Osteopathic Programs Research Articles

The Lack of Standardization of Allopathic and Osteopathic Medical School Grading Systems and Transcripts

The purpose of this study is to assess the variability in grading systems used by US allopathic and osteopathic medical schools across all 4 years of medical school coursework. Transcripts were reviewed from all participating allopathic and osteopathic medical schools for all 4 years of coursework for grading system type, the presence or absence of a key or guide, the inclusion of grade distribution within class year, inclusion of a class rank, and summary statements or evaluation systems used by the institution within the Medical Student Performance Evaluation to evaluate overall performance. Loyola University Medical Center. Maywood, IL. Transcripts were reviewed for 144 out of existing 147 allopathic medical schools (97.9%) and 37 out of 39 existing osteopathic medical schools (94.8%). For allopathic schools, grading system distribution for preclinical years was-41.6% Pass/Fail, 40.3% Honors, 13.2% Letter; while grading system distribution for clinical years was-78.5% Honors, 15.9% Letter. Only 35.4% of allopathic medical schools used the same system for all 4 years, while the remaining schools used a different system for preclinical and clinical years. For osteopathic medical schools, grading system distribution for preclinical years was-45.9% Letter, 32.4% Honors, and 13.5% Pass/Fail; while grading system distribution for clinical years was-59.5% Honors and 29.7% Letter (Table 4). Overall, 56.7% of osteopathic programs used the same system for all 4 years, while the remaining schools used a different system for the preclinical years than the clinical years. Variability also existed within each of these broader grading system categories (Table 1, Table 3). Our results highlight the variability in grading systems used by medical schools both among programs and between preclinical and clinical years. From the residency program perspective, the lack of consistent, objective comparisons between school transcripts makes comparing applicants from different institutions difficult.

Expanding options: Supporting skills transfer from a post-graduate osteopathy program to clinical practice

BackgroundContinuing education is a requirement for most health professions including osteopaths in Australia and other jurisdictions around the world. Osteopaths need to be sure that the time and effort spent on their ongoing education translates to practice and meets their needs. ObjectiveTutors on a postgraduate osteopathic course asked: as educators, how do we support students transfer skills developed from this program to their clinical setting? Design, Setting, Methods and ParticipantsStudents in postgraduate fee-paying osteopathic programs were asked to provide unidentified written responses to what advice or strategies they would use to transfer learning from a course to practice. Responses were collated, coded and analysed for themes to support a presentation outlining strategies to support learning transfer. Additional data collections underpinned review of the initial theme and category leading to saturation. ResultsThe outcome was an over-arching theme: Expanding Options, supported by six categories that emerged from the data: Choice of Tools; Managing Time; Patient Selection, Developing Support Networks; Learning ‘AT Stillness’ and Building Trust & Confidence. The results were presented at a focus group type workshop on the post-graduate course. ConclusionThe themes generated may be applied to other training programs. However, the limitation of the small data set, the specific nature of the course and that it teaches in an area that generates controversy within the osteopathic profession need to be recognised when reflecting on the utility of outcome.

The Changing Characteristics of Anesthesiology Program Directors

Residency program directors (PD) play a critical role in graduate medical education (GME) programs. We previously published a manuscript that defined the population of programs and program directors of ACGME-accredited anesthesiology residencies and established benchmark data for comparison.1 This study compares characteristics of current anesthesiology programs and PDs with baseline data reported in our previous study. Data were gathered through review of ACGME and American Board of Anesthesiology (ABA) websites, medical licensure records, residency program websites, and electronic search engines. Program characteristics assessed included accreditation status, number of approved positions, and previous osteopathic accreditation. PD characteristics assessed included age, academic rank, sex, time since appointment, ABA certification, and simultaneous appointment as department chair. The number of programs increased from 131 to 147 (12.2%) and was mostly (9/13, 68.2%) due to new ACGME-accreditation of preexisting osteopathic programs. PD age, sex, and time since appointment (3.6 years) did not differ between study periods. The number of PDs with senior academic rank and the number who also serve as department chairs decreased significantly. The number and size of anesthesiology programs increased since our last study. This can be largely explained by ACGME accreditation of osteopathic programs. PD characteristics are similar except for a decrease in the number with senior academic rank and the number who also serve as department chairs. There was no change in the percentage of women PDs between the study periods. The high rate of anesthesiology PD turnover and low median duration of appointment merit further investigation.

