Why is the AOA pursuing a unified accreditation system with ACGME?
About a year ago, the ACGME proposed two policies (Common Program Requirements). One policy would limit the ability for AOA-trained DOs to enter a second year of training in an ACGME program. The other policy would not recognize completion of an AOA-accredited residency program for entry into an ACGME fellowship.
The AOA is interested in ensuring that physicians who complete osteopathic graduate medical education have access to ACGME residencies and fellowships.
Did the AOA try to get the ACGME to rescind or amend these proposed Common Program Requirements?
The AOA met multiple times with ACGME leadership to share our concerns. We also testified before the ACGME Committee on Requirements. As a result, the ACGME Board did delay the effective date for the new Common Program Requirements to allow for more discussion.
Will the ACGME organizational structure include osteopathic representation?
If negotiations are successful in moving forward with the unified accreditation system, AOA and AACOM will become member organizations of the ACGME – along with the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies – and will nominate DOs to serve on the ACGME Board and to the individual Residency Review Committees.
How does a unified accreditation system benefit the osteopathic medical profession?
The unified accreditation system will preserve access to all training programs for DOs. Currently, there are 11,025 AOA training positions and more than 4,000 DO graduates each year. Osteopathic programs alone could not support the demand to train more DOs and help fill the upcoming physician shortage.
This move also preserves access to ACGME residency and fellowship programs for our DOs as well as eliminates any issues with DO eligibility for ACGME programs.
In addition, those DOs who want to be program directors/faculty for ACGME programs can do so with AOA certification beginning in 2015.
For physicians who completed AOA GME in the past, the ACGME’s agreement to deem the AOA programs ACGME accredited represents an historic acceptance of AOA graduate medical education.
What will happen to the osteopathic training programs?
If negotiations are successful, as of July 2015, all osteopathic training programs will automatically be deemed accredited by ACGME. And, as occurred in the osteopathic accreditation process, when inspection time rolls around, all training programs will have to meet the same ACGME requirements.
Will the osteopathic training programs become allopathic programs?
No. If discussions are successful, current AOA GME programs will be accredited by ACGME, but will not abandon OPP and OMM as expected competencies. We will be having ongoing discussions with ACGME regarding preserving OPP and OMM within osteopathic training programs. In addition, these discussions will include how OPP and OMM can remain central to these osteopathic-focused training programs.
Will the osteopathic rotating internship required in some states become a transitional year for ACGME purposes?
This will be determined in discussions with ACGME, but it is certainly possible that the Residency Review Committee that oversees transitional year programs will also be responsible for current AOA accredited internships. However, some state licensing boards may choose to do away with the internship requirement if discussions are successful on the unified accreditation system.
Will there be a single Match?
We will be discussing implementation of the unified accreditation system with AACOM over the next several months, including the best approach to a Match system. However, starting in March 2015, if all programs are considered ACGME approved, it is likely there will be one Match.
Will MDs and IMGs be allowed to train in osteopathic training programs?
Allowing MDs to enter into osteopathic-focused training programs will also be part of our transition discussions with ACGME. However, if they are allowed into osteopathic-focused programs, we would work with ACGME to identify educational prerequisites or other accomplishments or “check points” expected for MDs to meet in regard to OPP and OMM. The same would apply for IMGs.
What will happen to the PTRC, COPT and other AOA education committees associated with postgraduate training?
All AOA education committees will still be active at least until 2015. At that time, there will likely be DOs from these committees who will be appointed to the ACGME Residency Review Committees as well as the ACGME Board and various ACGME Board committees.
The COPTI, however, may stand as ACGME does not have an OPTI structure and is interested in pursuing discussions on this model.
How will this affect DOs in residency training now?
There will be no changes for those in postgraduate training programs (either AOA or ACGME) until 2015.
If discussions are successful, as of July 1, 2015, all programs become ACGME-accredited and DOs will have access to all training programs and fellowships when the Common Program Requirements are implemented.
How will this affect DOs entering into residency programs in 2015 or after?
