Osteopathic Medical Education:Osteopathic Medical Education:
State of the “Union”State of the “Union”
Karen Nichols, DO, M...
Osteopathic Medical EducationOsteopathic Medical Education
(Spheres of Influence)(Spheres of Influence)
Specialty
Colleges...
The VisionThe Vision
 To have a proactive on-going “think
tank” on medical education involving all
the osteopathic profes...
The PlanThe Plan
Series of sessions

5 over 10-14 years

MES I – January, 2006
 Global Medical Education Issues

MES I...
SuccessesSuccesses
 Analyze the relevance of theAnalyze the relevance of the
osteopathic internship for OGMEosteopathic i...
SuccessesSuccesses
 Enforce “Opportunities” andEnforce “Opportunities” and
TIVRA reportingTIVRA reporting

COPT imposed ...
SuccessesSuccesses
 Revise and enhance GMERevise and enhance GME
standardsstandards

COPTI and COPT have extensively rev...
SuccessesSuccesses
 Remove barriers and streamline theRemove barriers and streamline the
OGME accreditation processesOGME...
SuccessesSuccesses
 AACOM and AOA with state societiesAACOM and AOA with state societies
should lobby to ease federal UME...
SuccessesSuccesses
 Promote mentoring andPromote mentoring and
professionalism competency programsprofessionalism compete...
SuccessesSuccesses
 Increase Medicare CMS funding for GMEIncrease Medicare CMS funding for GME

The AOA has testified be...
SuccessesSuccesses
 Dual and parallel GME/OGME trainingDual and parallel GME/OGME training
programs should be studied and...
SuccessesSuccesses
 Increase the number of OGMEIncrease the number of OGME
programs and funded FTEsprograms and funded FT...
Not all issues addressedNot all issues addressed
 Osteopathic Graduate MedicalOsteopathic Graduate Medical
EducationEduca...
Medical Education
Summit II
“ Framing the Future”
November 10-12, 2007
 The Problem:The Problem:

HHS/HRSAHHS/HRSA

““Physician Supply/Demand: ProjectionsPhysician Supply/Demand: Projections...
 How we got here:How we got here:

Downward Pressure on SupplyDownward Pressure on Supply

Medical SchoolsMedical Schoo...
Genesis of the Problem:
Failure to Sustain Growth in GME
0
5,000
10,000
15,000
20,000
25,000
1950 1960 1970 1980 1990 2000...
Nor even will increasing residency positions by 10,000
over ten years starting in 2010
200
250
300
350
400
1980 1990 2000 ...
…and the gap will continue for decades.
200
250
300
350
400
1980 1990 2000 2010 2020 2030 2040 2050
Year
Physiciansper100,...
 19801980
 17000 med students17000 med students
 MD 91%MD 91%
 DO 9% (1500)DO 9% (1500)
 2012-132012-13
 24974 med s...
“…“… an increase in allopathic medicalan increase in allopathic medical
school graduates will almost certainlyschool gradu...
Global
Issues
How do we ensure that osteopathic graduate medical
education maintains the essence of what makes it
osteopat...
Resources/
Structure
How do we ensure that there are sufficient resources
and an appropriate structure for the graduate
me...
Specialty
Mix
How do we approach the issues of specialty mix?
Specific goal per specialty
Structural Overview
1. Understanding ourselves
 Studying the definition of “osteopathic”
graduate medical education

Ref...
Structural Overview
2. Improving infrastructure
 Improve quality

2 pilot surveys

Newly graduated MS IV students in Oh...
Structural Overview
2. Improving infrastructure
 Improving the OPTI concept and
implementation

360 degree study

RFP b...
Structural Overview
(continued)
3. Improving support for OGME
 Promoting clinical and education research

Referred to Re...
Structural Overview
(continued)
4. Dealing with three special issues
 Studying admitting MD’s into DO
residencies

