American Osteopathic Association Research Articles

Impact of osteopathic manipulative medicine training during graduate medical education and its integration into clinical practice.

Osteopathic manipulative medicine (OMM) is a unique skill set consisting of physical manipulations that treatthe neuromusculoskeletal system. Although OMM can improve patient outcomes such as functionality and pain, as well as increase physician reimbursement, its use is declining. Barriers to its use include a lack of proficiency, support, reimbursement, and time. Knowledge gaps remain as to how OMM training during graduate medical education (GME) affects OMM use. This study describes relationships between OMM exposure during GME and the use of OMM in practice. An online survey of physicians in a variety of medical fields during late 2022 assessed the impact of OMM education during postgraduate training on its use in clinical practice. Survey data were analyzed to compare training characteristics and OMM use via chi-square tests and binary logistic regression. A total of 299 surveys were completed. Respondents who received formal OMM education during residency were more likely (59.8 %) to utilize OMM in medical practice than those who practiced OMM informally (37.8 %, p<0.001) and those who had no OMM exposure during residency (10.3 %, p<0.001). Respondents who trained with more osteopathic attendings (p<0.001) and co-residents (p=0.012) were also more likely to utilize OMM. Those who completed residencies that were accredited by the Accreditation Council for Graduate Medical Education (ACGME) with an Osteopathic recognition track, by the American Osteopathic Association (AOA), and were dually-accredited (ACGME/AOA), were all more likely to utilize OMM (60 %, 56 %, and 53 %, respectively) than those who completed residencies with ACGME accreditation alone (22 %, p<0.01). Although OMM can improve patient outcomes, it is underutilized by Doctors of Osteopathic Medicine (DOs) in practice. Lack of training after medical school has been identified as a contributing factor to its disuse. The results of our study illustrate that there is a positive association between OMM education during postgraduate training and OMM use in clinical practice.

Geographical Distribution of Osteopathic Neurosurgery Residents.

The neurosurgery residency match has grown increasingly competitive, especially for osteopathic (DO) medical students, amidst the transition to a single accreditation system in 2020. This shift required former American Osteopathic Association (AOA) programs to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation, leading to a notable reduction in programs with a history of accepting DO applicants. This study aims to explore both potential geographical trends in residency match among recent DO neurosurgical residents and in the number of DO neurosurgical residents pre- and post-ACGME merger. Neurosurgery residency programs during the 2023-2024 academic year were identified, and each program's residents, resident degrees, and resident post-graduate years were collected from residency programs' websites. Descriptive statistics were used to analyze the ratios of DO and allopathic (MD) residents, while regression analyses were used to determine the trends in DO residents between 2017 and 2024. DO residents were also collated by state to observe their geographical distribution. A comprehensive cross-sectional analysis of 115 neurosurgery residency programs across the United States from 2016 to 2024 reveals a significant decrease in DO residents, from 14 in 2016 to four in 2024, with an average of six DO residents per year post-merger. A geographical heatmap analysis pinpointed New Jersey, Michigan, and California as states with the highest proportions and numbers of DO neurosurgery residents. These findings show the geographical distribution of DO neurosurgery residents in the US. Recognizing and understanding these geographical trends could be essential in the strategic application planning for DO candidates and the need for residency programs to reassess selection criteria to be more inclusive of DO applicants.

Examining differences in trends in the orthopedic surgery match for osteopathic and allopathic medical graduates after the transition to single accreditation.

