Clinical Rotation Landscape Across Colleges of Osteopathic Medicine

This report draws on three datasets. The 2023 Dean Survey (31 respondents) captured perceptions of difficulty, concerns, and strategies related to clinical rotations. Separately, a subset of COMs were asked to report on the characteristics of their rotation sites: each COM completed either the AACOM 2024 clinical rotation distance survey (11 COMs, 422 site records) or uploaded the COCA 6.9b clinical rotation worksheet (15 COMs, 2,571 records), but not both.

These two site-level datasets therefore represent distinct, non-overlapping groups of schools, and comparisons across them should be made with that design in mind. The Dean Survey respondents partially overlap with both site-reporting groups but were not matched by design.

The clinical rotation landscape for COMs is under significant and multidirectional pressure. OB/GYN, Pediatrics, and Psychiatry face acute staffing shortages. Competition — from MD schools, other COMs, and allied health programs — is the dominant threat to site retention. The OMM and DO supervision challenge pervades the system. Costs are rising, geographic reach is expanding, and nearly three-quarters of deans say the situation is harder than five years ago.

The primary responses — paying more and going farther — are adaptive but unsustainable. Structural innovations in clinical education models, rather than incremental expansion of the current approach, will be necessary to sustain the quality and distinctiveness of osteopathic clinical training.