Graduate Medical Education: Reflection of Past and Present Trends

Presentation by: Danielle Maholtz, COSGP National Medical Education Representative, Gabrilelle Rozenberg, COSGP National Legislative Affairs Representative, and Fritz Stine,  OMS-II UP-KYCOM
Written by: Daniel Krajcik, OU-HCOM

Brief History         

Federal funding of GME first started when the GI Bill was enacted in 1944, but was officially transitioned into a payment through Medicare in 1965, where a retrospective cost-based reimbursement for inpatient stays was enacted. This funding of GME was never intended to last long term, and was initially intended to only cover costs associated with Medicare patients. In this initial model, only Direct GME costs (DGME) were covered by Medicare – this includes resident salaries and is now calculated based on a per-resident amount (PRA). This model was modified in the 1980’s when the Indirect Medical Education (IME) funding stream was developed. The theory behind the development of IME costs is that teaching hospitals incur additional costs just by being a teaching hospital and having residents. IME was intended to help offset some of these additional costs to the hospitals. Both of these Medicare funding streams are tied to the institution’s Medicare patient volume.  These streams were developed at a time when hospitals served as the main site for physician training and GME monies are still primarily distributed to teaching hospitals, meaning most residents are trained in hospitals despite the fact that many go on to work in outpatient facilities. Also at this time, the switch to large health system focused training led to the development of OPTIs, where Osteopathic Medical Education was, and still is, run in consortiums with Osteopathic Medical Colleges, hospitals, and community based healthcare facilities.

The Balanced Budget Act (BBC) of 1997 was a major milestone in GME, where allopathic and osteopathic residency slots were capped at 1996 levels, meaning no more additional slots would be paid for by Medicare beyond what they had at the time (Note slots are still limited by this law today). Hospitals could, however, form entirely new residency programs where their cap would be limited by the maximum amount of residents within a five-year period at the end of their first five years in existence. It is also important to know that payment through Medicare severely limited the amount of funding to children’s hospitals, but this was partially fixed through the Children’s Hospital GME (CHGME) Program in 1999 and later the State Children’s Health Insurance Program (sCHIP).

Today

In 2014, the Affordable Care Act (ACA) created a $230 million Teaching Health Center GME program in an effort to expand primary care training. In total, the annual federal spending exceeds $15 billion with Medicare and Medicaid as the largest contributors ($9.7 and $3.9 billion dollars, respectively) followed by the Veterans Health Administration and HRSA.  Despite the cap imposed in 1997, many hospitals have expanded their teaching programs and added nearly 17,000 slots since then, through private donations and grants found outside the usual government beneficiaries.

In 2012 the Institute of Medicine (IOM) Committee on Governance and Financing of GME was chartered to address several current issues: including, but not limited to, mismatch between the health needs of the community and the specialty make-up of the physician workforce, the geographic maldistribution of physicians, and the growing gap between new physician’s knowledge and the competencies required for modern medical practice. Recommendations were made to continue using Medicare as a primary source of funding, but to also modernize the GME system to answer these growing issues we face today.

Moving forward from here, despite the cap, we still see first year residency spots growing steadily. Importantly, there are roughly 7000 more residency spots than applicants each year, but this still doesn’t address resident’s choice to practice in primary care or underserved areas. Medicare is still directly funding teaching hospitals, where only about 50% of primary care residents train. The Health Resources and Service Administration (HRSA), further backed by the ACA, is currently assessing workforce needs on a long-term basis to make recommendations both to congress and the senate.

There may be LOTS of changes that we see over the next few years coming from medical schools, GME programs, and the government. Government mandates in the near future will strongly influence where and what type of residency programs are formed, while 12 medical schools (one of which is Osteopathic, 11 are AMA Transformative Medical Schools) are starting to look into new ways to transform Undergraduate Medical Education (Competency-based systems) to meet the needs of the American population today and the future.

 

COMLEX Level 2 Survey

NOTE – Please complete ONLY if you have taken COMLEX Level 2 CE since January 1, 2014.