BOE s...
Oversight and Follow-up:
Medical Education Summit Progress Task
Force
Presentations
Publications
Report to AACOM, AOA, OHF...
The “Real” Outcomes
1. Getting all the stakeholders in the
same room.
The “Real” Outcomes
1. Getting all the stakeholders in the
same room.
2. Developing the data repository.
The “Real” Outcomes
1. Getting all the stakeholders in the same
room.
2. Developing the data repository.
3. Creating a pro...
The “Real” Outcomes
1. Getting all the stakeholders in the same
room.
2. Developing the data repository.
3. Creating a pro...
Where do we go from here?
Where do we go from here?
Medical Education Summit III
“Think out 25 years. What
does the profession look like
in 2032 after we made good
decisions at these summits?”
Anonymous
“If you keep doing what you
are doing, you will keep
getting what you got.”
Yogi Berra
“Choose change before
change choose you.”
Anonymous
Osteopathic Medical Education:Osteopathic Medical Education:
State of the “Union”State of the “Union”
Karen Nichols, DO, M...
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January 2009 Osteopathic Medical Education Conference Presentation ...

  1. 1. Osteopathic Medical Education:Osteopathic Medical Education: State of the “Union”State of the “Union” Karen Nichols, DO, MA, FACOI, CSKaren Nichols, DO, MA, FACOI, CS Medical Education Summit II ChairMedical Education Summit II Chair Medical Education Summit Progress Task Force,Medical Education Summit Progress Task Force, ChairChair Osteopathic Medical EducationOsteopathic Medical Education Conference PresentationConference Presentation
  2. 2. Osteopathic Medical EducationOsteopathic Medical Education (Spheres of Influence)(Spheres of Influence) Specialty Colleges’ RESC AACOM (COMS) AOA Education Divisions Residency Standards And Program Approvals UME Admission, Curriculum And “Pipeline Issues” OPTI Administration And Oversight Bureau of Education COPT PTRC COPTI COCA
  3. 3. The VisionThe Vision  To have a proactive on-going “think tank” on medical education involving all the osteopathic profession stakeholders.
  4. 4. The PlanThe Plan Series of sessions  5 over 10-14 years  MES I – January, 2006  Global Medical Education Issues  MES II – November, 2007  Osteopathic Graduate Medical Education
  5. 5. SuccessesSuccesses  Analyze the relevance of theAnalyze the relevance of the osteopathic internship for OGMEosteopathic internship for OGME  Restructured the osteopathic internshipRestructured the osteopathic internship  July 2008July 2008
  6. 6. SuccessesSuccesses  Enforce “Opportunities” andEnforce “Opportunities” and TIVRA reportingTIVRA reporting  COPT imposed penalties in 2007 forCOPT imposed penalties in 2007 for incomplete or non-completion of TIVRA andincomplete or non-completion of TIVRA and OPPORTUNITIESOPPORTUNITIES
  7. 7. SuccessesSuccesses  Revise and enhance GMERevise and enhance GME standardsstandards  COPTI and COPT have extensively revisedCOPTI and COPT have extensively revised the OPTI standards.the OPTI standards.  PTRC and COPT have extensively revisedPTRC and COPT have extensively revised specialty college standards.specialty college standards.  Innovative programsInnovative programs  ORCA projectORCA project  Promote rapid approval processes for programsPromote rapid approval processes for programs without compromising GME quality standards.without compromising GME quality standards.
  8. 8. SuccessesSuccesses  Remove barriers and streamline theRemove barriers and streamline the OGME accreditation processesOGME accreditation processes  PTRCPTRC  new administrative processnew administrative process  April 2007April 2007
  9. 9. SuccessesSuccesses  AACOM and AOA with state societiesAACOM and AOA with state societies should lobby to ease federal UME loanshould lobby to ease federal UME loan restrictionsrestrictions  AOA supports legislationAOA supports legislation  Student loan deferment legislation (HR 2583)Student loan deferment legislation (HR 2583)  AOA supports PHS loan forgiveness orAOA supports PHS loan forgiveness or payback incentives for UME traineespayback incentives for UME trainees