Understanding ACGME Scholarly Activity Requirements for General Surgery Programs in the Era of Single Accreditation and the Next Accreditation System

Becoming compliant with the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarly activity and remaining compliant over time requires time and attention to the development of an environment of inquiry, which is reflected in detailed documentation submitted in program applications and annual updates. Since the beginning of the next accreditation system, all ACGME programs have been required to submit evidence of scholarly activity of both residents and faculty on an annual basis. Since 2014, American Osteopathic Association-accredited programs have been able to apply for ACGME accreditation under the Single Graduate Medical Education Accreditation initiative. The Residency Program Director, Chair, Designated Institutional Official, Faculty, and coordinator need to work cohesively to ensure compliance with all program requirements, including scholarly activity in order for American Osteopathic Association-accredited programs to receive Initial ACGME Accreditation and for current ACGME-accredited programs to maintain accreditation. Fortunately, there are many ways to show the type of scholarly activity that is required for the training of surgeons. In this article, we will review the ACGME General Surgery Program Requirements and definitions of scholarly activity. We will also offer suggestions for how programs may show evidence of scholarly activity.

Approaching the Single Accreditation System: Curricular Variation in Allopathic, Osteopathic, and Dually Accredited Family Medicine Residency Programs.

With the approval of a single accreditation system for graduate medical education, allopathic and osteopathic residency programs are moving toward 1 set of accreditation standards, with full implementation planned for 2020. Minimal research has been done on the variations between allopathic and osteopathic family medicine (FM) residency programs. The aim of this study was to examine variations in allopathic, osteopathic, and dually accredited FM programs, and to allow them to be addressed. We collected information in July 2014 on faculty-to-resident ratio; number of half-days spent in clinic; and the months performing maternity, pediatric, and surgical care for each program from the American Academy of Family Physicians and the American College of Osteopathic Family Physicians. Location and number of approved positions were also obtained. Data were compared between allopathic, osteopathic, and dually accredited programs. The number of approved positions was twice as large for allopathic and dually accredited FM programs (n = 24) compared to osteopathic programs (n = 12). Osteopathic FM programs offered 5 months of surgical training compared to 2 months in allopathic and dually accredited residencies, and resident stipends in osteopathic programs were about $2,000 lower than those in allopathic and dually accredited programs. All programs had similar faculty-to-resident ratios (1:2.8-3.3), and offered comparable months of maternity (3 months) and pediatric care (4 months) rotations. Outpatient experiences appeared similar between all types of FM residency programs. Key differences included smaller program size and more months of surgical experience in osteopathic programs. These differences may become increasingly important as osteopathic programs strive to meet accreditation requirements.

CORR® curriculum--osteopathic and allopathic residency education: Why not the same standards?

CORR® curriculum--osteopathic and allopathic residency education: Why not the same standards?

Benchmarking the strategies for assessing clinical reasoning in osteopathic curricula

BackgroundBenchmarking between educational institutions is a vital component of quality assurance and contributes to greater consistency and quality in teaching and learning practices. The investigation of clinical reasoning in osteopathy has only recently begun to be explored in depth. Benchmarking builds confidence in our education practices and processes and demonstrates a maturing of the osteopathic academic profession. ObjectiveThe aim of this project was to benchmark the assessment strategy used for clinical reasoning across the final two years of the clinical components of four osteopathic programs. MethodsLearning objectives and clinical assessments from the final two years in each of the four programs were analysed to identify the types and frequency of assessments and the degree of alignment between learning objectives and Bloom's taxonomy and Miller's heirarchy. ParticipantsRepresentatives from Southern Cross University, Australia, Victoria University, Australia, Unitec, New Zealand and the British School of Osteopathy, UK. ResultsAll institutions assess clinical reasoning in a variety of ways such as the assessment of student's actual performance during real-time, in-situ clinical consultations; the assessment of simulated performance; the clinical supervisors' report and; oral or written reports - on simulated case study. The results show that the osteopathy teaching institutions in the present study do not scaffold the expected learning objectives to reflect an increase in difficulty as the student's progress; the learning objectives tend to be clustered and relatively stable. However, this may be a reflection of only investigating the final years of an osteopathy teaching program. This opens the field for future research. ConclusionsIt would be worthwhile if future studies benchmarked the criteria used in clinical assessments and made explicit the key professional values related to assessing clinical competencies in line with the Core Competencies outlined in the World Health Organization's Benchmarks for Training in Osteopathy.