The landscape of medical education in the United States has undergone significant changes, particularly with the rise of osteopathic medical students, constituting a substantial portion of medical school entrants. The merger of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) in 2020 opened residency slots to allopathic graduates that were previously historically allocated to osteopathic (Doctor of Osteopathic Medicine [DO]) physicians. This has impacted various medical specialties, notably orthopedic surgery. Despite an increase in orthopedic surgery applicants, the match rates for DO candidates have faced challenges, raising concerns about the impact of this merger on the future of orthopedic training for DO students. This research aims to analyze the trends in orthopedic surgery match rates for DO vs MD applicants since the single accreditation merger, which began in 2015 with a 5-year transition period that was finalized by 2020. By examining factors such as application numbers, research output, standardized test scores, and program director preferences, the study seeks to identify disparities and challenges faced by DO applicants in securing orthopedic surgery residencies. This study utilized publicly available data from the National Residency Match Program (NRMP) 2018, 2020, and 2022 reports. Data encompassed applicant characteristics, including standardized test scores, research experiences, and match outcomes. The study also incorporated insights from NRMP program director surveys, focusing on interview and ranking practices. The analysis involved comparisons of application numbers, match rates, research productivity, and test scores between DO and MD applicants. Statistical analysis was employed to identify any statistically significant differences among the examined variables for the 3 years included in the study. The research revealed a consistent increase in orthopedic surgery applicants from both DO and MD backgrounds. However, MD applicants consistently had higher match rates compared to their DO counterparts, with the gap narrowing over the years. Notably, disparities persisted in research output, with MD applicants demonstrating a significant advantage in publications and presentations. Standardized test scores, although slightly higher for MD applicants, did not significantly impact the differences in match rates. MD applicants had statistically significantly higher numbers of applicants (P = .0010), number of publications (P = .0091), and number of research experiences (P = .0216) over the years examined. However, there was no statistically significant difference in the scores on Step 1 (P = .5038) or Step 2 (P = .4714) between MD and DO candidates. Despite progress in the acceptance and ranking of DO applicants by program directors, the study highlights enduring challenges in orthopedic surgery match rates between DO and MD candidates. The lack of research opportunities for DO students stands out as a crucial area for improvement, necessitating systemic changes within medical education. Addressing this disparity and ensuring equal access to research experiences could mitigate the gap in match rates, promoting a more equitable environment for all aspiring orthopedic surgeons, regardless of their medical background. Such efforts are vital to fostering inclusivity and enhancing opportunities for osteopathic medical students pursuing competitive specialties like orthopedic surgery.

Characterizing the initial effects of the single accreditation system merge on the ophthalmology residency match

ABSTRACT Introduction In 2020, the American Osteopathic Association merged its residency programs into one system under the Accreditation Council for Graduate Medical Education (ACGME). The effects of this transition on the ophthalmology match is not fully understood. The purpose of this study is to assess the early impact of the transition to ACGME accreditation on MD, DO, and IMG representation in ophthalmology residency programs. Materials and Methods Information about resident medical degree and resident medical school was gathered from ophthalmology residency program websites from a resident class before and after the Transition. Additionally, the medical degree of residency program directors (PD) was collected to analyze MD vs DO leadership in ophthalmology residency programs and to further stratify resident data to identify any trends in PD preference for different medical graduates. Results Data was obtained for 915 ophthalmology residents in 110 residency programs that met the study’s inclusion criteria. Of these programs, 102 were allopathic with MD leadership, 1 was allopathic with DO leadership, 3 were osteopathic with MD leadership, and 4 were osteopathic with DO leadership. Overall, MD representation increased while DO and IMG representation decreased although not significantly. For both classes analyzed, DO and IMG representation was disproportionately low. Discussion The transition to ACGME accreditation seems to have primarily harmed DO and IMG applicants in the ophthalmology match while benefitting MDs. Various factors such as loss of protected residency positions for DO applicants and the closure of osteopathic ophthalmology residency programs are likely reasons to blame for this decrease in osteopathic representation.

Parental Leave: What Do Physician Societies Provide for Their Employees?

Parental leave yields significant health benefits for parents and children. While many medical associations endorse parental leave, it is unknown what parental leave they provide for their employees. To assess parental leave policies of national physician societies for their employees including paid versus unpaid and parity between birth mothers and non-birthing parents. A cross-sectional analysis in 2023 examined parental leave policies of national physician societies, including the American Medical Association (AMA), American Osteopathic Association (AOA), and six specialty societies: American College of Obstetricians and Gynecologists (ACOG), American College of Osteopathic Obstetricians and Gynecologists (ACOOG), American Academy of Pediatrics (AAP), American College of Osteopathic Pediatricians (ACOP), American Academy of Family Physicians (AAFP), and American College of Osteopathic Family Physicians (ACOFP). Examination of policies included: duration, whether paid or unpaid; qualifications before receiving benefit; and whether non-birthing, adoptive, and foster parents were covered. Among the eight societies surveyed, two (25%) did not disclose their policies (ACOG, ACOP), and one (12.5%) lacked a policy (ACOOG). Of the remaining five, two (40%) offered paid leave (AMA, AAP), while three (60%) provided unpaid leave in line with legal requirements (AOA, AAFP, ACOFP). Benefits for non-birthing parents mirrored those for birth mothers, although the AMA offered birth mothers enhanced benefits. Only a minority of surveyed physician societies provide paid parental leave. Physician societies should consider providing paid parental leave for their employees and making their policies publicly available to promote and model the benefit of paid parental leave.