For those entering residency programs in 2015 or later, they will have the option to choose osteopathic-focused training programs or allopathic-focused training programs.
While details will be worked out in negotiations with ACGME, AOA board certification will be stressed for all DOs at the end of training as a demonstration of continued competence in osteopathic medicine.
How will this affect my board certification/COMLEX examination/continuing medical education?
Discussions with ACGME are limited to GME accreditation.
How does the single, unified accreditation system affect Resolution 42?
Resolution 42 is the current mechanism used by four states who require a first year of AOA residency training for licensure in their state. The AOA has a process to provide recognition of DOs who have completed a first year of training in an ACGME program for acceptance of their PGY1 year as AOA approved to satisfy the requirements of an OGME1 year. Resolution 42 will remain available for the foreseeable future for DOs who are currently completing or have already completed ACGME training. Unless the four states change their requirements for licensure, the AOA will reevaluate the situation after the unified system is implemented and determine if Resolution 42 will still be needed. It is likely that Florida, Michigan, Oklahoma and Pennsylvania will continue to require a first year of AOA training for licensure in their state for any DO who completed an ACGME program prior to the start of the unified accreditation system which will start in July 2015.
What does the new single, unified GME accreditation system mean for osteopathically distinctive competency assessment, licensure, and COMLEX-USA?
COMLEX-USA will continue to be the required examination series and the pathway to licensure for osteopathic physicians. It is widely recognized and universally accepted as the valid examination for osteopathic physician competency assessment for licensure. It is also required by accreditation standards established by the Commission on Osteopathic College Accreditation (COCA), and is a requirement for graduation from all colleges of osteopathic medicine. COMLEX-USA is regarded by the majority of residency program directors of AOA and ACGME accredited residency programs as an important and useful assessment tool as part of evaluation of DO residency applicants for their programs.
How will this affect ACGME programs taking or interpreting COMLEX-USA scores and what will the AOA/AACOM/NBOME be doing to help those Program Directors understand those scores?
While COMLEX-USA is first and foremost a licensure examination, a widely recognized secondary use is as a means for Residency Program Directors to assess applicants to their programs. In addition, the National Board of Osteopathic Medical Examiners (NBOME) has for the past several years escalated its efforts to educate ACGME Residency Program Directors about COMLEX-USA scores, score interpretation, the predictive validity of COMLEX-USA scores in relation to performance in residency, etc. The planned unified GME negotiations should afford even more opportunities for helping ACGME Residency Program Directors understand and interpret COMLEX-USA scores. The AOA, AACOM, and the NBOME, will work with the ACGME to develop and implement an appropriate informational and educational program for ACGME Residency Program Directors.
How will we be able to distinguish osteopathic programs from ACGME programs after July 2015?
The details of how we will be able to distinguish between osteopathic-focused training programs and allopathic residencies are still under discussion. Of course, the osteopathic-focused programs will have expected core competencies in OPP and OMM, but for purposes of programs recruiting residents and providing comprehensive information for students selecting residencies, we will want osteopathic medical students to be able to distinguish which programs have an osteopathic-focus.
How will a single, unified accreditation system impact AOA's efforts in Washington, D.C.?
The single system presents a unified commitment to advocating for continued public support for funding the best-trained future physician workforce, especially to Members of Congress and the Institute of Medicine. As efforts are made to potentially cut GME funding, the unified accreditation process is a clear reflection of the collaborative work being done by the AOA and ACGME to improve graduate medical education with a focus on achieving demonstrated quality improvement.
How will a single, unified accreditation system impact AOA's efforts internationally for practice rights of U.S.-trained DOs?
There are currently some countries that will accept AOA or ACGME training while others accept ACGME only or require additional training completed within that country. Therefore, the AOA believes the unified accreditation system will be helpful to our work in gaining practice rights around the world because ACGME accreditation is better known internationally than the AOA’s. However, it will not provide carte blanche recognition of postgraduate training internationally, as every country’s licensure system is different.