Single GME Accreditation System FAQs

The intent of the agreement to create a single GME accreditation system is to expand graduate medical education access to osteopathic graduates. Without the agreement, that access would likely shrink as a result of the implementation of the ACGME’s common program requirements in 2016.

The health care landscape has been changing, and we are in the midst of a period of consolidation and standardization in many domains of medicine. 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 to the nation’s health care system – one in four U.S. medical students who matriculated last year is studying osteopathic medicine. With the majority of DO graduates now pursuing GME training in the ACGME system, osteopathic medical education has outgrown the dual GME accreditation pathways.

Furthermore, the risks to maintaining the status quo far outweigh any risks associated with uncertainties in the single GME process. ACGME’s new common program requirements under the dual system would limit DOs’ ability to move from AOA to ACGME training programs. Also, as the number of DO graduates rises at a faster rate than the medical school graduate population as a whole, there is a risk that competition for osteopathic graduate medical education slots will worsen, or that dually accredited programs may opt to become ACGME-only. Finally, the expense of transitioning to a competency-based accreditation system to meet appropriate standards for GME education would require some extensive enhancement in current AOA systems that would increase the cost for osteopathic GME programs.

Student opinions have been taken into consideration from the beginning of discussions on bringing together the two systems. Given the number of students seeking out ACGME residencies and fellowships, a single GME system is necessary to maintain the current patterns of training for osteopathic medical students. Input has been solicited through online webinars, surveys, and in-person student meetings. In addition, throughout the discussions and decision-making process, a student representative from the Council of Student Government Presidents (COSGP) was a fully participating and voting member of the AOA’s Board of Trustees.

In the weeks following the announcement of the single GME accreditation agreement, AACOM in conjunction with the COSGP conducted an online survey to assess the opinions of osteopathic medical students. Of the 5,307 students who submitted responses – representing nearly one in four students enrolled at AACOM member colleges – 82.5 percent expressed support or strong support for the single GME accreditation system. Only 5.6 percent were opposed or strongly opposed. The COSGP has also recently issued a joint resolution with the Student Osteopathic Medical Association (SOMA) and Counsel of Student Affairs (CSA) that presents strong endorsement of the single pathway.

In January 2012, AACOM, AOA, and ACGME first met to discuss potential ways to improve the GME system. Months of subsequent discussions eventually led to an agreement in October 2012 by the three organizations to seek to develop a single GME accreditation system. Over the course of the following months, there was significant discussion with leaders and stakeholders in osteopathic medical education. Numerous individuals with extensive knowledge and expertise related to the nation’s medical education system, osteopathic medicine, relevant public policy, GME, the osteopathic profession’s financing, and the nation’s physician self-regulatory system, spent countless hours and resources analyzing a variety of scenarios related to this effort. All along the way, a key aspect of AACOM’s deliberations centered on what would be in the best interest of the osteopathic medical students, graduates, and colleges, as well as the profession of which we are all members.

In February 2014, after a Memorandum of Understanding (MOU) document was reviewed and vetted extensively by the boards and executive leadership of the AOA and AACOM as well as the ACGME's board and executive leadership, all three boards decided to move forward in establishing a single GME accreditation system.

While the MOU commits the organizations to a single GME accreditation system and creates the decision-making structure, many of the details will be worked out by existing and new oversight bodies. 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 single GME system’s accreditation process. The lengthy, five-year transition period outlined in the agreement provides all stakeholders the time to work through questions and “what-if” scenarios that will undoubtedly surface.  

Both AACOM and AOA leadership will monitor the implementation of the single accreditation system throughout this period. AOA- and AACOM-nominated members will become members of the ACGME Governing Board and will have representation on the ACGME Monitoring Committee that oversees consistency of standard and process implementation. An ACGME/AOA/AACOM Joint Task Force, which forged the agreement for the new single accreditation system for GME, will continue to oversee and monitor the transition process as well. We anticipate that regular reports on a variety of metrics will be made available to members of the profession.

Students considering an osteopathic medical school should know that by 2020 there will be a single system for accrediting GME. Due to this single system, there will be a streamlined process for applying to residency programs and wider access to a range of residency and fellowship programs. In addition, DO students can continue their training in ACGME programs and still continue osteopathic training through ACGME programs with osteopathic recognition. 

