ACGME Brings the Hammer Down on the AOA

[Textbookversion]

I haven't seen this posted here yet:

http://www.acgme.org/acgmeweb/Portals/0/PDFs/CPR_Eligibility.pdf

Interesting parts start at the bottom of page 7: AOA internship --> ACGME residency? Not anymore. No exceptions.

"All prerequisite post-graduate clinical education required for entry into ACGME accredited residency programs must be completed in ACGME accredited residency programs, ACGME International accredited residency programs, or Royal College of Physicians and Surgeons of Canada (RCPSC) accredited residency programs located in Canada... Review committees will not grant exceptions to these eligibility requirements for residency education."

Pages 8 & 9 are the fellowship info and too long to reproduce here. Basically, you are going to have to move mountains to get into an ACGME fellowship after doing an AOA program and that exception only exists if the review committee for your specialty allows it. Each specialty individually has the option of adopting a rule that doesn't allow exceptions.

It says in order to be granted an exception and allowed go from non-ACGME residency to an ACGME fellowship you have to take USMLE steps 1, 2 and even 3 if you are eligible for 3. I think all DO grads would be eligible for step 3 if they had taken 1, 2CK, 2CS which are required. You also have to have a demonstrated record of clinical excellence, leadership in the field, a serious publication record, etc which obviously a new grad of residency doesn't have. Basically the requirements are tailor made to only let in foreign docs who are superstar leaders in their field abroad who want to train in the US for a bit. And that's only if a specific specialty allows exceptions, if they don't then AOA docs are totally shut out.

ACGME is bringing down the hammer big time. I haven't finished reading I'll update with more if there is anything else interesting.

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[7wonders]

Hello All,

As you all are already aware, the ACGME is moving forward with the proposed changes to the common program requirements and is currently taking comments from stakeholders on these changes. While we as individuals cannot offer comment directly to ACGME, AACOM will be submitting comments on the topic. As the current to representative to the AOA Board of Trustees for all osteopathic medical students, I would like to prepare an official statement regarding the student position on these proposed changes.

The proposal as written along with a section for comments and input to AACOM can be found at http://www.aacom.org/news/latest/Pages/GMEnews.aspx. A pdf is also available at http://www.acgme.org/acgmeweb/Portal...ligibility.pdf (see lines 292-390). Although you can feel free to offer comments directly to AACOM, I would really like for comments to be sent directly to me so that I can include our collective perspectives in my letter to AACOM President Dr. Shannon and the AOA Board as the official student position on this issue.

PLEASE understand that comments should address the proposed common program requirements and that this is NOT about a proposed AOA/AACOM/ACGME merger. Comments should be limited to how the common program requirements will affect students and should be stated in a professional manner. This is our opportunity to demonstrate how strongly we feel about these proposed changes, but that message will carry much more weight if our arguments are grounded in a solid understanding of the question at hand and have a professional tone. Please email me directly by September 3 with your comments, questions or concerns.

PS: The level of frustration expressed on these threads is clear. Although I did not assume my position on the Board until after the announcement about the MOU was released, I can assure you that I am committed to representing the best interests of all osteopathic medical students throughout my term of service.

All the Best,
Amber Hull, OMS-IV
DO Candidate- Arizona College of Osteopathic Medicine
American Osteopathic Association Board of Trustees Student Delegate
AACOM Council of Osteopathic Student Government Presidents
[email protected]

 

[The kitchen sink]

I haven't seen this posted here yet:

http://www.acgme.org/acgmeweb/Portals/0/PDFs/CPR_Eligibility.pdf

Interesting parts start at the bottom of page 7: AOA internship --> ACGME residency? Not anymore. No exceptions.

"All prerequisite post-graduate clinical education required for entry into ACGME accredited residency programs must be completed in ACGME accredited residency programs, ACGME International accredited residency programs, or Royal College of Physicians and Surgeons of Canada (RCPSC) accredited residency programs located in Canada... Review committees will not grant exceptions to these eligibility requirements for residency education."

Pages 8 & 9 are the fellowship info and too long to reproduce here. Basically, you are going to have to move mountains to get into an ACGME fellowship after doing an AOA program and that exception only exists if the review committee for your specialty allows it. Each specialty individually has the option of adopting a rule that doesn't allow exceptions.

