American Association Of Colleges Of Osteopathic Medicine Research Articles

Where are the Black men in osteopathic medical schools?

Over the past decade, the American Association ofColleges of Osteopathic Medicine (AACOM) and the Association of American Medical Colleges (AAMC) have emphasized the need to enhance diversity within medical education. Despite concerted efforts, the representation of underrepresented populations in medicine (URiM), particularly Black men, remains alarmingly low. This commentary delves into the persisting challenges and potential solutions surrounding the lack of diversity of Black men in osteopathic schools. Black men, in particular, continue to be significantly underrepresented in osteopathic medical schools across the United States. Factors contributing to this disparity include limited access to resources, pervasive negative stereotypes, and biases within the medical community. Addressing these challenges necessitates multifaceted interventions such as mentorship programs, pipeline initiatives, and implicit bias training to enhance the recruitment and support for URiM applicants, particularly Black men. Institutions like Touro College of Osteopathic Medicine and A.T. Still University have underscored the importance of tailoring programs in fostering a sense of belonging and academic success among Black men aspiring to be osteopathic physicians. The creation of a supportive environment for Black men in osteopathic medical schools is not only crucial for promoting diversity but also crucial for improving patient health outcomes, because research consistently depicts enhanced patient outcomes and experiences with diverse healthcare teams. However, despite progress in some areas, Black men continue to face systemic barriers and biases that hinder the pursuit of a career in osteopathic medicine. Thus, increasing the representation of Black men in osteopathic medical schools requires a concerted effort from all stakeholders, including medical institutions, policymakers, and the broader medical community. By implementing targeted interventions, fostering a sense of belonging, and addressing systemic barriers, the medical community can work toward a more equitable and inclusive future in healthcare. Ultimately, promoting diversity is not only a matter of fairness but also essential for ensuring the delivery of high-quality, culturally competent care to all patients.

Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey.

Spanish is the language in the United States with the greatest language-concordant physician deficit. Allopathic medical Spanish programs have proliferated, but the national prevalence of medical Spanish education at osteopathic medical schools has never been evaluated. The objectives of this study are to describe the medical Spanish educational landscape at US osteopathic schools and evaluate program adherence to previously established basic standards. Between March and October 2022, surveys were sent to all 44 member schools of the American Association of Colleges of Osteopathic Medicine (AACOM). For nonrespondents, data were obtained from publicly available websites. Primary surveys were sent to deans or diversity, equity, and inclusion officers at each osteopathic school to determine whether medical Spanish was offered and to identify a medical Spanish leader. Medical Spanish leaders received the secondary survey. The main measures of this study were the prevalence of medical Spanish programs at osteopathic schools and the extent to which existing programs met each of the four basic standards: having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit. We gathered medical Spanish information from 90.9 % (40/44) of osteopathic schools. Overall, 88.6 % (39/44) offered medical Spanish, of which 66.7 % (26/39) had formal curricula, 43.6 % (17/39) had faculty educators, 17.9 % (7/39) assessed learner skills, and 28.2 % (11/39) provided course credit. Only 12.8 % (5/39) of osteopathic schools with medical Spanish programs metall basic standards. Urban/suburban schools were likelier to offer medical Spanish than rural schools (p=0.020). Osteopathic schools in states with the highest Spanish-speaking populations were more likely to offer student-run initiatives (p=0.027). Most osteopathic schools provide medical Spanish education, but work is needed to improve consistency, quality, and sustainability. Future research should focus on osteopathic student language proficiency assessment, improve medical Spanish accessibility for students at rural programs, and explore the unique content areas of osteopathic medical Spanish education.

Building Interest in the Primary Care Specialty Through Enhanced Global Health Experience.

