JAOA • Vol 107 • No 2 • February 2007 • 57-66
Osteopathic Graduate Medical Education
Joyce L. Obradovic, MA, RDH;
Pamela Winslow-Falbo
From the American Osteopathic Association's Division of Postdoctoral
Training in Chicago, Ill.
Address correspondence to Joyce L. Obradovic, MA, RDH, Department of
Education, American Osteopathic Association, 142 E Ontario St, Chicago, IL
60611-2864. E-mail:
jobradovic{at}osteopathic.org
For the 2004-2005 academic year, as in preceding years, the number of
graduates from colleges of osteopathic medicine (COMs) and the number of
osteopathic medical internship positions approved by the American Osteopathic
Association (AOA) continued to increase, by 2% and 1%, respectively. However,
student participation in the AOA's Intern/Resident Registration Program dipped
by 5% to a total of 44% for the class of 2005. Notwithstanding, a striking
majority (1120 [91%]) of participating 2005 COM graduates were matched to
their first choice training program—most often in traditional
osteopathic rotating internships (63%). Next in popularity for osteopathic
medical graduates were internships in family practice (11%), internal medicine
(9%), and emergency medicine (5%). As a model for training, the traditional
osteopathic rotating internship has undergone extensive revision in the past
year as a result of extensive collaboration among the AOA's Council on
Postdoctoral Training and each of the 23 osteopathic specialty colleges. The
restructured plan will go into effect as of July 1, 2008.
Annual data on osteopathic graduate medical education (OGME) is reported
using information gathered from the American Osteopathic Association's
Intern/Resident Registration Program (ie, the AOA "Match") and
data reported by AOA-approved residency programs using the AOA's Trainee
Information, Verification, and Registration Audit (TIVRA) reporting system.
Although data from the Match does not change in a given year, program data
does change because the AOA Council on Osteopathic Postdoctoral Training's
(COPT's) Program and Trainee Review Committee meets quarterly to approve
residency programs and positions. These new programs and positions are added
to TIVRA at that time.
When compared with the data reported for the class of
2004,1 the class of
2005 represented a 2% increase in the number of graduates from colleges of
osteopathic medicine (COMs). Concurrently, there was an increase of 1% in the
number of AOA-approved osteopathic medical internship positions available to
these COM graduates—though this number is to be considered incomplete
until finalized1 in
THE JOURNAL's 2008 Medical Education issue.
So-called match rates through the AOA's Intern/Resident Registration
Program have dipped by 5% to 44%, with 1120 (91%) of the 1228 participating
COM graduates being matched to their first choice training program. For match
participants, the majority (778 [63%]) seek and obtain traditional rotating
internships, followed by internships in family practice (137 [11%]), internal
medicine (106 [9%]), and emergency medicine (64 [5%]).
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Restructuring the Traditional Osteopathic Internship
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In July 2006, the AOA's Board of Trustees and House of Delegates supported
a COPT resolution for restructuring the traditional osteopathic internship
(ie, Resolution 19 [A/2006]—Restructuring of the Osteopathic
Internship). After long-standing discussions about the traditional rotating
internship's ongoing
relevance,2 ongoing
deliberation by the COPT, and widespread conjecture within the osteopathic
medical profession,3
the plan for restructuring is finally
complete.4 The
arrangements for this new postgraduate training model are moving forward
quickly and will go into effect July 1, 2008.
After reviewing the three options, each specialty college specified its
preferred model for OGME in the first year of postgraduate training (OGME-1)
(Figure 1):
- Option 1: AOA OGME-1 Resident (Residency)—The AOA-approved
residency training programs that selected this option will grant residency
credit for the first year of postdoctoral training. Students will
"match" directly into the residency program and the first
postdoctoral year will be considered the first year of residency training. All
option 1 positions will be recorded as residency positions in the AOA's TIVRA
reporting system.
- Option 2: AOA OGME-1 Preliminary (Internship)—Although the
training programs that selected this option will not grant residency credit,
they will require (or continue to require) a "preliminary" first
year of training. These programs have agreed that completion of designated
preliminary year curricular rotations are prerequisites for entry into the
first year of residency training (ie, year 2 of postdoctoral training).
Matching through the AOA's Intern/Resident Registration Program ensures
osteopathic trainees that they will gain program entry and will be able to
fulfill the requirements of residency training for their first 2 postdoctoral
years.
In most cases, both required training periods are offered by the same
institution. In a few instances, however, a residency training program may
have formed an affiliation with another institution for internship trainees.
The residency match registration will indicate the affiliated intern
institution if it is different from the residency institution. Both
institutions will be listed together on AOA match forms. All option 2
positions will be recorded as internship positions in the AOA's TIVRA
reporting data.