Measurement of glycemic control in diabetic patients—an evaluation of risk adjustment using a primary care registry

Background The ability to measure hemoglobin A1c in populations under the care of physicians or physician groups has become increasingly important with the advance of system-based interventions that can affect this outcome and with payment linked to levels of diabetes control. Objective To evaluate the effect of patient and system factors on the rate of glycemic control as measured by a hemoglobin A1c of <7% using a diabetes mellitus registry from osteopathic training programs in internal medicine and family medicine. Design Observational study. Participants A cohort of 4715 diabetes cases abstracted from the medical records of 127 residency programs nationally between 2003 and 2008. Measurements and main results: Associations between glycemic control and age, gender, medications used, insurance type, race/ethnicity, levels of appointment adherence, hypertension, and presence of evidence of nephropathy were evaluated. In bivariate and multivariate analysis, age, medication type, insurance type, level of appointment adherence, and presence of evidence of nephropathy had a statistically significant association with hemoglobin A1c control. Age was associated with increased levels of control, whereas use of insulin, insurance other than Medicare, non-Caucasian race, missing more than 20% of office visits, and the presence of microalbuminuria or nephropathy were associated with decreased glycemic control. Conclusions System and patient factors not under the control of the physician have a significant effect on levels of glycemic control. To evaluate physician or practice performance, methods of controlling for these factors need to be developed and implemented.

An evaluation of osteopathic school programs designed to promote rural location by graduates

Background Many osteopathic medical schools across the United States seek to produce physicians who will ultimately locate in rural areas. Most of these schools offer courses and programs designed to promote rural location. Objective To explore how mandatory and optional programs offered by Oklahoma State University (OSU) College of Osteopathic Medicine (and student perception of them) impacted the location decisions of students graduating from the osteopathic program between 1997 and 2002. Methods Data on student hometowns, medical school schedules and course evaluations, and current practice location were obtained for 190 OSU osteopathic graduates. Logistic regression was used to find factors that were significant in predicting the location decision. Results Of the 190 students in the dataset who are now practicing physicians, approximately 30% chose to practice in a rural location. The regression results suggest that an optional summer program during a student’s first year in which they spend 4 weeks in a rural primary care setting increases their probability of locating in a rural area by roughly 24%. There is also some evidence that a more positive overall experience in the first one-month rotation in a rural community hospital improves the likelihood of rural location. Conclusions The findings show that programs implemented by an osteopathic school can influence where graduates choose to practice. In particular, programs taking place in both the 1st and 4th year of training have an impact on rural practice location, implying that students can be influenced both early and late in their medical school careers.

Progression through osteopathic training in Australia: The student experience

Background The objective of this study was to explore the lived experience of being an osteopathic student. The paucity of published material on the experience of osteopathic students highlighted the need for such research to record the nature of this aspect of osteopathic culture in Australia. Methods One on one in-depth interviews with participants were conducted and explored employing a phenomenological approach to information gathering and analysis. Setting Students undertaking the five-year osteopathic program at RMIT University, Melbourne, Australia. Analysis Colaizzi's seven step approach to phenomenological analysis was utilised. Subjects Purposeful sampling was used to select nineteen participants across all year levels to form the cohort of the study. Results The RMIT osteopathic program was found to be described in relation to five main stages; Acceptance into and Commencement of the Program, Progression through the Program, The Clinical Experience, The Masters Program and Looking Beyond Graduation to the Future. Each stage provoked significant and varied emotional responses forming the major themes of the study; Stress and Anxiety, Happiness and Excitement, Contentment, Self-Satisfaction, Frustration, Fear of Failure and Self-Doubt, Anger and Resentment, Sense of Support, Fear of the Unknown and Sadness. Conclusions The most prevalent emotional experience reported was that of stress and anxiety within the student's journey. While this was of great significance, it was concluded that a student's underlying passion for osteopathy and strong friendships formed within the program are what enable the student to get through the challenges and difficulties associated with undertaking the osteopathic program.

Dual and parallel postdoctoral training programs: implications for the osteopathic medical profession.

