Single Graduate Medical Education Accreditation Research Articles

An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system.

Upon requests from osteopathic medical schools, the National Resident Matching Program (NRMP) Charting Outcomes were redesigned to include osteopathic medical school seniors beginning in 2018 and one joint graduate medical education (GME) accreditation system, the Accreditation Council for Graduate Medical Education (ACGME), formed in 2020. The goal of this study is to analyze the match outcomes and characteristics of osteopathic applicants applying to surgical specialties following the ACGME transition. A retrospective analysis of osteopathic senior match outcomes in surgical specialties from the NRMP Main Residency Match data from 2020 to 2022 and the NRMP Charting Outcomes data from 2020 to 2022 was performed. For surgical specialties, results show matching increased as United States Medical Licensing Examination (USMLE) Step 2 CK (clinical knowledge) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 CE (cognitive evaluation) scores increased along with the number of contiguous rankings (p<0.001). The greatest indication for matching looking at scores alone were those who scored greater than 230 on Step 2 CK compared to below (p<0.001) and above 650 on Level 2 CE (p<0.001). However, those who scored 240 (p=0.025) on Step 2 CK were just as likely to match as those who scored 250 (p=0.022) when compared to those who scored below those scores. Increasing research involvement had little to no significance with the likelihood of matching across most surgical subspecialties. Our study demonstrates that there are unique thresholds for Step 2 CK scores, Level 2 CE scores, and the number of contiguous ranks for each surgical specialty that, when reached, are significantly associated with match success. Although certain board score delineations are linked with higher match success rates, the rates level off after this point for most surgical specialties and do not significantly increase further with higher scores. In addition, thresholds within contiguous ranks for increasing match likelihood exist and vary across surgical specialties. Overall, this study highlights that the quantitative metrics utilized to assess applicants lack the correlation reported historically, and the data presently available need to be more substantiated.

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

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

Characteristics of ACGME Residency Programs That Select Osteopathic Medical Graduates

The transition from American Osteopathic Association (AOA) and Accreditation Council for Graduate Medical Education (ACGME) residency matches to a single graduate medical education accreditation system culminated in a single match in 2020. Without AOA-accredited residency programs, which were open only to osteopathic medical (DO) graduates, it is not clear how desirable DO candidates will be in the unified match. To avoid increased costs and inefficiencies from overapplying to programs, DO applicants could benefit from knowing which specialties and ACGME-accredited programs have historically trained DO graduates. This study explores the characteristics of residency programs that report accepting DO students. Data from the American Medical Association's Fellowship and Residency Electronic Interactive Database Access were analyzed for percentage of DO residents in each program. Descriptive statistics and a logit link generalized linear model for a gamma distribution were performed. Characteristics associated with graduate medical education programs that reported a lower percentage of DO graduates as residents were surgical subspecialties, longer training, and higher US Medical Licensing Examination Step 1 scores of their residents compared with specialty average. Characteristics associated with a higher percentage of DO graduates included interviewing more candidates for first-year positions and reporting a higher percentage of female residents. Wide variation exists in the percentage of DO graduates accepted as residents among specialties and programs. This study provides valuable information about the single Match for DO graduates and their advisers and outlines education opportunities for the osteopathic profession among the specialties with low percentages of DO students as residents.

Report on 7 Years' Experience Implementing an Undergraduate Medical Curriculum for Osteopathic Medical Students Using Entrustable Professional Activities.

Calls for changes in undergraduate medical education and the advent of the single graduate medical education accreditation system have challenged the osteopathic medical profession to maintain its identity and distinctiveness while adapting to innovations. For the osteopathic medical profession to thrive, its colleges must provide students with an educational framework that solidifies their osteopathic identity. The authors developed an integrated anatomy-clinical skills course at the University of New England College of Osteopathic Medicine, Osteopathic Clinical Skills, that used the performance benchmarks of the Entrustable Professional Activities and the Osteopathic Core Competencies for Medical Students from the American Association of Colleges of Osteopathic Medicine. A primary tenet of osteopathic medicine is the relationship of structure and function; Osteopathic Clinical Skills fuses anatomical sciences with clinical skills and underscores this tenet in clinical diagnosis and treatment. This article describes the development and implementation of an educational framework that integrates anatomy, physical examination, history taking, and other clinical skills with osteopathic medicine principles and practice and osteopathic manipulative treatment.

Medical Degree Disparity Among Authors of Original Research in Pediatric Journals: A Four-Year Follow-Up.