It says in order to be granted an exception and allowed go from non-ACGME residency to an ACGME fellowship you have to take USMLE steps 1, 2 and even 3 if you are eligible for 3. I think all DO grads would be eligible for step 3 if they had taken 1, 2CK, 2CS which are required. You also have to have a demonstrated record of exceptional clinical excellence, leadership in the field, a serious publication record, etc which obviously a new grad of residency doesn't have. Basically the requirements are tailor made to only let in foreign docs who are superstar leaders in their field abroad who want to train in the US for a bit. And that's only if a specific specialty allows exceptions, if they don't then AOA docs are totally shut out.

ACGME is bringing down the hammer big time. I haven't finished reading I'll update with more if there is anything else interesting.

Question: If you are already in an ACGME program, do these rules apply ie take step 1, 2 ck cs and 3 or does it only apply to people applying from non acgme programs to acgme fellowships?

Thanks

 

[7wonders]

My understanding of the language is that anyone who wishes to enter an ACGME fellowship must pass all Steps of the USMLE even if residency was completed at an ACGME institution.

 

[Textbookversion]

My understanding of the language is that anyone who wishes to enter an ACGME fellowship must pass all Steps of the USMLE even if residency was completed at an ACGME institution.

That isn't my reading of it, although there is a distinct possibility I am wrong. It says if you don't meet the above requirement for fellowship entry (III.A.2) of completing an ACGME residency, then an exception can be made of you meet the following criteria, where passing the steps is one of those criteria (III.A.2.b).

It does say you must meet the milestone "core" requirements of completing your ACGME residency and that completion must be verified to your fellowship program. But as far as the core requirements go I don't see any explicit mention of passing the steps. It talks obliquely about systematically measuring progress in a number of areas but no mention of the USMLE steps. USMLE is only mentioned in the context of the fellowship exception (I checked via ctrl+f as well).

I'm glad to see you are on top of this issue Amber. These developments, if they go through, will damage the opportunities of many DO students. I doubt the ACGME will back off now that the AOA has squandered it's opportunity to avert this change.

I just feel bad for those DO students that matched this year planning to do an AOA internship year and then go directly into an advanced position at an ACGME program. They are probably screwed.

 

[kedrin]

Hello All,

As you all are already aware, the ACGME is moving forward with the proposed changes to the common program requirements and is currently taking comments from stakeholders on these changes. While we as individuals cannot offer comment directly to ACGME, AACOM will be submitting comments on the topic. As the current to representative to the AOA Board of Trustees for all osteopathic medical students, I would like to prepare an official statement regarding the student position on these proposed changes.

The proposal as written along with a section for comments and input to AACOM can be found at http://www.aacom.org/news/latest/Pages/GMEnews.aspx. A pdf is also available at http://www.acgme.org/acgmeweb/Portal...ligibility.pdf (see lines 292-390). Although you can feel free to offer comments directly to AACOM, I would really like for comments to be sent directly to me so that I can include our collective perspectives in my letter to AACOM President Dr. Shannon and the AOA Board as the official student position on this issue.

PLEASE understand that comments should address the proposed common program requirements and that this is NOT about a proposed AOA/AACOM/ACGME merger. Comments should be limited to how the common program requirements will affect students and should be stated in a professional manner. This is our opportunity to demonstrate how strongly we feel about these proposed changes, but that message will carry much more weight if our arguments are grounded in a solid understanding of the question at hand and have a professional tone. Please email me directly by September 3 with your comments, questions or concerns.

PS: The level of frustration expressed on these threads is clear. Although I did not assume my position on the Board until after the announcement about the MOU was released, I can assure you that I am committed to representing the best interests of all osteopathic medical students throughout my term of service.

All the Best,
Amber Hull, OMS-IV
DO Candidate- Arizona College of Osteopathic Medicine
American Osteopathic Association Board of Trustees Student Delegate
AACOM Council of Osteopathic Student Government Presidents
[email protected]

I would like to point out that you appeared completely weak and failed us as our student rep during the town hall meeting most recently concerning the merger. I have no faith in your ability to stand up for students and their beliefs. You have failed us in general since the AOA got off with their BS comments about why the merger failed and how it will "benefit" us that it did fail.