Graduates of osteopathic medical schools have several options when considering postdoctoral training programs. In addition to traditional programs approved by the American Osteopathic Association or those accredited by the Accreditation Council for Graduate Medical Education, students can train in programs accredited by both institutions (ie, dual programs) or osteopathic programs that occur side-by-side with allopathic programs (ie, parallel programs). In the present article, we report on the availability and growth of these two training options and describe their benefits and drawbacks for trainees as well as for the osteopathic medical profession as a whole.

National Growth in Simulation Training within Emergency Medicine Residency Programs, 2003–2008

The use of medical simulation has grown dramatically over the past decade, yet national data on the prevalence and growth of use among individual specialty training programs are lacking. The objectives of this study were to describe the current role of simulation training in emergency medicine (EM) residency programs and to quantify growth in use of the technology over the past 5 years. In follow-up of a 2006 study (2003 data), the authors distributed an updated survey to program directors (PDs) of all 179 EM residency programs operating in early 2008 (140 Accreditation Council on Graduate Medical Education [ACGME]-approved allopathic programs and 39 American Osteopathic Association [AOA]-accredited osteopathic programs). The brief survey borrowed from the prior instrument, was edited and revised, and then distributed at a national PDs meeting. Subsequent follow-up was conducted by e-mail and telephone. The survey concentrated on technology-enhanced simulation modalities beyond routine static trainers or standardized patient-actors (high-fidelity mannequin simulation, part-task/procedural simulation, and dynamic screen-based simulation). A total of 134 EM residency programs completed the updated survey, yielding an overall response rate of 75%. A total of 122 (91%) use some form of simulation in their residency training. One-hundred fourteen (85%) specifically use mannequin-simulators, compared to 33 (29%) in 2003 (p < 0.001). Mannequin-simulators are now owned by 58 (43%) of the programs, whereas only 9 (8%) had primary responsibility for such equipment in 2003 (p < 0.001). Fifty-eight (43%) of the programs reported that annual resident simulation use now averages more than 10 hours per year. Use of medical simulation has grown significantly in EM residency programs in the past 5 years and is now widespread among training programs across the country.

Joint clinical clerkships for osteopathic and allopathic medical students: New England's experience.

Although combined osteopathic and allopathic medical programs are well established for graduate medical education and continuing medical education, little has been published in the literature about such integration at the undergraduate level. The authors describe the preliminary efforts of a joint clinical clerkship program with students from regional osteopathic and allopathic medical schools at a major community teaching hospital in New England. Osteopathic principles and practice are consistently reinforced, exposing students from both medical backgrounds to them. It is hoped that this pilot program serves as a model for developing similar combined programs throughout the United States.

Osteopathic continuing medical education.

The current continuing medical education (CME) cycle began on January 1, 2007, and will end on December 31, 2009. Statistics for the 2004-2006 CME cycle will not be available until May 31, 2008. The author provides an update on trends in osteopathic CME programs and details minor changes to CME requirements for state licensure. In addition, this article explains changes to several policies of the American Osteopathic Association with regard to the Association's awarding and recording of CME credits for physicians who hold specialty board certification.

Physician Recruitment into Geriatrics—Further Insight into the Black Box

Physician Recruitment into Geriatrics—Further Insight into the Black Box

Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice in Geriatric Medicine.

