What Are We Really Trying to Preserve?

During the June 20226 Accreditation Council for Graduate Medical Education Single GME Summit, a participant asked a closing question that has stayed with me:

“What exactly are you (the DO community) trying to preserve?”

As a community, our answer cannot be purely institutional. Organizations, examinations, accreditation systems and professional structures matter, but they alone are not what we are trying to preserve. I think (and hope) we are trying to preserve something much more fundamental: the cognitive architecture of osteopathic medical education (OME).

By cognitive architecture, I mean the intentional organization of knowledge, experiences, scientific disciplines and professional values to shape how physicians perceive, reason through and solve clinical and health system problems.

Every allopathic medical school (MD) teaches biomedical, clinical science and health system science. The distinction between allopathic and osteopathic education is not whether these subjects exist elsewhere. The distinction is how they are intentionally integrated.

OME intentionally integrates biomedical, clinical and health systems sciences along with biomechanical science and concepts attributed to modern complexity science into a coherent framework for physician formation. Osteopathic philosophy serves as the integrative lens through which these domains influence clinical reasoning.

The question of preserving osteopathic medicine's cognitive architecture is not about claiming exclusivity. It is not whether others teach elements of these domains. We see outstanding MD colleagues, particularly those in family medicine and ambulatory internal medicine, who demonstrate similar practice behaviors. The question is whether others intentionally organize these topics into a curriculum designed to cultivate this particular, reproducible pattern of thinking within their graduates.

For the DO community, the result is physicians who strive to excel at both promoting and maintaining health and treating disease; who value relationships as well as diagnoses; who recognize that structure and function are linked; who appreciate context, adaptation, prevention and community; and who use medical, surgical, manual, behavioral and social interventions as complementary tools in patient care.

Identity is therefore not found in examinations, organizations or traditions. Those are mechanisms that support a mission. Identity is expressed in how physicians think and, ultimately, how patients experience their care.

I think the better question is not, “What are you trying to preserve?”, but rather “What contributions to medicine are diminished if this particular medical education architecture disappears?”