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Dr. Stephen Shannon's "Inside OME" column on the New, Single Accreditation System

From Mar 2014 Inside OME

A Single GME Accreditation Process: Forging the Future for Osteopathic Medical Education

By Stephen C. Shannon, DO, MPH
 
On February 26, ACGMEAOA, and AACOM jointly announced an historic agreement to develop a single graduate medical education (GME) accreditation system for osteopathic and allopathic medicine. In an environment of consolidation and standardization in many of the domains of medicine, we are joining with our closest colleagues in healthcare to unify the system for accreditation of specialty training of DO and MD physicians in the United States.  AACOM has joined this effort in order to maintain and expand osteopathic medical school graduates’ access to quality specialty training; to incorporate the recognition of osteopathic principles and practices into the nation’s system for assuring quality GME for all U.S. physicians; to meet expectations for efficiency in the use of public funds; and to uphold and enhance the public’s trust by aligning competency standards in the training of all physicians in the United States. 

While we begin the work of building a unified system, some will find the transition to be difficult and confusing at times; however, we are committed to collaborating with all elements of our profession as we move toward a single GME pathway. The lengthy (five year) transition period outlined in the agreement provides all stakeholders the time to work through the many questions and “what-if” scenarios that will undoubtedly surface.

The development of a single accreditation system for graduate medical training applies to the three-to-seven year period of residency training after medical school (and for some, the additional one-to-three years of fellowship training) that leads to licensure and specialty certification. The agreement will be slowly phased in between 2015 and 2020, giving members of the osteopathic medical education community the opportunity to join existing oversight committees within the ACGME system, and providing ample time for the development of additional oversight bodies within ACGME to accredit osteopathic programs. This transition period will also enable programs accredited by the AOA to work their way through the unified system’s accreditation process.  The benefits of this agreement are many, as it effectively brings training, quality, and competency standards into alignment for all physicians in specialty training, which in turn will allow those involved in training the nation’s physicians in GME to speak with a more unified voice. This will help with the ongoing issue of federal funding of GME which, for decades, has been financed almost exclusively by the federal Medicare program at an annual cost of around $10 billion. These dollars have been in jeopardy for some time as voices in the congressional and executive branches challenge the use and value return of these expenditures. A single GME accreditation system better enables a unified voice to support the value of GME to our nation’s healthcare system.

In addition, this agreement provides MD and DO physician trainees the potential for much greater exposure to osteopathic principles and practices by codifying these principles and practices within the ACGME standards, and by enabling the expansion of that training to MD trainees. For the public, the single system demonstrates consistency of training competencies, evaluation, and accountability across all programs, helping to ensure quality healthcare and streamlined operations. 

Of particular importance to AACOM are the opportunities this agreement will solidify and expand for osteopathic medical students—the doctors of the future who will be the ones who must cope with the challenges, and shape the future of medicine in the coming decades. I believe that, as in the past, today’s osteopathic medical students and graduates do best in achieving their dreams when they have the opportunity to compete on a level playing field, and this agreement offers that promise. There is evidence that today’s students agree with that assessment and also support the decision to unify the GME accreditation system. In a recent online poll of the current student body at the nation’s colleges of osteopathic medicine—responded to by 5,307 students (22.9 percent of the collective student body)—82.5 percent of students supported or strongly supported this initiative, 5.6 percent opposed or strongly opposed, and the balance were neutral (read the survey report).

All three organizations are working to establish an accreditation system that provides the most benefit with the least disruption and provides the most opportunities for the greatest number of students. This new process protects students’ access to primary and subspecialty programs and, I anticipate, will lead to a single, combined match.  The resulting single system and common structure of evaluation will even further solidify the standing of DOs in the eyes of the public and other health professions, both in the United States and beyond.

The forging of a single accreditation system for GME is part of the ongoing evolution of the development of osteopathic medicine in the United States and reflects the major growth in importance of osteopathic medicine in American healthcare—one in four medical students who matriculated last year are studying osteopathic medicine. Osteopathic medicine has been “mainstream” for decades. Our graduates have been served well by two separate GME accreditation pathways during an important time of growth and development for our profession. But now we have outgrown this dual system; the majority of DO graduates are pursuing the graduate medical education training in the ACGME system and they have been for a number of years [A. DeRosier, T.A. Lischka, B. Martinez, “Osteopathic Graduate Medical Education 2014, JAOA, v 114 no 4, April 2014, p 299; and S. Shannon and H. Teitelbaum, “The status and future of osteopathic medical education in the United States,” Academic Medicine 2009; 84:707]. 

The growth of osteopathic medicine in the context of the transformation occurring in the overall U.S. healthcare system is a testament to the importance of our profession in those changes. Our educational system, including osteopathic medical principles and practices, is an important part of that recognition and success. A single unified GME accreditation system with AACOM and AOA representation on the ACGME board, and the presence of osteopathic physicians on the key committees providing oversight to U.S. graduate medical education, enables those principles and practices to influence the training of all physicians in the United States.

I realize that there are many questions by those who think they will be impacted, and AACOM—working in partnership with AOA—will be providing answers as we collectively move forward. I look forward with anticipation to the new levels of excellence that will come to our profession with this unified GME accreditation, as we advance into this latest evolutionary period of the profession of osteopathic medicine, and I stand ready to work with all those impacted to assure that this transition period is as smooth as possible.