Hello Osteopathic Medical Student,

The College of Osteopathic Student Government Presidents (COSGP) is the student group of AACOM, comprised of the two of the elected student government leaders from each osteopathic medical school. The COSGP Medical Education committee is comprised of some of the student representatives from COSGP and we would like your help! We are conducting a quick survey on your experience with COMLEX Level 2. Your participation will provide information that can assist with other medical student who will take the exam in the future. The survey is anonymous, but we ask that your response is as accurate as possible. This survey is optional and no students are required to participate. Here is the link to the survey: https://docs.google.com/…/17b8nQ2X_OOl2y3h4Y2TUtZw…/viewform

Please complete the survey by March 22, 2015.

Thank you so much for you help. Please visit our website COSGP.org for resources and other information about your representation at the national level. If you have any questions please e-mail me at: COSGPMedEdRep@aacom.org

Thank you!

COMLEX Level 1 Survey

Note – Please complete ONLY if you have taken COMLEX Level 1 since January 1, 2014!

Hello Osteopathic Medical Student,

The College of Osteopathic Student Government Presidents (COSGP) is the student group of AACOM, comprised of the two of the elected student government leaders from each osteopathic medical school. The COSGP Medical Education committee is comprised of some of the student representatives from COSGP and we would like your help! We are conducting a quick survey on your experience with COMLEX Level 1. Your participation will provide information that can assist with other medical student who will take the exam in the future. The survey is anonymous, but we ask that your response is as accurate as possible. This survey is optional and no students are required to participate. Please note, any surveys less than 50% complete will not be able to be used in our research so please fill out as much as you can! Here is the link to the survey: https://docs.google.com/forms/d/1PwNdUQU6DowKLxb-Nf-xeebci9xZfgsXeKr094XlaHI/viewform. Please complete the survey by March 22, 2015.

Thank you so much for you help. Please visit our website COSGP.org for resources and other information about your representation at the national level. If you have any questions please e-mail me at: COSGPMedEdRep@aacom.org

Thank you!

The COCA Handbook Highlights

Speakers: The Medical Education Committee, COSGP

Written by: Jordan F. Geroski, OU-HCOM

The Commission on Osteopathic College Accreditation (The COCA) is made up of 17 members that meet three times a year to discuss the accreditation processes for Colleges and Schools of Osteopathic Medicine.  Currently, no student voting members sit on The COCA.  As a branch of the United Stated Department of Education (USDE), The COCA is not directly tied to the American Osteopathic Association (AOA) but must report any happenings, changes, updates to the AOA.  The COCA has a COM Accreditation Standards and Procedures handbook consisting of 9 chapters outlining the standards and procedures of The COCA.  Below are a small number of highlights of each standard.

  • Standard 1 – Mission, Goals, and Objectives
    • Encourages schools to continually evaluate and update their mission statement
    • Schools must release statistics on each class’s COMLEX performance to their students
  • Standard 2 – Governance, Administration, and Finance — If a school is part of a larger university then that school must be USDE accredited
  • Standard 3 – Facilities, Equipment, and Resources
  • Standard 4 – Faculty — schools must have faculty development program for continued development
  • Standard 5 – Students — schools must provide information about behavioral health programs to their students (availability of counselors, etc)
  • Standard 6 – Curriculum
    • Inter-professionalism must be a part of the education
    • Basic knowledge of components of research must be a part of the curriculum
  • Standard 7 – Research and Scholarly Activities — the school must do some form of research
  • Standard 8 – GME outcomes — the school must annually publically report acceptance and first time pass rate on the Level 3 examinations
  • Standard 9 – Prerequisites for Accreditation — this additional chapter pertains new colleges and schools. It contains information regarding starting a new COM/SOM.

Summary of the Applicant and Accreditation procedures:

  • Status progression
    • Applicant status – “I want to open a COM/SOM”
    • Pre-accreditation status (must be within 5 years of applicant status) – the Dean must be among the first hires
    • Provisional accreditation status – must be achieved by March in the year which the first class graduates and can be kept for up to 5 years
    • Accreditation status – this must be renewed every 7 years
      • “Accreditation with warning” remains private between The COCA and the school
      • “Accreditation with probation” becomes public knowledge
    • Self-study process
      • completed by a COM in preparation for their actual The COCA visit
      • Self-study must be sent to The COCA 60 days prior to the actual The COCA visit
    • On-site visit procedures – meetings are held between The COCA members and faculty, students, and administration

Information on The COCA can be accessed at www.aoacoca.org.