- Option 3: AOA OGME-1 Traditional (Internship)—The third option
represents a traditional osteopathic rotating internship and stands alone
(Figure 2). This
option is often the best choice available to students who are either undecided
on their future plans or who plan to enter residency training with a program
accredited by the Accreditation Council for Graduate Medical Education
(ACGME).
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Figure 2. Components of the traditional osteopathic rotating internship (AOA
OGME-1 Traditional [Internship]), the third option in the revised three-option
model provided by the Council on Postdoctoral Training
(Figure 1).
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Students who subsequently choose to enter a medical specialty that has
selected either option 1 or option 2 for its trainee pathway must then contact
their specialty college to determine whether advanced standing will be
granted. Obtaining advanced standing will depend on the number of residency
positions available (if any) because most will already have been filled with
matched first-year trainees who are advancing to AOA OGME-2 positions. All
option 3 positions will be recorded as internship positions in the AOA's TIVRA
reporting data. In addition, the COPT has decided to retain the same six
rotation requirements as in the existing/current version of the internship for
the option 3 requirement (Figure
2).
Each specialty college is in the process of defining its first-year
rotational requirements. These requirements will be submitted to the COPT for
review in April. As this restructuring continues, the Association and the COPT
will provide additional information to the osteopathic medical profession well
in advance of the July 2008 launch date.
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The Match: Academic Training Year 2005-2006
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At the nation's COMs, a total of 2826 students graduated in the class of
2005 (Table 1). The
addition of 57 students to COM capacity reflects a 2% increase on the 2769
graduates from the class of
2004.1 The number of
approved osteopathic medical internship positions available to COM graduates
increased by 36 (1%), from 2616 positions in 2004 to 2652 positions in
2005.1
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Table 1 AOA Registration Program: Intern Match Class of 2005 Participants
Matched to First Choice Osteopathic Medical Internship Positions by
COM
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The AOA's Intern/Resident Registration Program provides osteopathic medical
students with an opportunity to secure osteopathic internship positions before
graduation. Data on students from the class of 2005 who participated in the
AOA's Intern/Resident Registration Program is presented in
Table 1. A total of
1228 (44%) class of 2005 COM graduates participated in the program and were
matched to osteopathic internships for the 2005-2006 academic year. Although a
large number of COMs had 50% or more of their participating graduates matched
to internships through this program
(Figure 3), for the
class of 2005, Michigan State University College of Osteopathic Medicine (East
Lansing) once again had the highest percentage of participating graduates
matched.1,5-8
Of its 124 graduates, 107 (86%) of Michigan State University College of
Osteopathic Medicine's students secured internship positions through the Match
during the 2005-2006 academic year.
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Figure 3. The colleges of osteopathic medicine listed had more than 50% of their
participating graduates matched to internships through the American
Osteopathic Association's Intern/Resident Registration Program in the
2004–2005 academic year.
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Somewhat predictably, participation in the AOA's Intern/Resident
Registration Program is lower for COMs located in states with fewer
osteopathic postdoctoral training opportunities. Of the 1228 participating
students, 1120 (91%) were matched to the internship positions they listed as
their first choice (Table
1).
In the class of 2005, 778 (63%) of COM students chose a traditional
osteopathic rotating internship (Table
2). Collectively, about 25% of the matched students in this
graduating class chose internships in emergency medicine (64 [5%]), family
practice (137 [11%]), or internal medicine (106 [9%]). These figures are
comparable to data previously reported for the 2769 students who graduated in
the class of 2004. For these students, 774 (65%) of the 1196 participating
students were matched with a traditional rotating internship and approximately
26% chose internships in emergency medicine (69 [6%]), family practice (120
[10%]), or internal medicine (116
[10%]).1
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Table 2 AOA Intern/Resident Registration Program Intern Match Summary for the
Class of 2005 by COM and Program Type
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Osteopathic Graduate Medical Education Programs
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As noted elsewhere, annual data on OGME is reported using information
gathered from the AOA's Intern/Resident Registration Program and data reported
by AOA-approved residency programs using the AOA's TIVRA reporting system.
Although data from the Match does not change in a given year, program data
does change because the AOA COPT's Program and Trainee Review Committee meets
quarterly to approve residency programs and positions. These new programs and
positions are added to TIVRA at that time. Program data presented in this
article is current as of May 31, 2006, and will be
finalized1 in THE
JOURNAL's 2008 Medical Education issue.
