Stephen C. Shannon, DO, MPH
Osteopathic Medical Education in 2015 – Evolution, Innovation, and Change Management, 2014 in the Rear View Mirror
Although I am writing this column at the end of 2014, when you read it, we will be in 2015. And so I think it is appropriate to reflect on both the overall impact of 2014, as well as to take a look ahead into 2015, and what our profession needs to focus on to make it a successful and influential year.
As I look back over the past 12 months, I would like to share with you a meaningful infographic that AACOM recently posted on its website, which details in a visual way the progression and evolution of osteopathic medicine, from its birth with A.T. Still in 1874, through the accreditation changes that took place in 2014. This visual timeline accurately frames osteopathic medicine as a branch of the practice of medicine that has grown and evolved over time in response to changes in its operating environment and the needs of its constituents, America’s patients. We see a profession that has taken the charge of self-regulation seriously, and we see a series of important innovations in practice and policy that have kept DOs at the top of their game, in the provision of medical services that have answered the needs of the time.
This timeline places the important events that occurred in 2014 in perspective. As I look back and reflect on what I consider to be the most important of the many events that took place during the year, here are my top three:
1) The July vote by the AOA House of Delegates to approve the transition to a single accreditation system for Graduate Medical Education (GME)
This historic vote was the culmination of several years’ worth of research, analysis, and debate, and for AACOM, the capstone of the Board of Deans’ decision in February to join the single accreditation system initiative and become a member organization of the Accreditation Council on Graduate Medical Education (ACGME).
2) The issuance of the Institute of Medicine Report on GME
This report has stimulated a national dialogue on the current and future state of graduate medical education, and has elevated the discussion to a broader and higher profile platform. While there has been no consensus yet as to the implementation of any of the Report’s proposals, stakeholders are fully engaged in debating the merits of these proposals. The Report is helping to identify areas of policy that need discussion, compromise, and ultimately, resolution.
3) Innovations in the preparation and evaluation of our learners in medical school and during GME, in the form of Milestones, Competencies, and Entrustable Professional Activities (EPAs)
Patients must trust their physicians, and healthcare providers must trust each other in a highly interdependent health care system. EPAs are units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence. Sequencing EPAs of increasing difficulty, risk, or sophistication can serve as a backbone for medical education. The implementation of milestones as a measure of progressing competency in resident physician training further advances the accountability of our nation’s GME system.
The impact of these three developments will have long-term and far-reaching consequences on our students, our residents, our practicing professionals, and on our colleges. They each contribute in a unique way to the developmental timeline of the osteopathic profession. While 2014 saw many other very important accomplishments (such as the adoption of Interprofessional Education standards by the Commission on Osteopathic College Accreditation, a new AACOM strategic plan, continued growth of our schools, record applications and student enrollment, etc.), these top three will have significant and lasting impact.
But rather than analyze these impacts specifically, I would like to instead ask some perhaps provocative questions that we can use to guide our thinking and ultimately our actions on these topics during 2015. For example, how will our profession deal with this latest round of changes in terms of process and thought leadership? Who are our leaders, and how will they help us transition? How will the principles and best practices of change management be identified and applied as these new concepts become our reality? How can our colleges and our educational approaches foster innovation so that we continue our relevance and legacy of responding to the nation’s health care needs? How do we define “adaptability” in this new era, when adaptability is a key attribute to professions that continue to survive and thrive? How does adaptability conflict or complement “distinctiveness?” Can we have both?
2015: Full-Speed Ahead, or Half-Throttle?
Much has been written in business literature about the need for organizations and companies in the current environment to be nimble, flexible, and adaptable; to be able to pivot quickly when information, policies, or market conditions change. I very much agree. However, we need to move ahead with deliberation and intention, because many of us are finding ourselves in unfamiliar territory, where the rules of the road are new or unknown, and we are trying to collectively move forward into a future where not all variables are recognized. Communication will be a critical competency for all of us. As we begin to address the important questions we face in transition, we must gather and align our facts and messages so that we share all relevant information accurately and synchronously, to the greatest extent possible.
The questions I pose with this reflection revolve around three concepts: Innovation and Culture; Thought Leadership; and Change Management. And while to some people these will seem like “soft” disciplines compared to more quantitative and scientific ones, there are best practices in all of these areas that we can and should explore.
Strengthening these three organizational attributes throughout our profession helped fortify our collective ability to respond positively and effectively to the challenges posed to us in 2014, and will help provide us with the tools to move ahead with AACOM’s mission and strategic plan in 2015. The evolution continues, just as it has since 1874, as we think and act creatively and in concert to move forward to address the current and future challenges before us. As the theme of our 2015 Annual Conference suggests, this is a time when we should be “Exploring Opportunities & Achieving New Milestones.” Let’s ensure that we equip ourselves with the knowledge and tools at our disposal to make this year even more successful than the last.