Background An overwhelming majority of matriculating medical students in the USA are keen to deliver quality health care to all people, including the socioeconomically disadvantaged populations in remote, resource-scarce regions nationally and worldwide. Here, we describe a protocol developed to evaluate the interest of our medical students in global health activities. We also examined the relationship between students' interest in global health and readiness to pursue a future career in the primary care specialty. Materials and methods We designed a survey in Qualtrics online software and reached all first-year and third-year medical students between 2019 and 2022 enrolled at the Alabama College of Osteopathic Medicine (ACOM).The survey utilized ordinal scale items to explore the medical students' interest in primary care residency programs, their interest in global health and international travel, and their perceptions of how a range of factors might motivate their desire to participate in global health activities. The study was approved by ACOM's Institutional Review Board (IRB). In order to compare findings from this study withdata from other medical schools, we developed constructs using the national aggregate data, in percentages, from matriculants and graduates of Doctor of Osteopathic Medicine (DO) degree-granting medical schools according to gender, published by the American Association of Colleges of Osteopathic Medicine (AACOM). Statistical analysis of national aggregate data was performed using the unpaired t-test. Results Both female and maleparticipants had lived or traveled abroad before starting medical school.Female (98%, n=249) and male (95%, n=140) participants in the first-year cohorts considered helping the underserved population as important or very important as it is related to a career in medicine. Females in the third-year cohorts (97%, n=71) also ranked this statement as important or very important compared to male cohorts (89%, n=31). Ahigher proportion of females (43%, n=108) compared to males (35%, n=52) in first-year cohorts agreed or strongly agreed that they would likely pursue a residency in primary care.More females (59%, n=43)than males (46%, n=16)in the third-year cohorts agreed or strongly agreed with the same statement. Analysis of the aggregatenational data (2009-2022) revealed that the percentage (actual count not available) of female students who plannedto practice in underserved/shortage areawas higher both at the time of matriculation (M=51%, SD=4%) and before graduation (M=40%, SD=4%) compared to males (matriculation: M=40%, SD=5%; graduation: M=33%, SD=4%) presenting a significant difference (matriculation t(24)=6.7, p<0.0001; graduation t(24)=5.4, p<0.0001). Furthermore, a higher percentage of females at the time of matriculation (M=25%, SD=5%) and graduation (M=40%, SD=6%) plannedto practice in the primary care specialtiescompared to males (matriculation: M=17%, SD=4%; graduation: M=29%, SD=6%) presenting a significant difference (matriculation: t(24)=4.6, p = 0.0001; graduation: t(24)=4.8, p<0.0001). Conclusions Interest in global health activities may be associated with interest in pursuing a future career in the primary care specialty. In this study, more female medical students expressed interestin participating in global healthexperiences, serving the underserved population domesticallyand abroad, andexpressing interest in primary care than males.

Development of Osteopathic Neuromusculoskeletal Medicine (ONMM) residency curriculum guidelines to meet Accreditation Council for Graduate Medical Education (ACGME) milestones.