Because of a reduction in the number of AOA-approved internship training
positions available in several of the traditional "Big Six"
states,1 Illinois
gained in relative prominence for this measure during the 2005-2006 academic
year. Approximately 75% of all AOA-approved internship training positions
currently available are located in seven states
(Table 3): Florida,
Illinois, Michigan, New Jersey, New York, Ohio, and Pennsylvania. When
compared with data for the 2004-2005 academic
year,1 the number of
approved internship positions for the 2005-2006 academic year increased in 9
states and decreased in 10 states
(Figure 4).
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Table 3 AOA Registration Program: Number of Approved Osteopathic Medical
Internship Positions by State and Academic Year,
1996-2006*
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Figure 4. American Osteopathic Association's Intern/Resident Registration
Program. When compared to data reported for
2004–2005,1
the number of approved osteopathic medical internships in the
2005–2006 academic year increased in 9 states but decreased in 10
states. The number of internship positions added or lost in each state noted
is provided in parentheses.
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In the 2005-2006 academic year, there were 649 AOA-approved residency
training programs (Table
4), representing a 14% increase over the 569 programs
reported for the previous academic year.
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Table 4 No. of AOA–Approved Residency Programs and Residents Filling
Available Positions as
Reported* by
Academic Year and Specialty,
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In addition, there were 2535 residents in AOA-approved training programs in
the 2005-2006 academic year, representing a 5% increase from the 2422
residents in training during 2004-2005.
The AOA has established mechanisms by which osteopathic physicians may
obtain approval for training provided through residency training programs
approved by the ACGME (ie, Resolution 42 [A/2000]—Approval of ACGME
Training as an AOA-Approved Internship). This approval is key for osteopathic
physicians seeking medical licensure in states that require an osteopathic
internship (ie, Florida, Michigan, Oklahoma, Pennsylvania, and West Virginia)
and for physicians who seek osteopathic specialty board certification. Between
July 2001 and October 2006, a total of 1241 osteopathic physicians petitioned
the AOA for approval of their first year of ACGME postgraduate training. As of
October 10, 2006, 774 (62%) of these applications have been approved; 455
(37%), approved pending completion of residency training or requirements under
Resolution 42; and 12 (<1%), denied.
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Conclusion
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The AOA's Division of Postdoctoral Training continues to look forward to
working with osteopathic training programs and their osteopathic postdoctoral
training institutions during the coming year as the new internship process is
implemented. Postdoctoral residency training continues to demonstrate positive
growth in geographic regions where osteopathic opportunities were previously
limited for COM graduates. The AOA is committed to working collaboratively
with other stakeholders in OGME to provide high-quality training opportunities
to COM graduates.
Submitted December 21, 2006;
accepted December 21, 2006.
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References
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1. Obradovic JL, Beaudry SW, Winslow-Falbo P. Osteopathic graduate
medical education. J Am Osteopath Assoc. 2006;106:59-68. Available
at:
http://www.jaoa.org/cgi/content/full/106/2/59.
Accessed February 21, 2007.2. Crosby JB. The match—AOA's commitment to osteopathic medicine
[executive director's desk]. The DO.May
2005;46:15
-18.
3. Crosby JB. The osteopathic internship is here to stay. September
26, 2006. AOA Daily Report [serial online]. Chicago, Ill: American
Osteopathic Association; 2006. Available at:
http://blogs.do-online.org/dailyreport.php?itemid=339.
Accessed February 21, 2007.
4. Opipari MI. Osteopathic internship restructuring. Slide show
presented at: OME 17th Annual Leadership Conference; January 13, 2007;
Washington, DC. Available at:
https://www.do-online.org/pdf/acc_postdocomeconf07restructopipari.pdf.
Accessed February 21, 2007.
5. Obradovic JL, Beaudry SW, Winslow-Falbo P. Osteopathic graduate
medical education [published correction appears in J Am Osteopath
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Available at:
http://www.jaoa.org/cgi/content/full/104/11/468.
Accessed February 21, 2007.
6. Obradovic JL, Winslow-Falbo P. Osteopathic graduate medical
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2004;104:147]. JAm Osteopath Assoc. 2003;103:513-522. Available at:
http://www.jaoa.org/cgi/reprint/103/11/513.
Accessed February 21, 2007.
7. Obradovic JL, Bronersky VM, Winslow-Falbo P. Osteopathic graduate
medical education [published correction appears in J Am Osteopath
Assoc. 2003;103:215]. J Am Osteopath Assoc. 2002;102:582-589.
Available at:
http://www.jaoa.org/cgi/reprint/102/11/582.
Accessed February 21, 2007.
8. Swartwout JE, Bronersky VM, Winslow-Falbo P. Osteopathic graduate
medical education. J Am Osteopath Assoc.2001; 101:653
-659.[Medline]
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