On My Oath.

Most osteopathic medical students will take an oath adopted in 1954 by the American Osteopathic Association. We examine this oath to explore its ethical content by focusing on two specific lines. We conclude that the oath would benefit from scrupulous revision to promote patient-centered care.

Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match

The unprecedented number of unfilled emergency medicine post-graduate year 1 (PGY-1) residency positions in the 2023 National Resident Matching Program shocked the emergency medicine community. This study investigates the association between emergency medicine program characteristics and the likelihood of unfilled positions in the 2023 Match. This cross-sectional, observational study examined 2023 National Residency Matching Program data, focusing on program type, length, location, size, proximity to other programs, previous American Osteopathic Association (AOA) accreditation, first accreditation year, and emergency department ownership structure. We constructed a generalized linear mixed model with a logistic linking function to determine predictors of unfilled positions. A total of 554 of 3,010 (18.4%) PGY-1 positions at 131 of 276 (47%) emergency medicine programs went unfilled in the 2023 Match. In our model, predictors included having unfilled positions in the 2022 Match (odds ratio [OR] 48.14, 95% confidence interval [CI] 21.04 to 110.15), smaller program size (less than 8 residents, OR 18.39, 95% CI 3.90 to 86.66; 8 to 10 residents, OR 6.29, 95% CI 1.50 to 26.28; 11 to 13 residents, OR 5.88, 95% CI 1.55 to 22.32), located in the Mid Atlantic (OR 14.03, 95% CI 2.56 to 77.04) area, prior AOA accreditation (OR 10.13, 95% CI 2.82 to 36.36), located in the East North Central (OR 6.94, 95% CI 1.25 to 38.47) area, and corporate ownership structure (OR 3.21, 95% CI 1.06 to 9.72). Our study identified 6 characteristics associated with unfilled emergency medicine residency positions in the 2023 Match. These findings may be used to guide student advising and inform decisions by residency programs, hospitals, and national organizations to address the complexities of residency recruitment and implications for the emergency medicine workforce.

A Match Made in Rural: Interpreting Match Rates and Exploring Best Practices.

Although rural family medicine residency programs are effective in placing trainees into rural practice, many struggle to recruit students. Lacking other public measures, students may use residency match rates as a proxy for program quality and value. This study documents match rate trends and explores the relationship between match rates and program characteristics, including quality measures and recruitment strategies. Using a published listing of rural programs, 25 years of National Resident Matching Program data, and 11 years of American Osteopathic Association match data, this study (1) documents patterns in initial match rates for rural versus urban residency programs, (2) compares rural residency match rates with program characteristics for match years 2009-2013, (3) examines the association of match rates with program outcomes for graduates in years 2013-2015, and (4) explores recruitment strategies using residency coordinator interviews. Despite increases in positions offered over 25 years, the fill rates for rural programs have improved relative to urban programs. Small rural programs had lower match rates relative to urban programs, but no other program or community characteristics were predictors of match rate. Match rates were not indicative of any of five measures of program quality nor of any single recruiting strategy. Understanding the intricacies of rural residency inputs and outcomes is key to addressing rural workforce gaps. Match rates likely reflect challenges of rural workforce recruitment generally and should not be conflated with program quality.

Transcutaneous auricular vagus nerve stimulation may elicit anti-inflammatory actions through activation of the hypothalamic-pituitary-adrenal axis in humans