Single GME accreditation will have far-reaching effects on the entire health care delivery system, but we expect most of these effects to be positive, especially for the osteopathic medical profession. Identifying our audience as graduates of osteopathic GME programs ignores all other DO graduates who are our potential members. Because the single GME system will make the osteopathic medical profession more visible as a major component of health care, awareness of DOs among patients is expected to rise. This may benefit osteopathic specialty colleges and certifying boards as well. Though it may require a bylaws change, more physicians (both DO and MD) may be eligible for membership and certification through our osteopathic certifying boards. Rather than a small, captive audience, we will have a wide base of physicians seeking the benefits of osteopathic membership, certification, and community.

Osteopathic medical schools are much-valued on state and federal policy levels for the graduates and physicians they produce, as well as the health care services they provide to the population. DO graduates’ affinity for primary care, specialty care, community-based training, service to underserved populations, and the relative efficiency and less-costly infrastructure are well known, recognized, and celebrated. There is nothing about the single GME accreditation system agreement that impacts the status of the accreditation of osteopathic medical colleges by the Commission on Osteopathic College Accreditation (COCA). We are not aware of any policymaker or body that supports a change in that status – a change that could alter the success of AACOM’s member colleges at producing the kind of physicians needed by our current and future health care system. 

Osteopathic traditional rotating internships can apply for ACGME accreditation through the ACGME transitional year residency review committee which oversees ACGME transitional year programs. 

Students decide which supporting documents to provide with each of their residency applications. Neither the COMLEX-USA nor the USMLE exams are required by ACGME or AOA accreditation standards for residency program admissions applications. It is up to residency program directors to determine whether and which examination scores to accept. COMLEX-USA is already 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 the evaluation of DO residency applicants for their programs. Currently, 77 percent of ACGME-accredited graduate medical education program directors accept the COMLEX-USA as part of their evaluation of osteopathic medical student applicants, according to Program Director Surveys by the National Resident Matching Program. Extensive efforts are underway to help residency program directors understand and interpret COMLEX-USA scores, and the transition to a single accreditation system should afford even more opportunities for education about the COMLEX-USA.

The single GME accreditation system is not expected to reduce acceptance of the COMLEX-USA for residency admissions, but rather to continue to grow acceptance with the goal of one day achieving universal acceptance. However, it is likely – at least for a while – that some ACGME programs will continue to prefer to receive a USMLE score. If a student has aspirations for such programs, then that student will have to make the decision about whether to take the USMLE in addition to the 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 (COMs).

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 COMs. 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 the evaluation of DO residency applicants for their programs.

The MOU does not require that all ACGME residencies accept COMLEX-USA. 

Currently, neither the COMLEX-USA nor the USMLE exams are specifically required by ACGME or AOA accreditation standards for residency program application or acceptance. The exams are not required because the primary purpose of both exams is for physician licensure. However, the secondary use of examination scores in residency program applications and selection is recognized. The National Board of Osteopathic Medical Examiners (NBOME) has developed extensive materials to explain COMLEX-USA and assist program directors in understanding exam scores. A 2012 program director survey by the National Residency Match Program indicated that 77 percent of ACGME-accredited programs already accept the COMLEX-USA. The single accreditation system does nothing to change this.

In fact, the transition to a single accreditation system should afford even more opportunities for helping ACGME Residency Program Directors to understand and interpret COMLEX-USA scores. To this end, the NBOME has developed an informational video designed for program directors and has also created a mobile app version of its COMLEX-USA percentile score conversion tool, which is available at the Apple Store and at the NBOME website. 

Osteopathic medical students will continue to be required to pass the COMLEX-USA examination (Levels 1 and 2) in order to graduate from an osteopathic medical school. The primary purpose for the COMLEX-USA examination series is to assess an osteopathic physician's readiness for licensure, and all state medical licensing boards in the United States accept and use COMLEX-USA for that purpose. Many of these licensing boards require COMLEX-USA. The AOA and AACOM also support the premise that patients are best served by seeking care from osteopathic physicians who have passed COMLEX-USA, because it is the only medical licensing examination that follows an osteopathic-distinct blueprint, assesses osteopathic principles and manipulative technique, and has been shown to be valid for this purpose.