  10. 10. SuccessesSuccesses  Promote mentoring andPromote mentoring and professionalism competency programsprofessionalism competency programs in UME curriculumin UME curriculum  AACOM has multiple programingAACOM has multiple programing  The AOA OME conference has significantThe AOA OME conference has significant programmingprogramming
  11. 11. SuccessesSuccesses  Increase Medicare CMS funding for GMEIncrease Medicare CMS funding for GME  The AOA has testified before the SenateThe AOA has testified before the Senate committees on workforce and GME fundingcommittees on workforce and GME funding issuesissues  Many advocacy initiatives in placeMany advocacy initiatives in place  The AOA and AACOM have a representative onThe AOA and AACOM have a representative on the COGMEthe COGME  COGME lobbies for increases in CMS and other fundingCOGME lobbies for increases in CMS and other funding for GMEfor GME
  12. 12. SuccessesSuccesses  Dual and parallel GME/OGME trainingDual and parallel GME/OGME training programs should be studied andprograms should be studied and policies developed to maximizepolicies developed to maximize OGME positions.OGME positions.  A ‘white paper’A ‘white paper’  Completed and updatedCompleted and updated
  13. 13. SuccessesSuccesses  Increase the number of OGMEIncrease the number of OGME programs and funded FTEsprograms and funded FTEs  The AOA OGME Development InitiativeThe AOA OGME Development Initiative  Michael Murphy, DO, ChairMichael Murphy, DO, Chair  Four new hospitals in the pipelineFour new hospitals in the pipeline
  14. 14. Not all issues addressedNot all issues addressed  Osteopathic Graduate MedicalOsteopathic Graduate Medical EducationEducation  On to……On to……
  15. 15. Medical Education Summit II “ Framing the Future” November 10-12, 2007
  16. 16.  The Problem:The Problem:  HHS/HRSAHHS/HRSA  ““Physician Supply/Demand: ProjectionsPhysician Supply/Demand: Projections 2020”2020”  AAMC/Center for Workforce StudiesAAMC/Center for Workforce Studies  Edward Salsberg, DirectorEdward Salsberg, Director  ““The State of the Physician Workforce”The State of the Physician Workforce”  L.Davis Institute/Health Care Econ., U.L.Davis Institute/Health Care Econ., U. Penn Richard Cooper, MDPenn Richard Cooper, MD  ““It’s Time to Address the Problem ofIt’s Time to Address the Problem of Physician Shortages: Grad Med Ed isPhysician Shortages: Grad Med Ed is the Key”the Key”
  17. 17.  How we got here:How we got here:  Downward Pressure on SupplyDownward Pressure on Supply  Medical SchoolsMedical Schools  Graduate Medical EducationGraduate Medical Education  Downward Trend of Physician WorkDownward Trend of Physician Work EffortEffort
  18. 18. Genesis of the Problem: Failure to Sustain Growth in GME 0 5,000 10,000 15,000 20,000 25,000 1950 1960 1970 1980 1990 2000 Total PGY-1 (ACGME + AOA) MD Graduates IMGs in PGY-1 DO Graduates BBA of 1996 MD Schools, 1980 Source: Richard Cooper, MD
  19. 19. Nor even will increasing residency positions by 10,000 over ten years starting in 2010 200 250 300 350 400 1980 1990 2000 2010 2020 Year Physiciansper100,000ofpopulation . Demand Supply +1,000/year 2010-2020 No change Source: Richard Cooper, MD
  20. 20. …and the gap will continue for decades. 200 250 300 350 400 1980 1990 2000 2010 2020 2030 2040 2050 Year Physiciansper100,000ofpopulation . Demand Supply +1,000/year 2010-2020 No change Source: Richard Cooper, MD
  21. 21.  19801980  17000 med students17000 med students  MD 91%MD 91%  DO 9% (1500)DO 9% (1500)  2012-132012-13  24974 med students24974 med students  MD 79%MD 79%  DO 21% (5227)DO 21% (5227)