Introduction: Since the discovery of the cholinergic anti-inflammatory pathway, vagus nerve stimulation (VNS) has been suggested as a treatment option for chronic inflammatory conditions. This pathway relies on efferent vagal nerve fibers. Invasive cervical VNS activates afferent and efferent vagal nerve fibers and, thus, has the potential to directly activate the cholinergic anti-inflammatory pathway. In contrast, transcutaneous auricular VNS (taVNS) activates the auricular branch of the vagus nerve that is purely afferent and projects to the nucleus of the solitary tract. Thus, any anti-inflammatory actions of taVNS are unlikely to result from a direct activation of the cholinergic anti-inflammatory pathway. The objective of this study was to investigate alternative mechanisms by which taVNS may elicit anti-inflammatory effects. The hypothesis was tested that taVNS activates the hypothalamic-pituitary-adrenal (HPA) axis, resulting in adrenal cortisol secretion that will then modulate circulatory immune cell numbers. Methods: The study was approved by the appropriate authorities (IRB# 0054_2019 and NCT04177264). Study participants were healthy adults (n=19, 6 male, 13 female). On three consecutive days either taVNS (left ear, 10 Hz, 1-2 mA, 300 μs pulse width) or sham-taVNS (stimulator off) was applied for 10 minutes. A blood sample was drawn at the end of the third day. Plasma cortisol was determined by ELISA (K003-H1W, Arbor Assays, MI). Circulating T-helper cells (CD3+, CD4+), cytotoxic T-cells (CD3+, CD8+), B-cells (CD19+), monocytes (CD14+, CD11b+), and natural killer (NK, CD3-, CD56+) cells were counted using flow cytometry. Statistical significance was assumed at P&lt;0.05 and trends are reported for P&lt;0.15 based on unpaired t-tests. Results: Plasma cortisol levels tended to be higher following taVNS (72.5±9.5 ng/mL) compared to sham-taVNS (52.3±3.8 ng/mL, P=0.09). Following taVNS, the relative number of circulatory B cells was lower (0.48±0.11 % vs. 0.82±0.11 %, P&lt;0.05), while the number of circulatory monocytes was higher (2.21±0.32 % vs 1.58±0.16 %, P=0.06) compared to sham-taVNS. T-helper cells, cytotoxic T cells, and NK cells were not significantly affected by taVNS. In conclusion, the higher plasma cortisol levels following taVNS together with the higher number of circulatory monocytes and lower number of B cells suggest that taVNS elicits anti-inflammatory actions through activation of the HPA axis, because it is known that cortisol increases circulatory monocytes and reduces B cells. The decrease in B cells following taVNS gives rise to the intriguing hypothesis that taVNS may prevent secondary treatment failure to biologic drugs in chronic inflammatory conditions by reducing production of anti-drug antibodies. Funding: This study was supported by a grant from the American Osteopathic Association (Grant No.: 19137759). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

CD5 knockout modulates effects of alcohol consumption in mouse models (P1-12.008)

<h3>Objective:</h3> We seek to elucidate the impact of cluster of differentiation 5 (CD5) expression on the effects of acute ethanol (EtOH) exposure. <h3>Background:</h3> CD5 is a transmembrane glycoprotein expressed on the surface of T and B1 cells. It has been previously shown that CD5 expression is altered by chronic EtOH consumption. Additionally, GABA neurons in the ventral tegmental area (VTA) are inhibited by EtOH, while dopamine neurons are excited. Given that some CD5+ lymphocytes may be involved in the regulation of inhibitory GABA synapses, we hypothesize that CD5 knockout may modulate the behavioral and physiological effects of EtOH consumption. <h3>Design/Methods:</h3> CD5 knockout (CD5KO) mice were compared to C57BL/6J wild type (WT) mice. CD5KO was confirmed with flow cytometry. Behavioral changes were measured via open field behavior, loss of righting reflex, and 24-hour access two bottle choice drinking. Neuronal dynamics were assessed using single-unit recordings, loose patch clamp recordings, fast scan cyclic voltammetry, and qRTPCR. <h3>Results:</h3> CD5KO mice displayed reduced EtOH consumption versus WT mice in two bottle choice drinking as well as decreased reduction in locomotor activity at low dose (0.5–2.0g/Kg) EtOH and decreased sedation at high dose (4.0g/Kg). Paired-pulse frequency response measure of dopamine release also differed between CD5KO and WT strains. Additionally, decreased levels of dopamine transporter (DAT) RNA were found in the nucleus accumbens. <h3>Conclusions:</h3> CD5KO mice may be less sensitive to some of the effects of EtOH, suggesting that CD5 may play a role in EtOH consumption and sedation. <b>Disclosure:</b> Mr. Amendolara has nothing to disclose. Dr. Payne has nothing to disclose. Dr. Obray has nothing to disclose. Mr. Williams has nothing to disclose. Ms. Small has nothing to disclose. The institution of Dr. Yorgason has received research support from American Osteopathic Association. Dr. Edwards has nothing to disclose. Dr. Weber has nothing to disclose. Dr. Steffensen has stock in Syzygy Innovations, LLC. Dr. Steffensen has received intellectual property interests from a discovery or technology relating to health care.