A memorandum of understanding was reached between the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) in 2014 outlining the course for a single accreditation system for graduate medical education. This process was completed in 2020 and has included the transition of AOA-accredited neuromusculoskeletal and Osteopathic Manipulative Medicine (OMM) programs into programs now termed "Osteopathic Neuromusculoskeletal Medicine" (ONMM) under the single accreditation system. Progress through ONMM residency is evaluated on the basis of 15 ACGME milestones that encompass six core competencies. However, there are no curricular guidelines to help guide the achievement of these milestones. The primary purpose of this study was to develop a proposed structure and content for an ONMM residency curriculum that is based on (1) the alignment of residency curriculum with ACGME milestones in one ACGME-accredited ONMM residency program, and (2) the perceived needs of residents and faculty for an ONMM residency curriculum. A mixed-methods exploratory sequential approach with embedded design was utilized. Qualitative analysis of didactics curriculum content for the past 2 years was coded according to themes identified in the residency curriculum content, which were further coded according to ACGME milestones. Curriculum topics identified in qualitative analysis were utilized to create a questionnaire that was administered to residents and faculty (n=24) in the ONMM residency program to examine the perceived importance of each curriculum topic based on a five-point Likert scale. Open-ended questions were embedded in the questionnaire that asked how faculty and residents define ONMM and what they believe should be the purpose of an ONMM residency curriculum. Five themes were identified in qualitative analysis of curriculum: (1) OMM laboratory topics; (2) faculty-led activities and lecture topics; (3) resident-led activities and lecture topics; (4) research; and (5) training courses and volunteer activities. The most important perceived curriculum topics for faculty and residents were osteopathic structural examination, orthopedic exam, direct and indirect methods, osteopathic cranial manipulative medicine, pediatric OMT, common upper and lower extremity injuries, and low back pain. Each of these topics aligned well with ACGME milestones. Residents reported that integrative medicine topics such as acupuncture were a significantly more important OMM laboratory topic (mean=3.58, SD=0.996) compared to faculty (mean=2.33, SD=0.985), t (22)=-3.091, p=0.005. Study participants most commonly described ONMM in terms of the specialized knowledge required for the discipline (n=19, 79.2%) and the Tenets of Osteopathy (n=17, 70.8%), and they felt that the purpose of an ONMM residency curriculum should be to gain knowledge (n=20, 83.3%) and become a competent physician (n=19, 79.2%). The present findings were applied to the development of proposed ONMM residency curriculum guidelines and submitted to the American Academy of Osteopathy (AAO) for consideration. They are presented here as a resource for ONMM residencies to develop a program curriculum in alignment with individual program needs.

The Single Accreditation System: Risks to the Osteopathic Profession.

In August 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) signed a memorandum of understanding with the Accreditation Council for Graduate Medical Education (ACGME) to create the Single Accreditation System (SAS) for graduate medical education (GME) in the United States. The AOA made the decision that it would close its GME accreditation system in response to dramatic growth in colleges of osteopathic medicine, a shortfall in osteopathic GME positions with increasing dependence on the ACGME system, ACGME policy decisions that adversely impacted osteopathic students, and declining osteopathic student interest in primary care. Osteopathic teaching institutions bore responsibility for meeting ACGME accreditation standards between 2015 and 2020, including determining institutional sponsorship, which program applications to submit, program size, educational leadership, and whether to pursue Osteopathic Recognition. Approximately 692 of 954 (72.5%) eligible osteopathic GME programs in 2014-2015 obtained ACGME accreditation by June 1, 2020. There were sharp reductions in surgical and subspecialty programs and a significant drop of DOs in educational leadership positions. A low percentage of ACGME-accredited programs applied for Osteopathic Recognition. In closing its GME accreditation system and joining the ACGME, the AOA gave up control of its direct relationship with osteopathic residents, fellows, and teaching institutions to gain critical GME opportunities. In this article, the author considers whether this gain will offset the risks taken by the AOA, including decreased DO leadership opportunities and role models, lower than expected interest in Osteopathic Recognition, and possible decreased DO interest in osteopathic organizations and osteopathic specialty board certification. Time and the choices of current and future DO trainees in ACGME programs will determine the future of the osteopathic profession-and whether these risks were worth taking.

The ACGME Single Accreditation System: Alterations in the Force of Graduate Medical Education.

The Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) disturbed the gravitational forces of medical education when they entered into a historic agreement in August 2014. This agreement resulted in a 6-year journey to a single accreditation pathway for all residency programs and nearly all fellowship programs in the United States. It brought together the 2 traditions of medicine in the country for the first time in more than 100 years, unifying a critical phase of medical education for all physicians in the United States. In this commentary, the authors briefly describe the Single Accreditation System and relate their perspective on the factors leading to this profoundly important event and its impact on the ACGME, AOA, and medical education.

