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Stephen C. Shannon, DO, MPH
President     

New, Single Accreditation System for GME: Recognizing the Accomplishment and the Need to Synthesize and Secure

Accomplishment

With the historic decision at July’s American Osteopathic Association (AOA) House of Delegates now in the rearview mirror, it is appropriate to pause and reflect on what it means to us as individuals and as a profession. My natural inclination is to jump headlong into the next phase of this lengthy transition process and start planning and working on implementation. In fact, I am already doing just that, but I also feel that what we accomplished in this decision and the work that led up to it requires a moment of recognition. Why? Because out of the crucible of mixed opinions—pros and cons, naysayers and enthusiasts—we have forged a roughly hewn accord that I believe speaks volumes about our ability as a profession to meet the challenges of our day, and continue to evolve and adapt to whatever new issues will most certainly surface in the future.

This recognition of support by the House of Delegates in its resolution to support the establishment of a single graduate medical education (GME) accreditation system within the Accreditation Council on Graduate Medical Education (ACGME) did not come easily. The atmosphere at the House of Delegates meeting was charged with a sense of urgency and expectation. So many individuals and groups worked extremely hard to make sure that all voices, both for and against the new system, were given a platform and a time to speak. And they did. Impassioned voices of students, specialty societies, state association leadership, national association leadership, and many other stakeholders commented on the resolution. Emotions ran high and many took courageous stands. Sometimes there was applause, sometimes not. But whatever the reaction, the process was professional, respectful, and validated the decision.

And so it’s the process and the accomplishment, as well as the actual decision itself, which we should recognize. If I might draw an analogy from the tenets of our profession, “osteopathic medicine is a body capable of self-regulation and maintenance with a structure and function that are interrelated and a rational understanding of the basic principles of a changing world that will carry the profession successfully into the future.” As a professional “body,” we need to strive to achieve a unity of intent and action that will foster positive and principled change.

There are still those who disagree with this decision, yet the achievement of agreement to move forward on unification is something substantive that we can build upon. So, whether you were present at the AOA House of Delegates or not, and whether you are a DO or not, we can all recognize that the DO profession not only acted boldly but made a decision that will benefit our country’s healthcare system for years to come.

Synthesize

So after acknowledgement, what’s next? In addition to delving into the specific challenges of the timeline and tasks that are prescribed by the tripartite agreement between AOA, ACGME, and AACOM to develop a single accreditation system for U.S. GME, we need to closely examine our total operating environment and connect the dots between the unification of accreditation and the other driving forces that are dominating the U.S. healthcare system. For example, we should look at the trajectory of unification and consider how it affects broader issues such as those raised in the recently released Institute of Medicine report on GME, a document which we are still analyzing. We need to weigh its implications for the nation’s GME system as a whole, and for osteopathic medicine in particular.

Does the unification of accreditation better align us to deal with the far-reaching GME issues that are addressed in the IOM report? I believe that it does. Does unification of accreditation have a bearing on the important trend toward inter-professionalism? And how about the evolving demographics of those entering our profession, specifically the influx of young doctors preparing to take on the next generation of healthcare issues? Does the new accreditation system impact that dynamic? Again, I believe the answer is yes. We are entering a time of change that is similar to a simultaneous equation, where each variable effects the others, and changing one variable changes the others, and changes the outcome of the entire equation. None of these important issues exists in a vacuum, and we cannot afford to try to solve them in a siloed, linear fashion.

Secure

As work begins on the many tasks that must be accomplished between now and 2020 when full implementation of single GME accreditation will occur, the one mandate that I keep coming back to is that of protecting osteopathic medicine’s distinctive contribution to the health of the people of our nation. While many policy and governance mechanisms are contained in the tripartite agreement to ensure that our uniqueness is retained, the biggest onus in achieving that security is on us as the professionals who practice osteopathic medicine—to demonstrate its distinctiveness and value in the treatment of patients, i.e., to produce the evidence that will secure its continuation and expansion under a single GME accreditation system.

We need to conduct more research on osteopathic medical education across the continuum, as well as how its philosophy, values, and practice impact our patients and the advancement of medical science. We need more solid and unassailable information to validate our standing in the broader physician community. And we cannot procure this kind of data any other way than by undertaking the hard work ourselves. It will take focus, creativity, commitment, and dedication. Something I think we have proven we possess. So, let’s acknowledge our accomplishments, and then roll up our sleeves.

As we move into the transition phase of this important initiative, we urge you to mark your calendars for the Joint AACOM & AODME 2015 Annual Conference, where we will actively address strategies for the future. The Conference theme is "The Osteopathic Medical Education Continuum: Exploring Opportunities & Achieving New Milestones.” Join us in Fort Lauderdale, FL, along with members representing the entire spectrum of osteopathic medical education, during this time of formative change
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July/August 2014
Vol. 8, No. 7/8