizable number of osteopathic medical students continued to write of their desire for a change in the degree osteopathic medical colleges awarded. However, in July 2008 the AOA House of Delegates unanimously reaffirmed its commitment to continuing the traditional DO degree.

In Reply

We thank Dr. Gimpel for his thoughtful comments on the COMLEX examinations and our study,1 and we agree with the majority of his points. It is an extra burden for an osteopathic student to take the USMLE examination in addition to the COMLEX, and if there is a way to avoid this then allopathic residency programs should not require it of osteopathic students. The purpose of our study was to assess if the scores on one of the tests could be substituted for the scores on the other. We did not attempt to answer the question of which test predicts the better physician. It appears from our data that the tests are designed to measure different aspects of medical knowledge, and one cannot be substituted for the other. Osteopathic education trains students in a different manner than does allopathic education. As Dr. Gimpel notes, the COMLEX examination prepares students for the practice of osteopathic medicine. It is unknown if the COMLEX examination is predictive of success in an allopathic residency. The scores on examinations are one of the components used to assess a student’s projected ability to succeed in the allopathic program. In an era of grade inflation in both allopathic and osteopathic schools, universally superlative letters of recommendations, and inflated Medical Student Progress Evaluations, the USMLE and COMLEX examinations are perhaps the only objective measures of a student’s knowledge. This gives them added importance in the residency selection process, and the study of these tests may yield answers to how to best use them.

The Predicament of Osteopathic Postdoctoral Education

The growth of colleges of osteopathic medicine (COMs) during the past 20 years has been a catalyst for change and has created new challenges in osteopathic medicine. None of these challenges is more daunting than the task of sustaining an osteopathic graduate medical education (OGME) system that has suffered during this period of rapid development. Notable trends within the osteopathic medicine community since 1990 include allopathic residency programs obtaining OGME accreditation, COM graduates bypassing OGME, repeated major changes in American Osteopathic Association (AOA) accreditation policies, a growing dependence on Accreditation Council for Graduate Medical Education programs to train osteopathic graduates, and a lessening of options for the AOA to effectively direct its OGME system. The predicament is whether COMs can continue to grow without resulting in the demise of the OGME system and a loss of professional identity.

Performance of osteopathic medical school graduates on the American Osteopathic Board of Internal Medicine certifying examinations 1985 to 1994

This study examined the trends in the medical knowledge of osteopathic internal medicine residents in American Osteopathic Association-approved residency programs during a recent 10-year period and compared these trends with the declining medical knowledge observed for internal medicine residents graduated from allopathic medical schools and trained in allopathic residency programs. These results demonstrate a similar pattern of declining medical knowledge that appears to have leveled off during the past few years of the study. These trends occurred among candidates from both large and smaller training institutions. Various factors may have contributed to these observations.

Response: DOs who train in allopathic residency programs not 'disloyal'

Response: DOs who train in allopathic residency programs not 'disloyal'

DOs who train in allopathic residency programs not 'disloyal'

DOs who train in allopathic residency programs not 'disloyal'

Clarifying number of DOs in allopathic residency programs

Clarifying number of DOs in allopathic residency programs

Factors influencing osteopathic physicians' decisions to enroll in allopathic residency programs.

A survey of osteopathic physicians who were training in non-American Osteopathic Association (AOA)-approved (ACGME-accredited) internal medicine programs was undertaken in 1988. This was done in response to the AOA approval and implementation of the recommendations of the Task Force to Explore Alternative Mechanisms for Approval of Postdoctoral Training. Of the 188 physicians surveyed by mail, 137 physicians' responses provided the data for the results presented here. These respondents represented 39% of those residents who were training in nonosteopathic medical programs in 1988 and whose records were on file with the AOA Department of Education. The questionnaire investigated the factors that influenced these physicians' decisions to enroll in non-AOA-approved (ACGME-accredited) internal medicine residency programs. These reasons are discussed along with suggested solutions to alter this unhealthy trend.