Radiation oncology education and experience in the undergraduate medical setting

ABSTRACT The goal of this study was to determine the impact and experience of radiation oncology (RO) education in the undergraduate medical experience in the USA. A list of American medical schools was complied from various sources including the Association of American Medical Colleges (AAMC) and American Association of Colleges of Osteopathic Medicine (AACOM) in the summer of 2019. Data was extracted through institution website review, individual phone calls and email distribution. A total of 198 programs (155 allopathic and 43 osteopathic medical schools) were included. Every medical school curriculum had oncology lecture during MS year 1 and 2, although a minimal amount (4%) had a RO-specific lecture during MS year 1 and 2. There were significant differences in the RO education and experience in allopathic (MD) versus osteopathic (DO) programs. Home radiation oncology programs and career advising were associated with a radiation oncology elective during year 3 and 4. Furthermore, RO career advisors and older schools were associated with having one student match into radiation oncology. RO education during the didactic portion of the undergraduate medical experience remains extremely limited. This limitation is even more pronounced in medical schools without RO mentorship and in osteopathic medical schools. This lack of RO exposure perpetuates itself by bringing less students into the field. These issues require attention both on a national and medical-school-specific level.

When the Clinical Environment Is Closed to Students: The Harsh Reality of COVID-19 and Implications for Colleges of Osteopathic Medicine.

When the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a global health emergency, Colleges of Osteopathic Medicine (COMs) debated the role of medical students during this developing pandemic. Initially, the discussion included whether medical students were essential personnel contributing to meaningful patient care. Many questions arose regarding how COVID-19 would affect medical education and if the changes would be temporary or continue for a significant period of time.Due to the lack of availability of personal protective equipment (PPE) and a decreased focus on clinical education within many healthcare settings, in March the American Association of Colleges of Osteopathic Medicine (AACOM) declared that medical students were not essential personnel and recommended that COMs take a ‘pause’ and remove students from the clinical environment. This ‘pause’ would allow COMs time to assess where medical education could continue, to define the critical pieces of clinical education that required a clinical environment and to address how medical students could contribute during the pandemic.The AACOM Clinical Educators group began to meet on a weekly basis during this time so that Clinical Deans from Osteopathic medical schools across the country could collaborate, share ideas, discuss current challenges, and co-create a system to deliver medical education realizing the limitations of in-person clinical training.

Status of Entrustable Professional Activities (EPA) Implementation at Colleges of Osteopathic Medicine in the United States and Future Considerations.

Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entrustable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country. To review the status of EPA implementation at COMs nationally. An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from "moderate implementation with reporting" to "full implementation with reporting." Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings. Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above "somewhat knowledgeable" toward "expert" regarding knowledge of EPAs, but 23 (64%) also indicated "no confidence" or "somewhat confident" regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the "foundational implementation" (10; 28%), "slight implementation" (11; 31%), and "moderate implementation" (11, 31%) categories, with a few schools indicating "no implementation" (2; 5%) or "progressive implementation" (2; 5%). The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.

Educating Leaders 2018: Abstracts From AACOM's Annual Conference.

Educating Leaders is the annual conference of the American Association of Colleges Educating Leaders is the annual conference of the American Association of Colleges of Osteopathic Medicine (AACOM). In preparation for this event, the Call for Presentations receives hundreds of high-quality abstract submissions. Presentation submissions for Educating Leaders 2018 were based on seven focus areas: Advocacy and Policy, Graduate Medical Education, Humanism and Mentoring, Learner Affairs, Osteopathic Medical Education, Professional Development, and Research Support and Technology. Following Educating Leaders 2018, session presenters were provided the opportunity to submit their sessions for publication. These sessions were reviewed by fellows (listed below) of the National Academy of Osteopathic Medical Educators-we thank them for their service. The following abstracts comprise the research and scholarly work of faculty, administrators, students, and physicians from across the osteopathic medical education continuum and were accepted by AACOM and the American Osteopathic Association for publication in The Journal of the American Osteopathic Association.

The History of Sponsoring Institutions, 1982-2017.

The History of Sponsoring Institutions, 1982-2017.