Dual approval of a residency program: Ten years' experience and implications for postdoctoral training.

In 1985, the American Osteopathic Association (AOA) changed its educational policies to permit osteopathic postdoctoral programs in settings that were accredited by the Accreditation Council for Graduate Medical Education (ACGME). In response to this policy change, an existing ACGME-accredited emergency medicine residency was modified to create a combined osteopathic/allopathic residency program that meets the educational requirements of both the AOA and the ACGME. Our 10-year experience with this combined osteopathic/allopathic emergency medicine residency is described in terms of program development, governance structure involving key stakeholders, faculty distribution-equal numbers of allopathic and osteopathic faculty, and educational outcome of the total number of residents graduated (93 graduates, with 33 osteopathic physicians and 60 allopathic physicians). Lessons learned from the 10 years' experience of this combined residency program, as well as current issues, are explained. The future potential of such dual-approved programs on the supply of residency positions is discussed from the viewpoint of osteopathic postdoctoral education.

The Majority of Orthopaedic Surgery Residency Faculty in the United States are Allopathic Males

Introduction There is a paucity of information regarding the demographic characteristics of faculty at Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs. The purpose of this study was to determine the demographics and education training of all current orthopaedic surgery residency program faculty members. We hypothesized that there would be a sex discrepancy among orthopaedic surgery faculty, and that there would be fewer DO (Doctor of Osteopathic Medicine) than MD (Medical Doctor) orthopaedic surgeons in academic medicine. Methods The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. The following information was collected from each program website: faculty sex, degree, academic role, administrative title, and subspecialty. Faculty roles, titles, and subspecialties were compared across type of institution, degree earned, and sex using Chi squared and Analysis of Variance (ANOVA). Results Of the 4,325 faculty members identified, 3,893 were male (90%) and 4,033 were MDs (93%). The most common subspecialty was sports medicine (789, 18%). While traditional ACGME programs still had more MD faculty (3,728, 97.5%) (p&lt;0.001), the majority of faculty at traditional American Osteopathic Association (AOA) programs were also MDs (305, 61%). There were more male DOs than male MDs (95.6% vs. 89.3%, p&lt;0.001). More DOs practiced general orthopaedics (14.8% vs. 4.1%), whereas more MDs practiced upper extremity and orthopaedic oncology (p&lt;0.001). More male faculty practiced adult reconstruction (616, 15.8%), trauma (489, 12.6%), spine (471, 12.1%), and sports medicine (719, 18.5%), whereas more female faculty practiced pediatrics (135, 31.3%), upper extremity (100, 23.1%), and oncology (33, 7.6%). More male faculty held titles as chair of orthopaedic surgery (145, 3.7%) and fellowship director (111, 2.9%) than females (5, 1.2% and 5, 1.2%). Males were also listed as assistant professor (1057, 27.2% vs 188, 43.5%), associate professor (636, 16.3% vs 86, 19.9%), and professor (618, 15.9% vs 41, 9.5%) more commonly than females. Conclusion The current faculty of orthopaedic surgery residency programs is heavily male dominated, holding higher academic roles and administrative titles than women. There is also a high prevalence of MDs with higher academic roles and administrative titles than DOs.

Perspectives of Dermatology Program Directors on the Impact of Step 1 Pass/Fail.

The shift of Step 1 to Pass/Fail has generated several questions and concerns about obtaining residency positions among allopathic and osteopathic students alike. Determining the perspectives of Dermatology Program Directors in regards to post-Step 1 Pass/Fail is critical for students to better prepare for matching into dermatology. After receiving Institutional Review Board (IRB) exemption status, the program directors were chosen from 144 Accreditation Council for Graduate Medical Education (ACGME) and 27 American Osteopathic Association (AOA) Dermatology programs using contact information from their respective online website databases. An eight-item survey was constructed on a three-point Likert scale, one free text response, and four demographic questions. The anonymous survey was sent out over the course of three weeks with weekly individualized reminder requests for participation. A total of 54.54% of responders had "Letters of Recommendation" in their top 3. Forty-five percentof responders had "Completed Audition Rotation at Program" in their top 3. And, 38.09% of responders had "USMLE Step 2 CK Scores" in their top 3. Approximately 50% of responders agreed that all medical students will have more difficulty matching dermatology. Based on the survey study, Dermatology program directors want to focus more on letters of recommendation, audition rotations, and Step 2 CK scores. Because each field seems to prioritize different aspects of an application, students should attempt to gain as much exposure to different fields such as through research and shadowing to narrow down their ideal specialties. Consequently, the student will have more time to tailor their applications to what residency admissions are looking for.