The use of examinations for the secondary purpose of residency program applications and selection has been recognized as important and widespread. The majority of residency program directors in ACGME-accredited programs will accept the COMLEX-USA for use in evaluating DO applicants. The National Board of Osteopathic Medical Examiners (NBOME) and the AOA have been active in providing information about COMLEX-USA predictability to residency program directors, and we expect that in the vast majority of cases, COMLEX-USA will be increasingly recognized by ACGME-accredited residency program directors in the new single GME accreditation system. Program directors are generally enthusiastic to learn more about COMLEX-USA and osteopathic medicine. The NBOME website features numerous resources for program directors in this regard.

However, there are still some ACGME programs that will prefer to see a USMLE score. If a student has aspirations for such programs, then that student will have to make the decision about whether to take the USMLE in addition to the COMLEX.

Source: ACGME Frequently Asked Questions: Single Accreditation System

An individual who has completed an ACGME-accredited residency program in any given specialty is eligible for appointment to any ACGME-accredited subspecialty (fellowship) program that allows prerequisite training in that specialty, regardless of which licensing examination(s) that individual has pursued. 

An individual who has completed a residency program after that program has achieved pre-accreditation status is eligible for appointment to an ACGME-accredited subspecialty program according to the eligibility requirements for that subspecialty that were in effect June 30, 2013 or will be in effect July 1, 2016, whichever is less restrictive.* Again, this is regardless of which licensing examination(s) that individual has pursued. If the individual is appointed under the “exceptionally qualified applicant” provision detailed in the ACGME Common Program Requirements, and has successfully completed Levels 1, 2, and 3 of COMLEX USA, the candidate will not be required to take USMLE. This applies only to graduates of programs with a status of pre-accreditation.

An individual who has completed pre-requisite training in a program that was not ACGME accredited and did not have pre-accreditation status at the time that the individual completed training is subject to the eligibility criteria in effect as of the date that individual would matriculate into subspecialty (fellowship) training. Beginning July 1, 2016, some subspecialties will accept as eligible “exceptionally qualified applicants” (as defined in the ACGME Common Program Requirements effective that date). One of the criteria that must be met for the “exceptionally qualified applicant” is satisfactory completion of the USMLE Steps 1, 2, and, if the candidate is eligible, 3. NOTE: Some subspecialties did not in 2013, and will not in 2016, accept as prerequisite training anything other than completion of an ACGME-accredited program.

*The eligibility requirements for every ACGME-accredited subspecialty that were in effect as of June 30, 2013, that were/are in effect between June 30, 2013 and July 1, 2016, and that will be in effect as of July 1, 20

The ACGME’s Board of Directors recognizes that osteopathic graduates may take osteopathic certifying boards, and instructed all Review Committees to incorporate board certification requirements to accommodate this expectation. The ACGME now monitors pass rates on American Board of Medical Specialties (ABMS) board examinations and AOA board exams. For more, visit ACGME’s single GME web page FAQs.

The single accreditation system is strictly limited to GME and does not include board certification or medical school accreditation. The ACGME Board of Directors recently approved changes which incorporate AOA board certification throughout the ACGME Common Program Requirements. The ACGME Common Program Requirements, recognizing that osteopathic graduates may take osteopathic certifying boards, also incorporate AOA board pass rates, along with ABMS pass rates, for program assessment. In addition, program directors are also required to inform applicants of their eligibility for relevant specialty board examinations, including AOA board certification.

Source: https://osteopathic.org/students/resources/single-gme/single-gme-student-faqs/ 

There are many factors at play in the graduate medical education policy arena that have the potential to impact graduate medical education funding in the future. The development of a single accreditation system will simplify some of the processes and provide efficiencies to some aspects of the current system, and it will make it easier on a national basis to advocate for graduate medical education policies that would expand the number of residency slots in the United States. In addition, AACOM has received reports from member colleges of heightened interest in the establishment of GME training in hospitals that are not capped under existing rules (the so-called “virgin hospitals”) because of the single accreditation system announcement. One thing is clear – under the standards adopted in the ACGME’s Next Accreditation System, which will go into effect in 2016, unless AACOM, AOA, and ACGME join in the development of the single accreditation system, DO graduates that choose OGME training will face extraordinary restriction of their ability to access ACGME specialty and fellowship training. Under those circumstances, DOs would have limited career pathways if they chose to become osteopathic physicians.