Ready for Residency: A Bloomian Analysis of Competency-Based Osteopathic Medical Education.

Bloom's Taxonomy is a widely accepted tool for analyzing learning objectives, creating assessment materials, and ensuring that students move progressively through various levels of knowledge and cognition. Competency-based osteopathic medical education has, to the authors' knowledge, yet to be subjected to systematic bloomian analysis. To advance a bloomian analysis of competencies published by the American Association of Colleges of Osteopathic Medicine (AACOM) and draw consequences of that analysis for undergraduate osteopathic medical education. Content analysis of the verbs and contexts used in the AACOM competencies was conducted, followed by categorization by the various cognitive and knowledge dimensions as specified by the Revised Bloom's Taxonomy. The majority of AACOM competencies gravitate toward the taxonomy's apply and procedural cognitive and knowledge dimensions, respectively. In addition, 58% of the top 10 most-used verbs in the document were identified to be in the apply cognitive dimension. An analysis of the competencies revealed that 69% can be categorized under the procedural knowledge dimension. Of 657 code co-occurances, 45% were from the apply cognitive and procedural knowledge dimensions. These figures suggest a skewing toward application-based cognitive and procedural-based knowledge over other types of cognitive and knowledge dimensions. Bloom's Taxonomy offers a useful framework for understanding how competency-based osteopathic medical education is organized. Such analysis underscores the importance of attending to the language and construction of competencies to better understand how the language of competencies shapes pedagogic practices and begin a broader conversation about the appropriate use and distribution of lower- and higher-order cognitive processes within competency-based osteopathic medical education.

THE SINGLE ACCREDITATION SYSTEM: MORE THAN A MERGER

In February 2014 the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM) announced an agreement outlining a single graduate medical education accreditation system in the United

Doctors of osteopathic medicine (DO): a Canadian perspective

Doctors of osteopathic medicine (DO) are one of the fastest growing segments of health care professionals in the United States. Although Canada has taken significant leaps in the acknowledgment of US trained DOs, there continues to be a lack of understanding of the profession by Canadian trained physicians. In this article, we provide a brief overview of osteopathic medical education and training in the United States. Current information of osteopathic training by American Association of Colleges of Osteopathic Medicine (AACOM) and American Osteopathic Association (AOA) was presented. Data pertaining to Canadians enrolled in osteopathic colleges was compared with allopathic (MD) and international medical graduates (IMGs). Doctors of osteopathic medicine programs provide an additional pathway for students interested in pursuing a medical education. Canadian applications to osteopathic colleges are expected to grow due to successful post-graduate US residency matching, increased difficulty of matriculating at Canadian medical schools, and a greater awareness of the profession in Canada. Given the increasing enrollment of Canadian students in US osteopathic medical schools, we expect that Canadian DOs will play a significant role in shaping health care in both the US and Canada.

Research funding at colleges of osteopathic medicine in the United States.

Research is a vital component of a college of osteopathic medicine (COM) portfolio. Previous studies have described research activity at COMs from 1989 through 2004 using data from surveys of COM administrators conducted by the American Association of Colleges of Osteopathic Medicine (AACOM). However, these studies had limitations. To address the limitations of previous studies and to provide more depth of understanding regarding research activity at COMs by (1) documenting changes in research funding at COMs from 2004 to 2009 according to the funding agencies, principal investigators' degrees, and areas of study after considering inflation and (2) examining predictors of research funding at COMs. Information about 2004 and 2009 active research grants and contracts, research expenditures, and COM characteristics was obtained from AACOM databases. Descriptive statistics are presented for 20 COMs that completed the survey in both years. The 2004 dollar values were adjusted for the rate of inflation (13.57%). Bivariate and multivariate analyses were used to explore associations between school characteristics (eg, number of faculty), research expenditures, and research funding outcomes (total amount and number of awards) for all COMs completing the survey in 2009 (n=26). From 2004 to 2009, the total amount of awards increased from 115.2 million to 216.6 million, and the number of awards increased from 450 to 665. Funding rose substantially from foundations (336%), to PhD-DO principal investigators (909%), and for osteopathic manipulative medicine (60%). Total award amounts were positively associated with both research expenditures (P<.001) and the number of faculty (P<.001). Larger research expenditures also were related to securing a greater number of awards (P<.001). Research activity at COMs continues to advance partly because of investments in research and faculty made by COMs.

