JAOA • Vol 106 • No 2 • February 2006 • 70-75
Osteopathic Postdoctoral Training Institutions
Jonathan B. Webb, MPH
From the Department of Education, American Osteopathic Association,
Chicago, Ill.
Address correspondence to Jonathan B. Webb, Department of Education, American
Osteopathic Association, 142 E Ontario St, Chicago, IL 60611-2864.
E-mail:jwebb{at}osteopathic.org
The Osteopathic Postdoctoral Training Institution (OPTI) program has
flourished since the American Osteopathic Association (AOA) established it in
1995 as a system to structure and accredit osteopathic graduate medical
education (OGME). Each OPTI is a community-based training consortium composed
of at least one AOA-accredited college of osteopathic medicine and one
AOA-accredited hospital. Additional hospitals and ambulatory care facilities
may also form partnerships within an OPTI.
Each of the 17 OPTIs is required to undergo a site survey on a regular
basis to determine the institution's quality and compliance with AOA
standards. The results of this site survey are used to determine the length of
the OPTI's continuing accreditation. For example, if an OPTI is considered to
be standard compliant and is functioning close to the expected level of
quality, it may be granted a 4-year continuing accreditation. The next site
survey of that institution would take place at the end of that 4-year period.
Conversely, if an OPTI is deficient in various standard areas and is not
operating at the expected level of quality, it may be granted only a 1-year
continuing accreditation and will have to be inspected again at the end of
that year. Five years is the maximum length of accreditation that can be
granted to an OPTI, according to AOA guidelines.
At publication, each of the OPTI sites has been visited by AOA inspectors
at least twice since site surveys began in 1997
(Figure 1). The
average length of accreditation granted has increased with each new cycle of
site surveys, indicating increased compliance with AOA standards. The average
length of accreditation granted in the initial site survey cycle was 2.3
years. In the most recent site survey cycle, an average accreditation length
of 3 years was granted to OPTIs.
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Figure 1. The American Osteopathic Association's Osteopathic Postdoctoral
Training Institutions, listed by dates scheduled for resurveys.
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Analysis of Compliance with Standards
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In an attempt to further improve upon OPTI performance and elevate the
level of service provided to the OPTIs' hospital and ambulatory care facility
partners, the AOA Committee on Osteopathic Postdoctoral Training Institutions
(COPTI) has analyzed OPTI compliance with AOA standards. At the 2005 Annual
OPTI Workshop held in Tucson, Ariz, in May, the findings of this analysis were
presented and discussed.
In the AOA COPTI analysis, results from the two most recent OPTI site
survey cycles were examined for each OPTI. In the prior survey cycle, 12 OPTIs
were granted 2 years' continuing accreditation, while only one OPTI received 4
years' continuing accreditation. In the most recent survey cycle, seven OPTIs
received 4 years' continuing accreditation.
Similar progress was found in the AOA COPTI analysis in regard to cited
deficiencies of OPTIs in meeting standards of compliance. In the prior survey
cycle, nine OPTIs were cited for four or more deficiencies in meeting
standards, while only one OPTI had no cited deficiencies. In the most recent
survey cycle, four OPTIs had four or more cited deficiencies, and six OPTIs
had no cited deficiencies. It is clear that OPTI compliance with AOA standards
is steadily improving.
The AOA COPTI analysis determined that OPTIs most frequently failed to meet
standards within the organization, administration, and finance section of the
standard requirements. Fifty-four percent of the OPTI deficiencies cited
during the prior survey cycle were in this section, and 40% of the OPTI
deficiencies cited during the most recent survey cycle were in this section
(Figure 2). In
addition, 24% of the cited OPTI deficiencies in the prior survey cycle
pertained to the standards section on faculty and instruction, and 27% of the
cited OPTI deficiencies in the most recent survey cycle were in this same
section (Figure
2).
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Figure 2. Percentages of Osteopathic Postdoctoral Training Institution
deficiencies in meeting American Osteopathic Association standards of
compliance, by standards section, as indicated in the most recent and the
prior site survey cycles.
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From the prior to the most recent survey cycle, a shift occurred in the
most frequently cited deficient individual standards. The prior survey cycle
found a lack of compliance primarily in the submission of institution bylaws
and development of educational program policies
(Table 1). The most
recent survey cycle found increased deficiencies in standards regarding the
integration of osteopathic principles and practices in teaching services
(Table 2). Standards
regarding the presence of OGME committees, the meeting of research
requirements, and the development or evaluation of faculty in OPTIs were
consistently deficient in both survey cycles.
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Plans to Address Deficiencies
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Discussions regarding the best practices for addressing these cited
deficiencies took place in the OPTI Workshop breakout groups in Tucson.
Participants focused on the deficiencies pertaining to faculty development,
OGME committee activity, and research. Suggestions were offered for meeting
the standards related to these deficiencies. In addition, concerns were
expressed regarding possible obstacles to meeting the standards. The OPTI
Clearinghouse (available through
http://www.do-online.org)
was proposed as an appropriate method for sharing more detailed models of
those OPTI programs that have effectively complied with AOA standards.
The group comments were shared with all of the workshop participants and
will form the basis for further discussion at the 2006 Annual OPTI Workshop,
scheduled to be held in Savannah, Ga, on April 4, 2006. Additional workshop
topics will include defining the role of the OPTI versus the role of the
individual partner institutions, determining how OPTIs can better assist their
partner institutions in meeting AOA requirements, and identifying how OPTIs
can continue to improve upon their services to the osteopathic medical
community.
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Proposed Scoring System
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In light of the increased OPTI compliance with AOA standards, an important
question remains unanswered: Are OPTIs simply complying with minimal
standards, or are they functioning in the optimal intended capacity? In
order to address this question, the AOA COPTI—under direction of the
AOA's Bureau of Osteopathic Education—has begun to identify measurable
outcomes for the OPTIs that better reflect compliance rates with optimal
standards. The evaluation tool being designed by COPTI is a type of scoring
system that will help gauge whether each OPTI is providing a quality product
to its partners. This proposed scoring system would also help make the OPTI
evaluation process more uniform than it presently is. The expected
implementation date of the OPTI scoring system remains undetermined.
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Conclusion
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The AOA's OPTI program is striving to provide a high quality, seamless
continuum of osteopathic medical education and training for osteopathic
graduate medical students. The data from the site surveys indicates that the
OPTI program is steadily evolving and progressing. The AOA intends to further
improve upon the existing OPTI framework through continued self-analysis and
sharing of best practices.
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S. C. Shannon
Osteopathic Medical Education in 2006: Charting a Course for the Future
J Am Osteopath Assoc,
February 1, 2006;
106(2):
48 - 49.
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