The Demographic Make-up of Orthopaedic Surgery Residents in the United States Post ACGME Merger

Objective The purpose of this study was to investigate differences in the demographic characteristics of orthopaedic surgery residents in 2021 in regard to sex, degree earned, and regional or medical school affiliation. Design The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident sex, degree, residency year, and geographic region attended for residency and medical school were collected from each program website. Results 199 orthopaedic surgery residencies were identified: 153 traditional Accreditation Council for Graduate Medical Education (tACGME) programs, 38 traditional American Osteopathic Association (tAOA) programs, and 8 military programs, which were excluded. 4,095 orthopaedic surgery residents were identified. Females accounted for 16.6% (N=679) of residents, 17.6% (N=620) within tACGME programs and 10.4% (N=59) in tAOA programs (p&lt;0.001). The 573 orthopaedic residents with DO degrees accounted for 14% of the residents identified, 97.6% (N=533) of residents in tAOA programs, and 1.1% (N=40) of residents in tACGME programs. Regional data showed that 34.4% (N=1208) of MDs trained in the Northeast, while 41.9% (N=240) of DOs trained in the Midwest. Conclusion There has been a slight increase in the representation of females and DOs in orthopaedic surgery residency programs since the mid-2000s; however, data following the ACGME and AOA merger still shows significant predilection for male and MD degree applicants. This study suggests that the Northeast and Midwest regions of the United States train more MDs and DOs, respectively. This finding offers potential data for interested applicants and demonstrates opportunity for more heterogeneity in applicant selection.

Senator Elbert Thomas and the Hope for Industrial Equity

Senator Elbert Thomas and the Hope for Industrial Equity

APA Files Another Amicus Brief in Ongoing Texas Case on Banning Trans Care for Youth

APA Files Another Amicus Brief in Ongoing Texas Case on Banning Trans Care for Youth

Identifying Attitudes Toward and Acceptance of Osteopathic Graduates in Surgical Residency Programs in the Era of Single Accreditation: Results of the American College of Osteopathic Surgeons Medical Student Section Questionnaire of Program Directors.

PurposeThe purpose of this study was to quantify the number of surgical programs currently training osteopathic residents and to solicit advice for current osteopathic medical students who are interested in pursuing a surgical residency. MethodsA questionnaire was sent to all listed Electronic Residency Application Service® (ERAS®) email contacts for the following specialties: General Surgery, Neurological Surgery, Orthopedic Surgery, Otolaryngology, Urology, Integrated Vascular Surgery, Integrated Plastic Surgery, and Integrated Thoracic Surgery. The questionnaire was sent a total of three times.ResultsTwo hundred sixty-four of the 1,040 surgical residency programs responded to the questionnaire. Of these responses, 19% were formerly American Osteopathic Association (AOA) accredited programs. About 47.3% of responding programs indicated they are not currently training an osteopathic physician. One hundred thirteen programs provided additional comments on how osteopathic medical students may improve the competitiveness of their residency applications. These comments included increasing volumes of research activities, performing well on the United States Medical Licensing Exam (USMLE), and completing a sub-internship in the desired field or at a specific institution. ConclusionOsteopathic students still face many barriers to matching into surgical residencies. This study provides concrete steps students may take to increase the competitiveness of their application.

Differences Between Emergency Medicine Residency Programs That Accept the Comprehensive Osteopathic Medical Licensing Examination of the United States and Those That Prefer or Only Accept the United States Medical Licensing Examination.