Understanding the US Medical School Requirements and Medical Students’ Attitudes about Radiology Rotations

To learn what percentage of US medical schools require their students to complete rotations in radiology during the clinical years. A secondary goal was to survey students' opinions about radiology rotations. Data were collected from 159 US medical schools from the Association of American Medical Colleges (AAMC) for allopathic medical schools, the American Association of Colleges of Osteopathic Medicine (AACOM) for osteopathic medical schools, and by e-mailing curriculum directors at US medical schools with a survey. The secondary goal was achieved by e-mailing curriculum directors for voluntary medical student participation with an institutional review board-approved online survey. Data from the 2009-2010 academic year from AAMC and AACOM showed that 25% of US medical schools required radiology as a clinical rotation. Our survey of curriculum directors corroborated the AAMC and AACOM data. Data from our medical student survey showed that 87% of students from institutions requiring radiology thought radiology should be required. From institutions not requiring radiology, 45% of students thought that radiology should be required as a standalone course. Of students not required to take radiology, 63% planned to take radiology as an elective. Students, regardless of requirements, think there is value in having radiology as a regular aspect of a medical school curriculum. Medical schools should consider ways of incorporating radiology into their clinical curriculum.

National Board of Osteopathic Medical Examiners in the 21st century.

he National Board of OsteopathicMedical Examiners (NBOME) is anot-for-profit organization whose mis-sion is to provide “for the public welfarea means to assess competency in thehealthcare disciplines relevant to osteo-pathic medicine.” The NBOME wasestablished in 1934 to provide an eval-uation instrument by which osteopath-ic physicians could seek medical licensurewith full practice rights across the nation.Currently, the Board of Directors ofNBOME consists of 21 members. Thesemembers are elected to the Board fortheir experience and expertise in the clin-ical and basic science disciplines, andrelevant experience in osteopathic med-ical education and evaluation. Membersof the Board come from all regions of thecountry, and each brings unique talentsto the Board. Additionally, representa-tives of the American Osteopathic Asso-ciation (AOA), American Associationof Colleges of Osteopathic Medicine(AACOM), and the American Associa-tion of Osteopathic Examiners (AAOE)have been included to broaden the scopeof membership of the Board.The NBOME has the followingstanding committees: Finance, Mem-bership, Research, Standards, Liaison,and Product. These committees meetregularly throughout the year to sup-port the work and mission of NBOME.The Research Committee has recent-ly assembled an expert advisory panelthat includes Barbara Plake, PhD, fromthe University of Nebraska; Mark Wil-son, PhD, from the University of Cali-fornia-Berkley; John Norcini, PhD, fromthe American Board of InternalMedicine; and Benjamin Wright, PhD,from the University of Chicago, MESAPsychometric Institute. The NBOME isrepresented on the panel by DavidBaron, DO, MEd (chair of the ResearchCommittee); Thomas Cavalieri, DO(Vice President of the Board); and Lin-jun Shen, PhD (Director of Testing). ThisResearch Advisory Panel guides theresearch efforts of NBOME.Through the Liaison Committee,NBOME maintains communication withthe schools, the students, and the statelicensing boards through representationfrom AACOM, the Student Osteopath-ic Medical Association (SOMA), theCouncil of Osteopathic Student Gov-ernment Presidents (COSGP), and theFederation of State Medical Boards(FSMB). This committee provides aforum in which concerns from these var-ious constituencies can be presented tothe NBOME Board of Directors.