You really need to come through on this if you expect any of us to have any faith or involvement in the future with the AOA. As it stands now I will never support the AOA until there are some big changes made to the leadership.

 

[7wonders]

I'm not really sure why you think that attacking me personally is going to help this situation but I will take your comments under advisement. The town hall was coordinated in order to try to provide clarity on these issues and I'm sorry if you weren't happy with the answers that were given. It may be difficult to understand but we (as student leaders) are doing our best to take on these issues in a professional and productive manner. Being emotional and reactionary is not a productive way to accomplish our goals. It's not easy to be in a position such as this at a time when changes of this magnitude are being considered. We will do our best to stay in touch with students and request feedback just as I've offered to do above.

 

[sylvanthus]

Wow this sucks.

 

[kedrin]

I'm not really sure why you think that attacking me personally is going to help this situation but I will take your comments under advisement. The town hall was coordinated in order to try to provide clarity on these issues and I'm sorry if you weren't happy with the answers that were given. It may be difficult to understand but we (as student leaders) are doing our best to take on these issues in a professional and productive manner. Being emotional and reactionary is not a productive way to accomplish our goals. It's not easy to be in a position such as this at a time when changes of this magnitude are being considered. We will do our best to stay in touch with students and request feedback just as I've offered to do above.

What I am saying is that our student representatives do not have any balls to stand up to the plate and call out the blatant BS that is being spewed. I am not attacking you personally, professionally you all have failed us.

 

[NOsaintsfan]

I'm not really sure why you think that attacking me personally is going to help this situation but I will take your comments under advisement. The town hall was coordinated in order to try to provide clarity on these issues and I'm sorry if you weren't happy with the answers that were given. It may be difficult to understand but we (as student leaders) are doing our best to take on these issues in a professional and productive manner. Being emotional and reactionary is not a productive way to accomplish our goals. It's not easy to be in a position such as this at a time when changes of this magnitude are being considered. We will do our best to stay in touch with students and request feedback just as I've offered to do above.

I understand that you have to be professional when dealing with leadership w/in the AOA however the overall feeling that EVERYONE I know at my DO school is that the AOA is NOT acting in our best interest and that they have failed to adequately explain how the failed merger would benefit osteopathic students as a whole. More explanation is needed to clarify how the failed merger is "better" for osteopathic students. Issues like more than 50% of DO students train in ACGME residencies should be addressed as well as the fact that fewer than half of DO students practice OMM post residency. Preserving OMM is important and I think everyone would agree on that but AOA leadership should be realistic about the fact that MOST DO's wont use it in practice and tailor future GME plans around that fact. People who really want to use OMM and incorporate it into practice should have avenues to advance that training, but touting OMM as the end all be all to osteopathic GME isn't in line with most of osteopathic doctors in training.

Sooo if you could just relay that. I know many including myself would be appreciative.

Another point as well.

Specifically the comment that was made about the USMLE not being an adequate exam and implying that if DO students only had to take that exam then we would be a danger to patients was "unprofessional". I would like to get an answer as to why having a osteopathic exam in addition to the USMLE would not be feasible or adequate. Meaning for simplicity's sake why couldn't DO students take the USMLE series exams and have a separate OMM exam. Maybe when we take step 1 for example we could take the USMLE at the testing center like everyone else but have an extra "block" of 80 questions or whatever at the end of the test covering OMM.

The reason I bring this up as you know MOST osteopathic students go to an ACGME residency and as such many take both the COMLEX and USMLE. Some ACGME residencies will except the COMLEX but for many PD's its something that their not sure how to interpret and compare with the USMLE. Both tests cover the same material with the exception of OMM. Combining the tests and adding an extra block of OMM for osteopathic students seems logical and reasonable.

Thanks.

 

[Igor4sugry]

For years now the only sure way to get away from ridiculousness of DO world is to take USMLE and match into a MD residency. I'm not surprised MD residencies are tightening their standards.