Introduction and Objective: Scholarly activity is a major component of residency training and the accreditation process for graduate medical education. In 2014, Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine announced a single accreditation system with the transition beginning July 1, 2015. Previous data before the transition had shown that osteopathic physicians rarely published original research in three high-impact pediatric journals. The objective of this study is to determine if there is a degree disparity between osteopathic and allopathic physicians among authors who publish original research manuscripts in three high-impact pediatric journals after the beginning of the transition to a single graduate medical education accreditation system. Methods: Degree designation for the first and senior authors of original research manuscripts was reviewed for the Journal of Pediatrics (J Pediatr), Pediatrics, and JAMA Pediatrics (JAMA Pediatr) for the years 2016, 2017, 2018, and 2019. Inter-rater reliability was calculated by the kappa coefficient, and data were analyzed with descriptive statistics and simple linear regression. Results: A total of 3,252 manuscripts and 4,068 authors were reviewed with 0.98% of all authors being osteopathic physicians. A total of 1.65% of first authors and 0.41% of senior authors were osteopathic physicians. For those with a dual degree, a total of 1.03% of first, and 0.41% of senior authors were osteopathic physicians. No statistical trend could be established for increased first, senior, dual-degree first, or dual-degree senior osteopathic physician authorship.Conclusion: Osteopathic physicians continue to be underrepresented as first and senior authors in original publications in the three high-impact pediatric journals as compared to their allopathic counterparts.

Navigating Tumultuous Change in the Medical Profession: The Coalition for Physician Accountability.

Collaboration among the national organizations responsible for self-regulation in medicine in the United States is critical, as achieving the quadruple aim of enhancing the patient experience and improving population health while lowering costs and improving the work life of clinicians and staff is becoming more challenging. The leaders of the national organizations responsible for accreditation, assessment, licensure, and certification recognize this and have come together as the Coalition for Physician Accountability. The coalition, which meets twice per year, was created in 2011 as a discursive space for group discussion and action related to advancing health care, promoting professional accountability, and improving the education, training, and assessment of physicians. The coalition offers a useful avenue for members to seek common ground and develop constructive, thoughtful solutions to common challenges. Its members have endorsed consensus statements about current topics relevant to health care regulation, advanced innovation in medical school curricula, encouraged a plan for single graduate medical education accreditation for physicians holding MD and DO degrees, supported interprofessional education, championed opioid epidemic mitigation strategies, and supported initiatives responsive to physician workforce shortages, including the Interstate Medical Licensure Compact, an expedited pathway by which eligible physicians may be licensed to practice in multiple jurisdictions.

An Overview of the Allopathic Match.

The number of allopathic emergency medicine (EM) programs has been progressively increasing over the years. In 2018, allopathic EM postgraduate year-1 spots, compared with 2012, increased by around 60% to reach 2278 positions. EM is considered a competitive specialty and therefore, in this article we help guide students interested in EM through the allopathic match requirements, application process, interviews, and ranking EM programs. Additionally, we tackle the combined emergency medicine residency programs, namely the combined EM-Family Medicine (FM), EM-Anesthesiology, EM-Internal Medicine (IM), EM-IM-Critical Care Medicine, and EM-Pediatrics residency programs. Finally, we explain the increased likelihood of matching with the single graduate medical education accreditation system expected to happen in the year2020.

The Osteopathic Applicant.

The number of osteopathic students choosing emergency medicine (EM) as a specialty is continuously increasing. However, EM remains a competitive specialty. Accordingly, in this article we guide osteopathic students interested in EM through the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), the United States Medical Licensing Examination (USMLE), third- and fourth-year rotations, and the match process. Additionally, we provide tips on the process of applying to allopathic programs and we discuss the timeline of both the allopathic and osteopathic match. Finally, we discuss the effect of the Single Accreditation System and the Memorandum of Understanding, an agreement to merge the allopathic and osteopathic graduate medical education systems into a single graduate medical education accreditation system. This is expected tobe completed as of July 1, 2020. Therefore, we elucidate the expectations for osteopathic applicants (particularly with regards to the USMLE and COMLEX examinations).

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.

Single Accreditation System Update: Gaining Momentum.

In July 2014, the American Osteopathic Association House of Delegates endorsed the establishment of a new, single graduate medical education accreditation system in collaboration with the Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine. Since that time, the osteopathic medical community has made substantial headway in the transition to the new system. This article provides an update on the transition.

Teaching and Assessment of High-Velocity, Low-Amplitude Techniques for the Spine in Predoctoral Medical Education.