The complete phase-in of the single GME accreditation system is not scheduled to be completed until July 1, 2020. The national GME policy debate is ongoing. However, single GME is expected to better enable all parties involved in medical education to successfully advocate for ongoing GME support. AACOM believes that osteopathic medical school graduates, when allowed to compete on a level playing field for GME positions, will continue to demonstrate the success they have exhibited in the past. The intent of this agreement is to expand access of osteopathic graduates to residency positions. Without the agreement, that access would likely shrink as a result of the implementation of the ACGME’s common program requirements in 2016.

An overarching goal in agreeing to a single GME accreditation system is to maximize access to GME opportunities and options for all osteopathic medical students and graduates. DO graduates applying to currently AOA-accredited programs will enter the system during a time of transition. They should know that they will be eligible to move from their AOA program into ACGME fellowships and advanced residencies as long as their AOA program has applied for ACGME accreditation, which gives it “pre-accreditation” status, and there are no specialty-specific restrictions. For more on specialty-specific restrictions, see ACGME’s program eligibility requirements. DOs planning to enter ACGME residency programs during the transition process should see no change from the current process.

Overall, all DO students should know that this new system aims to benefit them. It will allow osteopathic medical students to apply for programs in specialties of their choice. It’s not necessarily going to be an easy transition across the board, but we believe it will increase recognition of osteopathic medicine and expand our distinct form of medical practice to a wider audience.

Resolution 42 is the current mechanism used by four states that 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 single accreditation 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 single accreditation system. 

Many ACGME specialty programs requiring a preliminary year have indicated that they will accept the AOA PGY1 year for entry into these programs. Each relevant ACGME Review Committee has drafted specific language on this decisions, read the exact language from the ACGME Review Committees.

Emergency Medicine is currently a four-year training program under the AOA, while the ACGME Emergency Medicine training programs are either three or four years. Under already established rules, the Centers for Medicare and Medicaid Services (CMS) will pay for medical training required for certification. The American Board of Emergency Medicine requires three years of Emergency Medicine residency to take their certification exam. CMS will not reimburse ACGME at 100 percent for the fourth year because it is not necessary for certification. CMS pays for half of the training costs for the fourth year of ACGME Emergency Medicine training.

According to the rules of the American Osteopathic Board of Emergency Medicine (AOBEM), four years of Emergency Medicine residency are a necessary requirement to be eligible to be AOBEM certified. CMS will pay full price for the fourth year of an Osteopathic Emergency Medicine Residency program because the fourth year is necessary to be certified in Osteopathic Medicine.

The reason that the fourth year is necessary for Osteopathic Board Certification is as follows:

Trainees must learn to incorporate an osteopathic structural examination and osteopathic manipulative treatment into the care of the emergency department patient, when appropriate. This requires first developing an understanding of the initial assessment of the patient (triage), followed by routine emergency care, taking into consideration the osteopathic philosophy as well as the osteopathic approach to structure and function. As osteopathic skills are skills that build upon each other, similar to milestone achievements, a trainee must have achieved a certain level of competence to be able to safely, reliably, and expediently incorporate the osteopathic techniques. (Source: statement from the AOA.)

Until a program receives ACGME Initial Accreditation, it will not be listed with the NRMP. Programs with pre-accreditation status are still approved by the AOA, and prospective residents still have to go through the NMS match.

AOA-accredited residency training programs participate in the AOA Match, which is administered by the National Matching Services Inc. (NMS). Most ACGME-accredited programs*  participate in the National Residency Matching Program (NRMP). Programs accredited by the AOA and the ACGME (dually accredited training programs) may participate in both Matches.  The NRMP and ACGME are separate organizations.  The NRMP is focused on matching residents and training programs and the ACGME is focused on the accreditation of training programs. With the transition to a single Graduate Medical Education accreditation system, training programs previously accredited by AOA will be ACGME accredited by July 1, 2020; therefore, the final AOA Match is expected to occur no later than 2019.  Until that time, the AOA will continue to administer the AOA Match to match DO graduates into AOA-accredited programs (including dually accredited programs that choose to participate in both matches). AOA-accredited programs that do not have ACGME accreditation cannot participate in the NRMP Match. Moreover, programs with pre-accreditation status are not allowed in the NRMP Match.

If an AOA-accredited program receives ACGME accreditation and terminates its AOA accreditation in the middle of the Match cycle (June – February), it will be given the option of staying in the AOA Match for the remainder of that Match cycle so as not to disrupt the matching process for students and programs; programs will not be withdrawn from the AOA Match simply because they received ACGME accreditation. However, a program must be AOA accredited to enter into the AOA Match process.

