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LETTER |
Vandalia, Ohio
To the Editor:
I would like to comment on the letter by Adam B. Smith, MSIV, evaluating the rationale of the osteopathic internship and the response by Michael I. Opipari, DO (J Am Osteopath Assoc. 2004;104:230, 231, respectively). My first thought was that neither author is aware of what he does not know.
As a fourth-year osteopathic medical student, I completed rotations in allopathic residency programs affiliated with my school. I followed that with rotations in osteopathic residency programs affiliated with osteopathic medical schools. I can say, without reservation, that a significant difference exists. The allopathic rotations' morning report and grand rounds were always taught by an attending, whereas osteopathic rotations were taught by interns, second- or third-year residents, or, occasionally, an attending.
By the time I decided I wanted to do an allopathic residency in internal medicine, it was too late to apply for the match. Therefore, I ended up completing a rotating internship in an osteopathic medical institution. When I applied to the allopathic residency program the following year, I inquired as to whether my first year in an osteopathic medical institution would count toward the residency. As I was told that it would not, I had to decide whether to complete an internal medicine residency program at an osteopathic medical institution or repeat my first year in an allopathic residency program. I did the latter.
It is my experience that there is a marked difference between postgraduate education in an osteopathic residency program and an allopathic residency program. Having been on both sides of the fence, I feel qualified to know the difference.
If there is a question among osteopathic physicians as to how well the profession is doing, one need only look at the number of residents opting for an allopathic residency. When osteopathic medical students ask me what they should do about their training, I tell them to decide which is the best training possible by evaluating both programs wherever they are going, doing both rotations at the chosen hospital, and choosing their direction based on the quality of the training received. Every one of my students has taken my advice; most of them opted for allopathic residencies. This is the same advice I would offer Adam Smith.
My response to Dr Opipari is that osteopathic medical students truly know their roots but must decide where they will obtain the best training. Although it is impressive that a system of osteopathic residency programs has been in place for more than 70 years, one cannot assume there is no need for improvement.
Apparently, Dr Hornbeck did not read my response carefully. He attempts to make a strong case for Accreditation Council for Graduate Medical Education (ACGME)–accredited (allopathic) postdoctoral training programs versus American Osteopathic Association (AOA)–approved (osteopathic) programs. My response to the letter by Adam B. Smith, MSIV, was intended to justify the osteopathic internship as a training requirement, not to compare AOA-approved versus ACGME-accredited programs.
Dr Hornbeck asserts that "neither author is aware of what he does not know." His knowledge seems to be based solely on his experience in clerkship rotations, an internship in an osteopathic medical institution, and an allopathic residency. I have had significant experience as well in both the osteopathic and the allopathic medical systems with 2 years of allopathic fellowship training and several years in both teaching systems. Therefore, I know of which I speak.
I advise Dr Hornbeck to refrain from judging all osteopathic medical programs based on his limited experience. That his student clerkship rotations were below his level of expectation does not indicate that all AOA-approved programs are the same. Having reviewed AOA-approved programs for some time and having served or chaired the AOA Council on Postdoctoral Training for more than 17 years, I have seen both outstanding training and weak programs. I have observed ACGME-accreditation review meetings and discussed the process with ACGME members and leaders. Believe me, they have as many weak programs of concern as do we. Further, it takes their process considerably longer to terminate those weak programs than does our process. The truth of the matter is that both the AOA and the ACGME attempt to create the highest quality programs possible to ultimately benefit the health of the people our trainees will treat.
One cannot determine that we have a problem judging solely by the number of students selecting allopathic residencies. Students often have a perception of quality that is not always based on appropriate criteria of quality, but rather, on name visibility, size, geography, etc. It is bothersome that perception, rather than reality, is often the driving force in selection.
I wholeheartedly agree with Dr Hornbeck that students should select the best available training as I did; however, I believe the best training can be found in an AOA-approved program as well. I would therefore advise students to find a different AOA-approved program if the one they have chosen is not a good fit.
I am pleased that Dr Hornbeck believes osteopathic medical students "know their roots." The osteopathic medical profession, which provided their education, can only survive if its students preserve and uphold the tenets of osteopathic medicine. I also agree that there is room for improvement; however, I remind Dr Hornbeck that this applies to both educational systems.
Council on Postdoctoral Training American Osteopathic Association
This article has been cited by other articles:
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  J. J. Snyder Jumping Through Hoops for Osteopathic Internships J Am Osteopath Assoc, October 1, 2005; 105(10): 443 - 443. [Full Text] [PDF]
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J. J. Rodos Loyalty to the Profession, Not the AOA: Evidence Base Necessary for Member Support of Association Policies J Am Osteopath Assoc, September 1, 2005; 105(9): 426 - 426. [Full Text] [PDF]
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