JAOA • Vol 104 • No 11 • November 2004 • 468-478
Osteopathic Graduate Medical Education
Joyce L. Obradovic;
Scott W. Beaudry;
Pamela Winslow-Falbo
Address correspondence to Joyce L. Obradovic, Division of Postdoctoral
Training, American Osteopathic Association, 142 E Ontario St, Chicago, IL
60611-2864. E-mail:
jobradovic{at}osteopathic.org.
For several years, osteopathic medical students have requested that the
American Osteopathic Association (AOA) develop an electronic residency
application service. At the July 2003 meeting of the Executive Committee of
the Council on Postdoctoral Training (ECCOPT), the Committee reviewed
presentations by two different application services. The first presentation
was given by the Canadian Residency Matching Service (CaRMS), and the second
was given by the Association of American Medical Colleges (AAMC). After
careful review and discussion, the Committee decided that ERAS® was the
best possible application service for the osteopathic medical students.
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Electronic Residency Application Service
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At the November 2003 meeting of the ECCOPT, ERAS® submitted a proposal
that the Committee reviewed in detail. Recommendation was made and approved by
the Council on Postdoctoral Training and forwarded to the Bureau of
Professional Education for its approval as well.
The AOA Board of Trustees granted final approval at its meeting in February
2004.
In May 2004, the AOA and the AAMC entered into an agreement for the purpose
of advancing the philosophy and practice of osteopathic medicine. ERAS®
will open to the osteopathic medical community to help facilitate applications
and applicants' supporting documents for internship and residency positions in
osteopathic graduate medical education (OGME) training programs.
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What Is ERAS®?
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ERAS® is a service that transmits internship applications, letters of
recommendation, deans letters/Medical Student Performance Evaluations, medical
school transcripts, Comprehensive Osteopathic Medical Licensing Examination
(COMLEX–USA) transcripts, and other supporting credentials from the
student and the designated dean's office to internship program directors using
the Internet.
ERAS® is made up of MyERAS® (the Web site where students create
their internship application), the Dean's Office Workstation (DWS), the
Program Directors Workstation (PDWS), and the ERAS® PostOffice
(ERASPO).1
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How Do Institutions Prepare for ERAS®?
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Some advance planning will facilitate the smooth introduction of ERAS®
at the college or hospital level. Now is the time to plan for the resources
necessary to implement ERAS®, eg, new computers, Internet access, etc. The
AAMC has provided a timeline (Table
1) to help identify what needs to be done at each stage.
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What Kind of Equipment is Necessary?
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At least one fairly new Windows based computer, connected to the Internet,
is needed for each user to access and run ERAS®. Minimum and suggested
specification for personal computers (PCs) are available on the ERAS® Web
site at
www.aamc.org/eras.
The Web site will also provide a link for program staff, and access to the
technical support area.
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How Is ERAS® Software Installed?
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The best way to install ERAS® is on a network, with multiple staff
viewing the same data. Not only does this method allow for easy sharing of
information, but it also allows staff to take advantage of nightly network
backups. If an institution is not able to install ERAS® on a network, it
should consider how it will back up the application data and documents and
should consider purchasing a Zip or Jazz drive. Or, if purchasing a new PC,
these students should consider including one with the ability to burn CDs.
These are good options for individual users.
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Is an Internet Connection Needed?
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An Internet connection is required to access the ERAS® PostOffice. Most
internship programs have access to the Internet through their institution's
connection. Institutions that double-click on a browser on their PCs and see a
web page do not need to worry. However, if an institution does not have such a
connection available, then the OGME program will need to consider how it will
access the Internet to download application files.
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What Kind of Training Is Necessary?
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Although the ERAS® software is very easy to use and is accompanied by
detailed manuals on the entire ERAS® process, many OGME programs like to
plan for training of key staff. Special training sessions for osteopathic
internship programs will be held in conjunction with the Association of
Osteopathic Directors and Medical Educators (AODME) meeting, May 11–15,
2005, at the Hilton El Conquistador Hotel in Tucson, Ariz, and will be free of
charge to registered participants. Please check the AODME Web site for
conference details and fees at
http://www.aodme.org/.
Regular ERAS® training will be held in cities around the United States in
July and August. The costs are $150 for a half-day session, and attendance
normally involves additional costs for travel and overnight accommodations for
attendees.
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What Kind of Fees Are Involved?
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Each training program will be charged a $250 ERAS® fee. This fee covers
the listing of the program in the MyERAS® web site for applicants, the
provision of the ERAS® Program Directors Workstation Software (PDWS), and
the delivery of application materials via the ERASPO. It also includes
year-round support from the friendly and competent ERAS® Helpdesk on all
aspects of using ERAS®.
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ERAS® Summary
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Sometime in November 2004, each program will receive advance information on
how ERAS® works, giving answers to the most frequently asked questions
about the use of ERAS®. In January 2005, registration for the upcoming
ERAS® season begins. Internship programs can update the listing that will
be displayed for applicants in the MyERAS Web site. They can also indicate
what type of training is to be offered: traditional, special emphasis, or
combined. During registration, internship programs also provide contact
information for ERAS® administrative use, such as addresses for mailing
manuals and software instructions, numbers for faxing advisories, etc.
In May 2005, the AODME will meet with the Association for Hospital Medical
Education in Tucson, Ariz. In conjunction with this meeting, ERAS® will
offer PDWS training. This comprehensive half-day course will give the
internship program staff all the skills necessary to successfully introduce
ERAS® to their program. During the months of July and August, ERAS®
Training will be offered in various US cities. Each year, this training is
arranged based on anticipated demand. In 2005, training sessions are planned
for Washington, DC, Chicago, Los Angeles, Atlanta, Boston, and New York.