 

[Igor4sugry]

Meaning for simplicity's sake why couldn't DO students take the USMLE series exams and have a separate OMM exam. Maybe when we take step 1 for example we could take the USMLE at the testing center like everyone else but have an extra "block" of 80 questions or whatever at the end of the test covering OMM.
Thanks.

If all DO students had to take USMLE Step I the passing rate would be abysmal (probably around 65%) and schools will be stuck with many students who can't graduate.
Current DO student who take USMLE put in a lot of work on their own and are very driven to pass the USMLE (you all know who those students are in your classes). DO schools would have to change their curriculum in order to prepare their students to pass UMSLE at the same rate as current MD students do.

 

[NeuroAP86]

If all DO students had to take USMLE Step I the passing rate would be abysmal (probably around 65%) and schools will be stuck with many students who can't graduate.
Current DO student who take USMLE put in a lot of work on their own and are very driven to pass the USMLE (you all know who those students are in your classes). DO schools would have to change their curriculum in order to prepare their students to pass UMSLE at the same rate as current MD students do.

I don't think the rate would be that low if the curriculum was geared towards Usmle versus the comlex. The real issue with the comlex is the poorly worded questions. For the most part, both exams are testing the same concepts. Granted there are some subjects that require much more in depth knowledge like biochem, biostats, and embryo amongst others I can't remember right now. I think it is very doable for DO students. First hand experience having passed step 1 and step 2 as DO student.

 

[kedrin]

If all DO students had to take USMLE Step I the passing rate would be abysmal (probably around 65%) and schools will be stuck with many students who can't graduate.
Current DO student who take USMLE put in a lot of work on their own and are very driven to pass the USMLE (you all know who those students are in your classes). DO schools would have to change their curriculum in order to prepare their students to pass UMSLE at the same rate as current MD students do.

I dont really care to have anyone practicing with me who cannot pass USMLE or the COMLEX. COMLEX is a crappy test lets just be honest. Maybe it is time to actually uphold standards upon ourselves?

I also doubt that 65% of ppl would fail the UMSLE

 

[DocEspana]

Question: If you are already in an ACGME program, do these rules apply ie take step 1, 2 ck cs and 3 or does it only apply to people applying from non acgme programs to acgme fellowships?

Thanks

That isn't my reading of it, although there is a distinct possibility I am wrong. It says if you don't meet the above requirement for fellowship entry (III.A.2) of completing an ACGME residency, then an exception can be made of you meet the following criteria, where passing the steps is one of those criteria (III.A.2.b).

It does say you must meet the milestone "core" requirements of completing your ACGME residency and that completion must be verified to your fellowship program. But as far as the core requirements go I don't see any explicit mention of passing the steps. It talks obliquely about systematically measuring progress in a number of areas but no mention of the USMLE steps. USMLE is only mentioned in the context of the fellowship exception (I checked via ctrl+f as well).

I'm glad to see you are on top of this issue Amber. These developments, if they go through, will damage the opportunities of many DO students. I doubt the ACGME will back off now that the AOA has squandered it's opportunity to avert this change.

I just feel bad for those DO students that matched this year planning to do an AOA internship year and then go directly into an advanced position at an ACGME program. They are probably screwed.

Just want to point out that the people on the cusp right now are fine. June 2015 Is the activation time.

Also, if there is no reason to take step 2 CS unless your program requires it.... Until now.

 

[DocEspana]

If all DO students had to take USMLE Step I the passing rate would be abysmal (probably around 65%) and schools will be stuck with many students who can't graduate.
Current DO student who take USMLE put in a lot of work on their own and are very driven to pass the USMLE (you all know who those students are in your classes). DO schools would have to change their curriculum in order to prepare their students to pass UMSLE at the same rate as current MD students do.

Your first comment is likely extremely wrong for the very point you made in the second half. It would require a change in educational structure, but a very minor one. Yoiu teach toward the test you have to take. We've been taking tests with "comlex-like" questions from day one. Just ask questions, and prep for questions, in the USMLE style. Personally my school we were taught for both. Our preclinical exams were done comlex-style and our clinical exams were the USMLE-based shelf exams. We had no issue with usmle pass rate.