IntroductionThe Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three-part series of examinations similar to the United States Medical Licensing Examination (USMLE) that osteopathic medical students must pass for medical licensure. Osteopathic students are not required to take the USMLE, but during the residency admission process, many emergency medicine (EM) residency programs will not consider osteopathic applicants who only take the COMLEX-USA. Therefore, we examined program-level characteristics between programs that accept the COMLEX-USA alone for osteopathic applicants and those that prefer the USMLE using free, publicly available online databases and residency program websites.MethodsEmergency Medicine Residents’ Association (EMRA) Match was the primary database used; however, missing exam preferences were supplemented from Fellowship and Residency Electronic Interactive Database Access (FREIDA) and individual program websites. Program characteristics were compared between EM residencies that accept the COMLEX-USA and those that prefer the USMLE using the Chi-square test for categorical variables and the Mann-Whitney test for interval variables.ResultsTwo hundred sixty of the 278 EM programs in the dataset were included in the analyses. One hundred and seven programs reported preferring the USMLE, while 151 reported accepting the COMLEX-USA alone. Programs differed by the educational environment of the primary training site (p <0.001), number of Standardized Letter(s) of Evaluation (SLOE) needed for an interview (p = 0.042), emergency department (ED) shift length (p = 0.021), former American Osteopathic Association accreditation (p <0.001), percentage of osteopathic residents (p <0.001), annual ED volume (p = 0.001), number of intern positions (p <0.001), and number of elective weeks (p = 0.028).ConclusionEM residency programs that reported accepting the COMLEX-USA alone for osteopathic applicants differed from those that prefer the USMLE. Therefore, osteopathic medical students interested in EM should consider these differences when deciding whether to take the USMLE.

ASAM calls for addiction medicine physicians in insurance networks

The proposed Patient Protection and Affordable Care Act rule by the Center for Medicare &amp; Medicaid Services (CMS) should include a requirement that addiction medicine physicians be included in health care networks, according to the American Society of Addiction Medicine (ASAM). In submitting a comment letter to the proposed rule Jan. 23, ASAM wrote that there should be a separate, individual provider specialty type specific to “Addiction Specialist Physicians” to be included as part of network adequacy. These specialists need to be available to patients in terms of specific time and distance standards, and should include physicians who receive subspecialty board certification in addiction medicine by the American Board of Preventive Medicine, subspecialty board certification in addiction psychiatry by the American Board of Psychiatry and Neurology, subspecialty board certification in addiction medicine by the American Osteopathic Association or certification by the American Board of Addiction Medicine. Along the same lines, on Jan. 27, ASAM released a new public policy statement that describes the role of addiction specialist physicians in U.S. health care. For the Jan. 23 letter to the CMS, go to https://sitefinitystorage.blob.core.windows.net/sitefinity‐production‐blobs/docs/default‐source/advocacy/letters‐and‐comments/22.01.23‐asam‐comments‐re‐2023‐notice‐of‐benefit‐and‐payment‐parameters‐rule.pdf. For the Jan. 27 public policy statement, go to https://www.asam.org/advocacy/public‐policy‐statements/details/public‐policy‐statements/2022/01/28/public‐policy‐statement‐on‐the‐recognition‐and‐role‐of‐addiction‐specialist‐physicians‐in‐health‐care‐in‐the‐united‐states.

The AOA/ACGME Single Accreditation System and Its Immediate and Future Impact on Family Medicine.

The American Osteopathic Association (AOA) agreed to combine its graduate medical education programs with the Accreditation Council for Graduate Medical Education (ACGME) between July 1, 2015 and June 30, 2020 in an initiative called the Single Accreditation System (SAS). The objective of our study was to identify the impact the SAS had on the ACGME, family medicine (FM), and implications for the future of FM. We collected and compiled data from the AOA, ACGME, and the National Residency Matching Program (NRMP). Analysis reveals the effects that the addition of former 122 AOA-accredited FM residencies had on the ACGME and FM programs. Several osteopathic FM programs encountered challenges meeting ACGME accreditation standards. As of June 1, 2020, 89 of 122 accreditation applications received initial or continuing accreditation; the others had accreditation issues to resolve. The Osteopathic Recognition program emphasizing training in osteopathic principles and practices was a popular option in FM residencies. Fewer DOs serve as program directors in former AOA-accredited FM residencies. The SAS has shifted the balance in the percentages of MDs, DOs, and international medical graduates (IMGs) in FM. Trends in FM show that as more DOs enter the NRMP the percent of MDs and IMGs decreases. In the future, it is projected that DOs will outnumber MDs and IMGs in ACGME FM residencies. The 51 new medical schools started between 2010 and 2020 will generate a test for the integration of their graduates into GME. Increased competition for FM residencies is expected.