On July 1, 2005, MyERAS, the applicant Web site, opens for osteopathic
medical students to register and start work on their application. On July 15,
2005, The ERASPO opens for the osteopathic internship application season.
Applicants may transmit their applications to internship programs; schools and
the National Board of Osteopathic Medical Examiners may transmit supporting
documents; and osteopathic internship programs may begin downloading
application materials (Ms Moira Edwards, assistant vice president for
Residency and Fellowship Application Services).
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Data on the 2003–2004 Academic Training Year
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In 2003, there were 2628 current graduates of colleges of osteopathic
medicine (COMs). Table
2 reflects a 1% increase from 2602 COM graduates in 2002.
Similarly, the number of approved internship positions increased from 2473
positions in 2002 to 2659 in 2003, nearly an 8% increase.
View this table:
[in this window]
[in a new window]
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Table 2 Approved, Budgeted, and Filled Intern Positions and Number of College of
Osteopathic Medicine (COM) Graduates Available to Fill Intern Positions
1993-2003
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The AOA Match provides osteopathic medical students with a means to secure
osteopathic internship positions before graduation.
Table 3 reflects the
variation in student participation in the AOA Intern Registration Program (the
Match) by COMs. Forty-eight percent of the 2670 COM graduates (represents the
class of 2003 plus 42 from previous years) matched in the 2003 AOA Intern
Registration Program. More than 75% of the graduates from Lake Erie College of
Osteopathic Medicine, Michigan State University College of Osteopathic
Medicine, Philadelphia College of Osteopathic Medicine, and the University of
Medicine and Dentistry of New Jersey–School of Osteopathic Medicine
matched in the AOA Match. Participation in the Match program is generally
lower in those COMs residing in states with fewer osteopathic graduate medical
training opportunities. Of those students who matched, approximately 89% of
the participants matched to their first choice
(Table 4).
View this table:
[in this window]
[in a new window]
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Table 4 American Osteopathic Association Intern Registration Program Intern
Match Statistics: 2003-2004 Applicants That Matched to First Choice (as of
February 12, 2003)
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A total of 63% of the 2003 COM graduates who matched chose a traditional
rotating internship, as shown in Table
5,
. Approximately 27% of the matched graduates chose family
practice, internal medicine, or emergency medicine.
View this table:
[in this window]
[in a new window]
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Table 5, Continued Intern Match Summary (Class of 2003) by Type of Matched Internship
Program as of February 12, 2003
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Table 6 reflects
the number of AOA-approved internship training positions by state.
Approximately 70% of AOA-approved internship training positions reside in
Florida, Michigan, New Jersey, New York, Ohio, and Pennsylvania. This
percentage represents a slight decline in the proportion of internship
positions offered in those six states, from approximately 75% down to 70%. The
number of approved internship positions increased in 25 states, whereas the
number of approved internship positions decreased in just 8 states. Seven
states began offering osteopathic internships again, after lapsing during the
last academic year, and three states began offering internship programs after
having lapsed for the past several years.
Beginning with the 2000–2001 Match, COM graduates have been able to
register for programs that link internships to AOA-approved second-year
residency programs. With the 2003–2004 Match, every specialty offered in
either specialty-tracked internships or traditional internships linked with a
chosen specialty were represented. Of the 866 linked internship and residency
positions offered in 2003–2004, as compared with 785 in 2002–2003,
73% were filled. These figures indicate 10% more linked positions offered
versus the number offered the previous year, with a similar percentage filled
compared with last year. COM graduates are most receptive to this combined
offering because it provides stability and security for subsequent training
years.
Table 7 provides information
on osteopathic residency training positions. In the 2003–2004 academic
year, there were 549 AOA-approved residency programs, representing a 5.2%
increase over the 522 approved programs in the 2002–2003 academic year.
In academic year 2003 2004, there were 2327 residents in AOA-approved
training, representing an 8% decrease from the 2532 residents in training
during 2002–2003.
The AOA has established mechanisms by which osteopathic physicians may
obtain approval for Accreditation Council for Graduate Medical Education
(ACGME) training. This approval is key for those osteopathic physicians
seeking licensure in states requiring an osteopathic internship or for those
desiring osteopathic board certification. Between 2001 and June 2004, a total
of 548 osteopathic physicians petitioned the AOA for approval of their first
year of ACGME postgraduate training compared with 344 through June 2003, a 60%
increase.
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Comment
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Graduate medical training is continually faced with complex changes within
the learning environment of our interns and residents. Growth and
reintroduction of osteopathic internship programs into geographic regions,
unavailable to graduates during the previous academic year, indicate
advancement toward providing osteopathic graduate medical training
opportunities for all COM graduates and in all areas of the United States. The
AOA continues to work collaboratively with a wide range of stakeholders in the
OGME arena to provide quality training opportunities to graduates of our
COMs.
From the American Osteopathic Association Division of Postdoctoral
Training, where Ms Obradovic is director, Mr Beaudry is manager of trainee
services, and Ms Winslow-Falbo is data manager.
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References
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1. ERAS®—The Electronic Residency Application Service Web
site. Available at:
http://www.aamc.org/students/eras/start.htm.
This article has been cited by other articles:
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S. E. Brotherton, P. H. Rockey, and S. I. Etzel
US Graduate Medical Education, 2004-2005: Trends in Primary Care Specialties
JAMA,
September 7, 2005;
294(9):
1075 - 1082.
[Abstract]
[Full Text]
[PDF]
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