 

[as1212559]

I see nothing professional about failing to adequately represent the strength of emotions that the people who put you in power have on this topic.

It's not like you are standing limply by as they take the soda machines from the student lounge. This isn't high school student council. The AOA is supposed to represent our profession's interests, and instead they allowing our profession to regress (really allowing isn't strong enough a word, the AOA is driving the regression).

What matters more? Our careers and the careers of the thousands of our OMS brothers and sisters? Or how dignified we look in front of a group of people who are so caught up in their pride that they are willing to screw us, their legacy, in our professional pursuits?

 

[California2000]

Are we sure that this means a D.O. in an acgme residency who wants to continue on to an acgme fellowship would have to jump through extra hoops (like taking step2 and 3). That would suck.

 

[Imnoglbln]

I would like to point out that you appeared completely weak and failed us as our student rep during the town hall meeting most recently concerning the merger. I have no faith in your ability to stand up for students and their beliefs. You have failed us in general since the AOA got off with their BS comments about why the merger failed and how it will "benefit" us that it did fail.

You really need to come through on this if you expect any of us to have any faith or involvement in the future with the AOA. As it stands now I will never support the AOA until there are some big changes made to the leadership.

I agree 100%. The AOA has backstabbed its own students and only concerns itself with the privileges, money and power of their non-elected government.

 

[DocEspana]

Are we sure that this means a D.O. in an acgme residency who wants to continue on to an acgme fellowship would have to jump through extra hoops (like taking step2 and 3). That would suck.

Yes we are sure. Unless you are a chief resident right now. Or "extraordinary"

 

[THH]

So foreign physicians that have attended international "ACGME-I" residencies will be able to do ACGME fellowships in the US under this proposal? Is this not a change from the current system?

 

[Imnoglbln]

The ACGME is basically implementing foreign medical students from overseas ACGME programs instead of US AOA trained physicians.

 

[DocEspana]

So foreign physicians that have attended international "ACGME-I" residencies will be able to do ACGME fellowships in the US under this proposal? Is this not a change from the current system?

The ACGME is basically implementing foreign medical students from overseas ACGME programs instead of US AOA trained physicians.

You guys realize that it is the residents of about 7 hospitals. 5 in Singapore and 2 in Qatar. The ACGME-I is an incredibly small venture by the acgme.

I doubt 95% of the program directors will know that the acgme-i even exists when this is implemented.

 

[evilbooyaa]

Are we sure that this means a D.O. in an acgme residency who wants to continue on to an acgme fellowship would have to jump through extra hoops (like taking step2 and 3). That would suck.

That's NOT what page 8 and 9 say. If you are a DO who gets into a ACGME residency, I do not see where it states that you will have to take Steps 1/CS/CK/3.

If you are a DO that does NOT go to a ACGME residency, then you will have to take the steps (+ be an excellent applicant and a bunch of other subjective factors) to be considered for ACGME fellowships.

^ That is the new stuff, which absolutely sucks for all DOs. Hope you guys get into ACGME residencies.

 

[Igor4sugry]

I also doubt that 65% of ppl would fail the UMSLE

OK, I will revise that number based on the following:
USMLE performance data:
http://www.usmle.org/performance-data/default.aspx#2012_step-1
Osteopathic 1st takers % passing: 92% (2012)

I think this 92% reflects the competitiveness in MD residency market right now. DO students are much more aware of the need to get into an MD residency and so are studying their butts off.
The date is quite interesting; in 2001 they started including separate passing rate for osteopathic students. The passing rate was in 70%s from 2001-2007. Then passing rate really took off;
2010: 82% (1,964 takers)
2011: 89% (2,145)
2012: 92% (2,496) 27% rise of takers compared to 2010

This data just adds to how competitive MD residencies are. DO students are taking USMLE very seriously and raising their passing rate to level of MD students (96%). It is only going to get worse as more DO schools are popping up (e.g. Ohio University is opening two branches (Columbus and Cleveland); http://www.oucom.ohiou.edu/communications/News/DublinCampus/
Now if all DOs were taking USMLE I would argue passing rate would be 80-85%. This is still quite a lot of students not passing.