  22. 22. “…“… an increase in allopathic medicalan increase in allopathic medical school graduates will almost certainlyschool graduates will almost certainly mean thatmean that fewer graduates offewer graduates of osteopathic medical schoolsosteopathic medical schools andand non-US schoolsnon-US schools will be acceptedwill be accepted into residency training programs.”into residency training programs.” Michael Whitcomb, Acad Med, 82, #9, Sept 2007, pp. 825-6Michael Whitcomb, Acad Med, 82, #9, Sept 2007, pp. 825-6
  23. 23. Global Issues How do we ensure that osteopathic graduate medical education maintains the essence of what makes it osteopathic? MD’s should take DO residencies
  24. 24. Resources/ Structure How do we ensure that there are sufficient resources and an appropriate structure for the graduate medical education needs of osteopathic medical students? OGME slot for every UME grad
  25. 25. Specialty Mix How do we approach the issues of specialty mix? Specific goal per specialty
  26. 26. Structural Overview 1. Understanding ourselves  Studying the definition of “osteopathic” graduate medical education  Referred to Osteopathic History/Identity Committee  Identifying what we do best and reformulating OGME based upon the societal needs of the 21st century  360 degree study  RFP being prepared
  27. 27. Structural Overview 2. Improving infrastructure  Improve quality  2 pilot surveys  Newly graduated MS IV students in Ohio  Being assessed for the broader audience  Enhancing and enforcing standards  Improving the inspection process  Improving the internal processes  Enhancing the educational structure  Analysis in process  COPT Subcommittee  AODME  BOSS – presentation at next meeting
  28. 28. Structural Overview 2. Improving infrastructure  Improving the OPTI concept and implementation  360 degree study  RFP being prepared
  29. 29. Structural Overview (continued) 3. Improving support for OGME  Promoting clinical and education research  Referred to Research Bureau  Advocating for increased funding for OGME  Ongoing Advocacy
  30. 30. Structural Overview (continued) 4. Dealing with three special issues  Studying admitting MD’s into DO residencies  BOE subcommittee  Ken Johnson DO, Chair  Survey in process  The proper approach to OGME capacity (related to UME/OGME collaboration)  AACOM/AOA Statement of Principles  Dealing with the issues in primary care, including mid-level providers  Working with ACOFP, ACOI, ACOP
  31. 31. Oversight and Follow-up: Medical Education Summit Progress Task Force Presentations Publications Report to AACOM, AOA, OHF Succession Plan
  32. 32. The “Real” Outcomes 1. Getting all the stakeholders in the same room.
  33. 33. The “Real” Outcomes 1. Getting all the stakeholders in the same room. 2. Developing the data repository.
  34. 34. The “Real” Outcomes 1. Getting all the stakeholders in the same room. 2. Developing the data repository. 3. Creating a process for dialogue/interaction/follow-up.
  35. 35. The “Real” Outcomes 1. Getting all the stakeholders in the same room. 2. Developing the data repository. 3. Creating a process for dialogue/interaction/followup. 4. Developing a joint Statement of Principles about osteopathic medical education.
  36. 36. Where do we go from here?
  37. 37. Where do we go from here? Medical Education Summit III
  38. 38. “Think out 25 years. What does the profession look like in 2032 after we made good decisions at these summits?” Anonymous
  39. 39. “If you keep doing what you are doing, you will keep getting what you got.” Yogi Berra
  40. 40. “Choose change before change choose you.” Anonymous
  41. 41. Osteopathic Medical Education:Osteopathic Medical Education: State of the “Union”State of the “Union” Karen Nichols, DO, MA, FACOI, CSKaren Nichols, DO, MA, FACOI, CS Medical Education Summit II ChairMedical Education Summit II Chair Medical Education Summit Progress Task Force,Medical Education Summit Progress Task Force, ChairChair Osteopathic Medical EducationOsteopathic Medical Education Conference PresentationConference Presentation

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