The full Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures can be found at http://www.osteopathic.org/inside-aoa/accreditation/predoctoral%20accreditation/Documents/COM-accreditation-standards-current.pdf.

COMLEX Level 2 (to fourth year students or students who have taken COMLEX Level 2-CE since January 2014)

Hello Osteopathic Medical Student,

The Council of Osteopathic Student Government Presidents (COSGP) is the student group of AACOM, comprised of the two of the elected student government leaders from each osteopathic medical school. The COSGP Medical Education committee is comprised of some of the student representatives from COSGP and we would like your help! We are conducting a quick survey on your experience with COMLEX Level 2. Your participation will provide information that can assist with other medical student who will take the exam in the future. The survey is anonymous, but we ask that your response is as accurate as possible. This survey is optional and no students are required to participate. Here is the link to the survey: https://docs.google.com/forms/d/17b8nQ2X_OOl2y3h4Y2TUtZwfIgHiWHW2yRjfMLqkPaY/viewform?usp=send_form Please complete the survey by March 22, 2015.

Thank you so much for you help. Please visit our website COSGP.org for resources and other information about your representation at the national level. If you have any questions please e-mail me at: COSGPMedEdRep@aacom.org

Thank you,

Danielle Maholtz, OMS-IV

COSGP National Medical Education Representative

COMLEX Level 1 (to third year students or students who have taken COMLEX Level 1 since January 2014)

Hello Osteopathic Medical Student,

The College of Osteopathic Student Government Presidents (COSGP) is the student group of AACOM, comprised of the two of the elected student government leaders from each osteopathic medical school. The COSGP Medical Education committee is comprised of some of the student representatives from COSGP and we would like your help! We are conducting a quick survey on your experience with COMLEX Level 1. Your participation will provide information that can assist with other medical student who will take the exam in the future. The survey is anonymous, but we ask that your response is as accurate as possible. This survey is optional and no students are required to participate. Please note, any surveys less than 50% complete will not be able to be used in our research so please fill out as much as you can! Here is the link to the survey: https://docs.google.com/forms/d/1PwNdUQU6DowKLxb-Nf-xeebci9xZfgsXeKr094XlaHI/viewform. Please complete the survey by March 22, 2015.

Thank you so much for you help. Please visit our website COSGP.org for resources and other information about your representation at the national level. If you have any questions please e-mail me at: COSGPMedEdRep@aacom.org

Thank you,

Danielle Maholtz, OMS-IV

COSGP National Medical Education Representative

Please Pay It Forward!

Hello, my name is Danielle Maholtz and I am the National Medical Education Student Representative to the Council of Osteopathic Student Government Presidents (COSGP). I am reaching out to you today with the hopes of gathering resources, tips and advice from you on any aspect of osteopathic medical education you feel you can contribute to. Our hope is to gather this information to share with all osteopathic medical students nationally, through their student government leaders and our website COSGP.org. Please take a few moments to fill out as much of the survey below as you can. All information will be de-identified before sharing and will be grouped into the categories they are listed under.

https://docs.google.com/forms/d/1J2d1_GlfZ6kNQhEGFTE0rrc_4NVQFOp3Gg6RT8UpyB4/viewform

Thank you so much for your time and assistance to future osteopathic medical students!

Sincerely,

Danielle Maholtz, OMS IV (COSGPMedEdRep@aacom.org)

 

Advice and Information on 4th Year

Looking for information on the process of 4th year, the timeline you need to follow and the financial planning you should be thinking about? Look no further! Attached is a presentation developed by our Medical Education Committee on the ins and outs of 4th year. If you have any questions, please feel free to contact COSGPmeded@gmail.com!

Download (PPTX, 3.34MB)

GME

Presentation on the Past, Present and Future of GME with additional information on the IOM Report on GME developed by the Medical Education Committee in Collaboration with the Legislative Committee. Special thanks to National COSGP Legislative Representative Gabrielle Rozenberg and general council member Frederick Stine! Any questions can be directed to cosgpmededrep@gmail.com.

Download (PPTX, 2.05MB)