I would also argue that USMLE is a much more analytical, intense, higher level of knowledge test than COMLEX is. If you remember, COMLEX just has one word answers to everything. While each USMLE question is long, has a lot of information to analyze and often times 3rd level answers.

 

[DocEspana]

Also a tiny note for those curious on the intern to resident move. Residencies in the acgme that require an intern year require it to be with the acgme, no exceptions.

Those currently in the aoa for internship will be fine. But from here on out its acgme transitional or prelim, not TRI if you want radiology, ophtho, gas, or neuro from the acgme. BUT if your program doesn't require a specific intern year, moving into the program after a TRI is allowed.

 

[DocEspana]

In my USMLE Step I book it shows:
Osteopathic 1st takers % passing: 82% (2007)
And this is for those motivated students. Now add all the DO students and the 65% doesn't seem that far off.

I would also argue that USMLE is a much more analytical, intense, higher level of knowledge test than COMLEX is. If you remember, COMLEX just has one word answers to everything. While each USMLE question is long, has a lot of information to analyze and often times 3rd level answers.

You're totally ignoring that we are trained to answer comlex questions. 2 years of training towards a test matters. Make the usmle the bench mark and we will teach towards it, not the comlex. One tests the rare but pathonomonic, the other teaches the most common and epidemiologic choice. It's a drastically different way to approach a question.

 

[THH]

You guys realize that it is the residents of about 7 hospitals. 5 in Singapore and 2 in Qatar. The ACGME-I is an incredibly small venture by the acgme.

I doubt 95% of the program directors will know that the acgme-i even exists when this is implemented.

Yeah, but I think its still a ridiculous standard to set and no doubt the ACGME will look to expand it.

 

[DocEspana]

Yeah, but I think its still a ridiculous standard to set and no doubt the ACGME will look to expand it.

Why? Its their programs. They haven't abandoned them. It just wasn't the success they expected. They can't really expand it... The handful of programs is 100% of all of them. They won't likely expand and make new programs because they haven't done so in a while and have no reason to start now. They just want equal standing for their random 7-ish hospitals with the other 500ish they run.

 

[malformation]

Just to play it from the other side (and I know hate responses will follow), one benefit is that we still get to keep our guaranteed AOA-only spots and IMO would've been tragic if we'd lost that under the unified system (just a counter point, that's all).

Are we sure that this means a D.O. in an acgme residency who wants to continue on to an acgme fellowship would have to jump through extra hoops (like taking step2 and 3). That would suck.

Actually we are sure that it doesn't mean that. If you are in an ACGME program nothing changes. The USMLE (1-3) requirement as currently stated in the posted document (and as it has been pointed out by few other users) ONLY applies to people who want to do an ACGME fellowship who did NOT do an ACGME residency (i.e. through the exception clause). Thus, based on current proposal, a DO who finishes an ACGME residency without taking any USMLE steps can still apply and be accepted to an ACGME fellowship (this doesn't mean they will or will not be discriminated against, it just means there is no ACGME rule against it).

 

[DrBowtie]

As moderator of town hall, did you have any choice in which questions were asked?

Didn't watch so not sure if that was covered.

 

[California2000]

Thanks for the clarification malformation. Seems like Doc espana thinks differently. Either way I hope this doesnt decrease the number of DOs in acgme programs. What a mess!

 

[DrEnderW]

I have heard on this site that a substantial portion of surgical fellowships are not ACGME accredited fellowships. Can anyone speak to the validity of this? If this is the case I'm assuming the AOA residency to surg fellowship route would be unaffected?

 

[Orthojoe]

that is correct

 

[Orthojoe]

That's NOT what page 8 and 9 say. If you are a DO who gets into a ACGME residency, I do not see where it states that you will have to take Steps 1/CS/CK/3.

If you are a DO that does NOT go to a ACGME residency, then you will have to take the steps (+ be an excellent applicant and a bunch of other subjective factors) to be considered for ACGME fellowships.

^ That is the new stuff, which absolutely sucks for all DOs. Hope you guys get into ACGME residencies.