Although national didactic criteria have been set for predoctoral education and assessment in osteopathic manipulative treatment, there is no criterion standard for teaching methods and assessments of osteopathic manipulative treatment competence in colleges of osteopathic medicine. This issue is more pressing with the creation of the single graduate medical education accreditation system by the American Osteopathic Association and Accreditation Council for Graduate Medical Education, which introduced the creation of "osteopathic recognition" for residencies that want to incorporate osteopathic principles and practice into their programs. Residencies with osteopathic recognition may include both osteopathic and allopathic graduates. Increased standardization at the predoctoral level, however, is recommended as osteopathic principles and practice training applications are expanded. The objectives of this article are to review the standards for teaching osteopathic medical students high-velocity, low-amplitude (HVLA) techniques for the spine; to review and discuss the methods used to assess medical students' proficiency in using HVLA; and to propose baseline standards for teaching and assessing HVLA techniques among medical students.

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

Program Characteristics Influencing Allopathic Students’ Residency Selection

Medical students must consider many overt variables when entering the National Resident Matching Program. However, changes with the single graduate medical education accreditation system have caused a gap in knowledge about more subtle considerations, including what, if any, influence the presence of osteopathic physician (ie, DO) and international medical graduate (IMG) house officers has on allopathic students' residency program preferences. Program directors and selection committee members may assume students' implicit bias without substantiating evidence. To reexamine which program characteristics affect US-trained allopathic medical students' residency selection, and to determine whether the presence of DO and IMG house officers affects the program choices of allopathic medical students. Fourth-year medical students from 4 allopathic medical schools completed an online survey. The Pearson χ(2) statistic was used to compare demographic and program-specific traits that influence ranking decisions and to determine whether school type (private vs public), valuing a residency program's prestige, or interest in a competitive specialty dictated results. Qualitative data were analyzed using the Pandit variation of the Glaser and Strauss constant comparison. Surveys were completed by 323 of 577 students (56%). Students from private vs public institutions were more likely to value a program's prestige (160 [93%] vs 99 [72%]; P<.001) and research opportunities (114 [66%] vs 57 [42%]; P<.001), and they were less likely to consider their prospects of being accepted (98 [57%] vs 111 [81%]; P<.001). A total of 33 (10%) and 52 (16%) students reported that the presence of DO or IMG trainees, respectively, would influence their final residency selection, and these percentages were largely unchanged among students interested in programs' prestige or in entering a competitive specialty. Open-ended comments were generally optimistic about diversification of the physician workforce, and 4 of the 709 student comments expressed cynicism or hostility to the presence of DOs or IMGs. Both overt and subtle variables influence students' perceptions of residency programs in the United States, but the presence of DO and IMG house officers seems relevant to a small percentage of them.

The Doctors Hospital and Nationwide Children's Hospital Dually Accredited Pediatric Residency Program: A Potential Best Model for Pediatric Osteopathic GME Training.

With the commitment on the part of the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education to transition to a single graduate medical education accreditation system by 2020, a legitimate concern exists about the future of pediatric residency training that maintains an osteopathic focus. The authors describe a dually accredited pediatric residency program at one of the nation's largest children's hospitals, which may serve as a potential model of how to integrate a robust osteopathic-based education into a general pediatric residency program.

The single graduate medical education accreditation system.

In 2014, the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education signed a historic Memorandum of Understanding, which creates a single accreditation system for graduate medical education. The present article outlines the history of the agreement and the 5-year transition process, which begins July 1, 2015, and ends June 30, 2020.

A Single Graduate Medical Education Accreditation System: Ensuring Quality Training for Physicians and Improved Health Care for the Public

Article A Single Graduate Medical Education Accreditation System: Ensuring Quality Training for Physicians and Improved Health Care for the Public was published on April 1, 2014 in the journal Journal of Osteopathic Medicine (volume 114, issue 4).

Preparing Osteopathic Students for the Single Graduate Medical Education Accreditation System: Evaluating Factors for Match Success in Emergency Medicine.

IntroductionWith the development of and progression toward a single graduate medical education accreditation system combining the current Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) residency programs, the total number of students competing for the same postgraduate training spots will continue to rise. Given this increasing competition for emergency medicine (EM) residency positions, understanding factors that contribute to match success is important to ensure a successful match for osteopathic medical students.MethodsOur anonymous survey to evaluate factors that led to a successful match was sent out to residents in current ACGME-, AOA-, and dually-accredited programs via the AOA program director listserv and the Council of Residency Directors (CORD) e-mail listserv in 2017.ResultsWe had 218 responses. Responses showed that osteopathic graduates had less affiliation with EM residencies, their home institutions provided less information regarding standardized letters of evaluations (SLOE), and that successful osteopathic graduates seemed to learn about them while on EM elective rotations. These students also had less direct EM mentorship and were generally unsatisfied with the level of mentorship available. Osteopathic graduates in current ACGME programs were also more likely to have taken the United States Medical Licensing Examination compared to their AOA resident counterparts.ConclusionOsteopathic medical schools can improve their graduates’ chances of successfully matching in EM by establishing mentorship programs and educating their students early about SLOEs.