*Ophthalmology, plastic surgery and urology residencies and many fellowships have separate match processes.  There is also a separate “military match” for physicians administered by the Joint Service Graduate Medical Education Selection Board. 

The new, single accreditation system codifies osteopathic medicine’s unique principles and practices within ACGME standards through the institution of the Osteopathic Principles Recognition Committee. In addition, a new ACGME Review Committee for Osteopathic Neuromusculoskeletal Medicine (ONMM) has been created. Osteopathic medical participation in ACGME governance ensures the continuation of osteopathic distinctiveness and osteopathic-oriented GME. This fosters community confidence that the skills and philosophy of osteopathic medicine will not be diluted for students who choose to train in this area.

Within the ACGME system, there is now a new residency review committee for Osteopathic Neuromusculoskeletal Medicine (ONMM) which will retain this specialty within the single accreditation system. For more, visit the ONMM Review Committee’s web page. 

Yes, once programs gain ACGME accreditation, MDs can apply to enter DO residencies. We anticipate that applications will be open to MDs as soon as there are AOA-accredited programs that gain ACGME-accreditation. 

We anticipate that applications will be open to MDs as soon as there are ACGME-accredited osteopathic-focused programs.

MDs were never prohibited from learning OMM. Many of our schools offer continuing medical education in OMM, and MDs have been welcome to attend those courses. Prerequisite competencies and recommended programs of training for MD graduates seeking entry into osteopathic-focused GME programs are expected to be implemented.

ACGME maintains a website dedicated to the single graduate medical education accreditation system. Please refer to ACGME’s website for information about the timeline, FAQs, application process, program eligibility requirements, and more.

 AACOM and AOA each offer resources on their websites to learn more about the single GME accreditation system agreement, status, and next steps. More information can be found on AACOM’s website and on AOA’s website. The resources include updates, timelines, videos, podcasts, frequently asked questions, fact sheets, reports, media coverage, and links to related content.

The AOA Opportunities page has a searchable database of AOA-accredited programs and institutions. Visit AOA’s Opportunities site. 

The ACGME website has a searchable database of all accredited-ACGME programs. Visit ACGME’s Accreditation Data System Public Site.

The AOA's Opportunities website lists formerly AOA-approved programs that have now fully transitioned to ACGME accreditation and withdrew their AOA-approval. View the list: Former AOA Programs That Have Transitioned to ACGME Accreditation.

The ACGME Accreditation Data System Public Site has a list of programs seeking osteopathic recognition and those that have achieved osteopathic recognition. Click here to access this list.

AOA-accredited programs that apply for ACGME accreditation will have automatic “pre-accreditation status”. To search for programs that have achieved this status, please visit  ACGME’s accreditation data system public site here. 

Institutions affiliated with AOA programs that apply for ACGME accreditation automatically receive “pre-accreditation status”. Once reviewed, they receive either a “continued pre-accreditation status” or “initial accreditation” status. Please see this full list of sponsors that applied for accreditation under the single accreditation system and their status.

ACGME has produced specialty and subspecialty program eligibility requirement charts to simplify information during the transition. Each chart includes eligibility requirements for each specialty and subspecialty that are in effect on June 30, 2013 and as of July 1, 2016. Interim requirements in effect between those dates are also provided. To view more, visit ACGME’s single GME web page. 

Several ACGME Review Committees have determined that, during the transition to the single graduate medical education (GME) accreditation system, residency programs in specialties requiring a preliminary clinical year will be permitted flexibility in accepting residents who have completed this training in an AOA-approved program. During this transition, ACGME-accredited residency programs in these specialties can consider applicants from AOA-approved internship programs that are not yet pre-accredited or accredited by the ACGME and not jeopardize their accreditation status if they accept such applicants. The Review Committees permitting this flexibility have communicated this information through FAQs and/or other communications with program directors in the specialty. View a summary of the Eligibility FAQs for Specialties with a Preliminary Year.

View the following Board Certification Chart to learn more about AOA and ABMS board certification eligibility requirements during the transition. Individuals seeking ABMS board certification should monitor relevant ABMS board websites or contact the relevant ABMS board for any changes in policy. Note that the rules for entering advanced ACGME training are established by the ACGME. Those rules may allow a trainee to enter advanced GME training, but do not guarantee the trainee would be eligible to sit for the ABMS board examination.