As a resident in an AOA ortho program with plans to do a fellowship I am not bothered by this at all. Who cares if I have to take the USMLE series (I've already taken the first two). It's just hoops!!! Not a big deal. There is bureaucracy in any professional field to navigate.. They are just tests and they are actually tests that grade you on performance. Don't you want to be the best physician you can? Why does a test stress you out.. try throwing a central line in a cardiac arrest patient (I did my first one by myself this last week, talk about sweating bullets!! not to mention the attending wanted a subclavian - freaking awesome experience)

Yes the AOA sucks in many venues, I'll be the first to point them out. But remember, they fought for full licensure, they stood toe to toe with the Allopallic heads and gained mainstream acceptance, they have given YOU an opportunity to become a physician! I am grateful for their sacrifice that has given me an opportunity to become an oustanding physician. You are a D.O. -- deal with it, we all knew its was a tougher path politically. We can respectively engage with our leaders but ultimately we have to accept the path before us until WE become the leaders.

As to fellowships.. I have spoken to so many fellowship directors and in the ORTHO world (I cant speak for other fields), this will not be an issue. I have full confidence in being able to fulfill a fellowship.. However if for some reason politics gets in the way-- no big deal.. I'll still be the best D%$#M general ortho doc I can and help change peoples lives. Thats what its about right? Its all a simple conscious choice - dont let external circumstances out of your control dictate your inner resolve.

 

[DrEnderW]

Thanks for the detailed response above Orthojoe. Your insight is appreciated as always.

 

[malformation]

Thanks for the clarification malformation. Seems like Doc espana thinks differently. Either way I hope this doesnt decrease the number of DOs in acgme programs. What a mess!

You are welcome; I encourage you and all others (incl Dr. E) to always try to obtain and certainly verify information especially in cases of dispute, by checking the primary source (in this case http://www.acgme.org/acgmeweb/Portals/0/PDFs/CPR_Eligibility.pdf, where the USMLE requirement is ONY listed under section III.A.2.b (Fellowship Eligibility Exception) on pg 7 and is NOT listed under any other sections).

As a resident in an AOA ortho program with plans to do a fellowship I am not bothered by this at all. Who cares if I have to take the USMLE series (I've already taken the first two). It's just hoops!!! Not a big deal. There is bureaucracy in any professional field to navigate.. They are just tests and they are actually tests that grade you on performance. Don't you want to be the best physician you can? Why does a test stress you out.. try throwing a central line in a cardiac arrest patient (I did my first one by myself this last week, talk about sweating bullets!! not to mention the attending wanted a subclavian - freaking awesome experience)

Yes the AOA sucks in many venues, I'll be the first to point them out. But remember, they fought for full licensure, they stood toe to toe with the Allopallic heads and gained mainstream acceptance, they have given YOU an opportunity to become a physician! I am grateful for their sacrifice that has given me an opportunity to become an oustanding physician. You are a D.O. -- deal with it, we all knew its was a tougher path politically. We can respectively engage with our leaders but ultimately we have to accept the path before us until WE become the leaders.

As to fellowships.. I have spoken to so many fellowship directors and in the ORTHO world (I cant speak for other fields), this will not be an issue. I have full confidence in being able to fulfill a fellowship.. However if for some reason politics gets in the way-- no big deal.. I'll still be the best D%$#M general ortho doc I can and help change peoples lives. Thats what its about right? Its all a simple conscious choice - dont let external circumstances out of your control dictate your inner resolve.

^ This (only with regards to general theme of the argument, I have no clue regarding details of surgery fellowships)

 

[evilbooyaa]

As a resident in an AOA ortho program with plans to do a fellowship I am not bothered by this at all. Who cares if I have to take the USMLE series (I've already taken the first two). It's just hoops!!! Not a big deal. There is bureaucracy in any professional field to navigate.. They are just tests and they are actually tests that grade you on performance. Don't you want to be the best physician you can? Why does a test stress you out.. try throwing a central line in a cardiac arrest patient (I did my first one by myself this last week, talk about sweating bullets!! not to mention the attending wanted a subclavian - freaking awesome experience)

Yes the AOA sucks in many venues, I'll be the first to point them out. But remember, they fought for full licensure, they stood toe to toe with the Allopallic heads and gained mainstream acceptance, they have given YOU an opportunity to become a physician! I am grateful for their sacrifice that has given me an opportunity to become an oustanding physician. You are a D.O. -- deal with it, we all knew its was a tougher path politically. We can respectively engage with our leaders but ultimately we have to accept the path before us until WE become the leaders.

