By: Krishna Patel, 2nd Vice Chair
In an historic vote on July 19, 2014, the AOA House of Delegates supported the decision of the AOA Board of Trustees to pursue a single accreditation system for graduate medical education (GME). The vote follows over two years of deliberations and a February 2014 announcement by the AOA, AACOM and the Accreditation Council for Graduate Medical Education (ACGME) that a tripartite decision was reached to move forward with the single GME accreditation system. This decision was overwhelmingly supported by students, as demonstrated at the National Osteopathic Student Caucus (NOSC) on July 16, 2014 and by a student survey conducted by AACOM in cooperation with COSGP in March 2014.1 See The NOSC Triumphant for more details.
Under the new system, AOA-approved training programs are encouraged to apply for ACGME accreditation beginning July 1, 2015 and through June 30, 2020. Upon submission of their application, AOA-approved programs will be granted pre-accreditation status as part of the ACGME accreditation process. Pre-accreditation status will allow for AOA-approved programs that have applied for ACGME accreditation and trainees to benefit from the terms of the agreement reached by the three organizations. By July 1, 2020, the AOA will cease to provide GME accreditation.
Single accreditation maintains greater opportunity for osteopathic students to pursue specialty and subspecialty fellowships, including some of which are not offered as AOA programs. Through this new system, osteopathic students will not be limited access to ACGME residencies or fellowships which would occur with the ACGME’s planned changes to its Common Program Requirements which take effect July 2016.
In other words, instead of two separate residency accreditation systems, AOA, AACOM, and the ACGME are joining together to provide a more efficient and effective means of GME accreditation that will benefit our students overall. Together, the AOA, AACOM, and the ACGME can stand under a single GME accreditation system to provide more powerful leverage when advocating to lawmakers on issues regarding GME, such as funding. Furthermore, the single GME accreditation system allows for more accountability and continuity of education between programs across the country. In turn, this will benefit our students while improving our healthcare system overall.
AOA-approved programs that apply for ACGME accreditation can seek osteopathic recognition with the new Osteopathic Principles Committee (OPC). The OPC will develop standards for recognizing osteopathically-focused programs and pre-requisite requirements for MDs seeking entry into these programs. Not only will this preserve our DO philosophy but will provide a powerful means to educate the country on our unique patient practices.
However, it is important to note that undergraduate medical education will not be affected. Commission on Osteopathic College Accreditation (COCA) will continue to accredit osteopathic medical schools, and Liaison Committee on Medical Education (LCME) will continue to accredit allopathic schools. The COMLEX will continue to be the standard examination tool our profession will use to determine licensure. A single Match has not been instated at this time.
“The AOA strongly believes the public will beneﬁt from a single standardized system to evaluate the effectiveness of GME programs for producing competent physicians. Through osteopathic-focused residency programs, the new GME accreditation system will recognize the unique principles and practices of the osteopathic medical profession and its contributions to health care in the U.S.”2
Stephen C. Shannon, DO, MPH, President of AACOM “Healthcare and medical education in the U.S. today face many challenges. We feel that this approach to GME accreditation not only streamlines but strengthens the postdoctoral education process, and will produce physicians who are able to meet those health care challenges, enhancing the ability for all physicians to learn the unique characteristics of osteopathic medical practice.”3
How did these discussions begin?
In late 2011, the ACGME proposed changes to their Common Program Requirements, that govern ACGME accredited resident programs. The change that would affect osteopathic medical students is: “All required clinical education for entry into ACGME-accredited fellowship programs must be completed in an ACGME-accredited residency program, an ACGME International-accredited residency program, or a Royal College of Physicians and Surgeons of Canada-accredited residency program located in Canada.”4 This would have potentially created a situation of limited access to advanced training in ACGME programs for DOs who had completed prior training in AOA-approved GME programs.
How does the umbrella of accreditation governance fall?
Accreditation Council for Graduate Medical Education (ACGME) is a private, non-proﬁt, professional organization responsible for evaluation and accreditation of more than 9,500 residency education programs in the U.S. Approximately 8.6% of these residency spots are ﬁlled by osteopathic physicians.5 ACGME is sponsored by ﬁve member organizations, and each organization nominates four members to the Board of Directors. AOA and AACOM will become member organizations of ACGME with each nominating four members to the Board of Directors. Therefore, our philosophy will be strongly represented and advocated through the new single accreditation system. This acts to preserve our profession as a whole, incorporating its values within a greater system, all while moving forward into a new residency era.
What is a Memorandum of Understanding?
It is a form of legal agreement. It sets out the intended formation of the single accreditation system for GME, the goals of the parties, the key events that will happen, when they are expected to take place, etc. It is intended to serve as a guide so that, if questions arise down the line, there is a record as to what was agreed to. It is intended to provide structure and guidance. Delegates of each state, including students were able to review the MOU at the House of Delegates this past July. (cont. page 3)
To learn more, please see the following resources and FAQs:
- AACOM’s website for single GME updates: http://www.aacom.org/news/latest/Pages/SingleGME.aspx
- Osteopathic Medical Students: http://www.osteopathic.org/inside-aoa/Pages/single-gme-accreditation-system-faq-students.aspx
- Faculty and Program Directors: http://www.osteopathic.org/inside-aoa/Pages/single-gme-accreditation-system-faq-program-directors.aspx
- Specialty Colleges: http://www.osteopathic.org/inside-aoa/Pages/single-gme-accreditation-system-faq-specialty-colleges.aspx
- ACGME’s new microsite dedicated to the single GME accreditation system: https://www.acgme.org/acgmeweb/tabid/445/GraduateMedicalEducation/SingleAccreditationSystemforAOA-ApprovedPrograms.aspx