This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteopathic (7) accredited geriatric medicine fellowship-training programs in the United States were involved. Data were collected using self-administered mailed and Web-based survey instruments. Longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, the Accreditation Council for Graduate Medical Education (ACGME), and the American Osteopathic Association (AOA) were also analyzed. The survey instrument was designed to gather data about faculty, fellows, program curricula, and program directors (PDs). In addition, annual AMA/AAMC data from 1991 to the present was compiled to examine trends in the number of fellowship programs and the number of fellows. The overall survey response rate was 76% (96 of 126 PDs). Most (54%) of the PDs had been in their current position 4 or more years (range: <1-20 years), and 59% of PDs reported that they had completed formal geriatric medicine fellowship training. The number of fellowship programs and the number of fellows entering programs has slowly increased over the past decade. During 2001-02, 338 fellows were training in allopathic programs and seven in osteopathic programs (all years of training). Forty-six percent (n = 44) of responding programs offered only 1-year fellowship-training experiences. PDs reported that application rates for fellowship positions were stable during the academic years (AYs) 1999-2002, with the median number of applications per first year position available in AY 2000-01 being 10 (range: 1-77). In 2001-02, data from the AMA/AAMC National GME Census indicated a fill rate for first-year geriatric medicine fellowship positions of 69% (259 first-year fellows for 373 positions). During 2001-02, more than half of programs (53%) reported having two or fewer first-year fellows, whereas 31% had three or four first-year fellows. Thirty-three programs (36%) reported having no U.S. medical school graduate first-year fellows, and another 25 (28%) reported having only one. Of the 51 programs offering second-year fellowship training, PDs reported 61 post-first-year fellows (median 1, range: 0-7). During the past 10 years, 27 new allopathic geriatric medicine fellowship programs opened; there are now 119 programs. There are also seven osteopathic programs. The recruitment of high-quality U.S. medical school graduates into these programs remains a challenge for the discipline. Furthermore, the retention of first-year fellows for additional years of academic training has been difficult. Incentives will be needed to attract the best graduates of U.S. family practice and internal medicine training programs into academic careers in geriatric medicine.

Current threats to osteopathic graduate medical education.

The Balanced Budget Act of 1997 and continuing changes put into place by the Educational Commission on Foreign Medical Graduates (ECFMG) are altering the environment for graduate medical education (GME) in ways that threaten osteopathic graduate medical education in particular. Hospital revenue is decreasing due to declines in Medicare GME and patient-care reimbursements. The new 3-year rolling average methodology for counting "house staff" makes it likely that unfilled positions will be eliminated. With osteopathic GME positions unfilled and financial resources decreasing, osteopathic medical programs may shrink further. Additionally, the ECFMG has put into place policies that may restrict the number of international medical graduates entering the United States. Approximately 25% of all allopathic GME positions in the United States are filled by international medical graduates. If this applicant pool decreases, allopathic medical programs may turn to osteopathic medical graduates as the only other available pool of individuals to fill program positions. At a time when allopathic internship positions are already unfilled and 30% of osteopathic medical graduates enter allopathic first-year programs, further inroads by allopathic programs could severely impact osteopathic GME efforts.

Combined allopathic and osteopathic GME programs: a good thing, but will they continue?

Combined allopathic and osteopathic GME programs: a good thing, but will they continue?

Geriatric education in osteopathic medical schools

To determine if the curricula at the colleges of osteopathic medicine (COMs) are adequately preparing their graduates to meet the challenge of the geriatric demographic imperative, the authors surveyed the 16 COMs using a modified version of a survey conducted by Karuza and colleagues. Results were compared with those obtained from the Karuza and colleagues' survey of 73 allopathic medical schools. Overall, 88% of the COMs reported that they were committed to teaching geriatrics to undergraduate medical students, compared with 72% of the allopathic medical schools. Lack of time and appropriate clinical facilities were the two greatest barriers to committing more time to geriatrics in both osteopathic and allopathic undergraduate medical training programs.

A multistate program to educate physicians

The Southern Regional Education Board (SREB) was formed in 1948 to facilitate multistate contracts for education exchange; at present, 15 states participate in this program. West Virginia is one of four states in the SREB that offer training in osteopathic medicine, and the West Virginia School of Osteopathic Medicine (WVSOM) is the only professional school in West Virginia that is a member of the SREB program. The authors describe (1) WVSOM's mission to provide primary care physicians to meet the medical needs of Appalachia, and (2) the success that an WVSOM-SREB partnership has had in training primary care physicians for participating states at a fraction of the effort and cost that would otherwise have been necessary. Concern is expressed for the program's future, and suggestions offered for the establishment of similar multistate programs to foster the production of physicians in a variety of specialties throughout the nation, since the WVSOM has clearly been successful in producing primary care physicians and in motivating graduates to return to their home states. For example, through the WVSOM-SREB osteopathic medicine program, students from states that share parts of Appalachia (Georgia, Mississippi, Alabama, and Maryland) and Florida have received their education at WVSOM. From 1978 until 1994, WVSOM graduated 148 SREB physicians; 122 of these are practicing physicians, 23 are in internships or residencies, and three have died. Of the 122, 53% have returned to practice in their home states; 85% of these graduates and 84% of all the SREB graduates who have returned to their home states or to other Appalachian states are practicing in primary care fields.