As to fellowships.. I have spoken to so many fellowship directors and in the ORTHO world (I cant speak for other fields), this will not be an issue. I have full confidence in being able to fulfill a fellowship.. However if for some reason politics gets in the way-- no big deal.. I'll still be the best D%$#M general ortho doc I can and help change peoples lives. Thats what its about right? Its all a simple conscious choice - dont let external circumstances out of your control dictate your inner resolve.

This doesn't affect you and (your possible future) ortho fellowship(s) nearly as much as it does IM fellowships. You were clearly an academic all-star as someone who got into AOA Ortho. Some of your classmates who are going into AOA IM programs may not be in the same boat. While you do bring up good points of what the AOA has done to bolster the DO profession, looking to the past while ignoring what the AOA has done (recently) to hurt the next batch of DO students isn't advisable.

Also, if you've taken the first two (I'm assuming CK) then all you have is CS and Step 3, the 2 easiest exams to pass. We cannot know if the scores that you receive on these exams will be factored into your fellowship application (does a 210 on Step 1 get the same credence as someone who gets a 240 after doing 3 years of residency?)

As a MD student, I understand the benefit the AOA has had in furthering the DO profession in the past, but its their recent actions that everyone is complaining about.

 

[DocEspana]

Thanks for the clarification malformation. Seems like Doc espana thinks differently. Either way I hope this doesnt decrease the number of DOs in acgme programs. What a mess!

Yes. I misread the delineation of when what is required.

 

[malformation]

This doesn't affect you and (your possible future) ortho fellowship(s) nearly as much as it does IM fellowships. You were clearly an academic all-star as someone who got into AOA Ortho. Some of your classmates who are going into AOA IM programs may not be in the same boat. While you do bring up good points of what the AOA has done to bolster the DO profession, looking to the past while ignoring what the AOA has done (recently) to hurt the next batch of DO students isn't advisable.

Also, if you've taken the first two (I'm assuming CK) then all you have is CS and Step 3, the 2 easiest exams to pass. We cannot know if the scores that you receive on these exams will be factored into your fellowship application (does a 210 on Step 1 get the same credence as someone who gets a 240 after doing 3 years of residency?)

As a MD student, I understand the benefit the AOA has had in furthering the DO profession in the past, but its their recent actions that everyone is complaining about.

These changes have no practical affect on IM fellowship applicants. As it has always been the case, although currently one could technically enter ACGME fellowship through AOA residency, that person would NEVER be eligible for board certification for their subspecialty by the ABIM, since its core requirement for subspecialty board certification was first obtaining ABIM board certification in IM which one would be ineligible to sit for, unless one had completed an ACGME IM residency. Therefore, even though you are/were "allowed" to enter the ACGME fellowship through AOA residency you could never become board certified (i.e. waste of fellowship years). So, this will have minimal (to no) affect on IM residents (AOA or ACGME kind).

Again, comments above ONLY apply to IM subspecialty fellowships.

 

[DocEspana]

AOA has released a resident focused set of questions and answers. While still carefully worded.... It is MUCH more revealing as they fielded some legit questions.

Also, check out the last question. That answers something I've been dying to know for 4 years. Perhaps the most asked question on this forum.

http://www.osteopathic.org/inside-aoa/Pages/acgme-intern-resident-faqs-august-2013.aspx

 

[Siggy]

As the current to representative to the AOA Board of Trustees for all osteopathic medical students, I would like to prepare an official statement regarding the student position on these proposed changes.

You think the AOA cares about us? That's funny, I don't care who you are, that's funny right there. If the AOA cared, they wouldn't have pulled the BS with the residency merger they already had. I guess sacrificing medical students to ensure that incredibly weak community and rural residency programs (the ones that would have, and should have, trouble being accredited) are still available is more important than current medical students.

If the current AOA was around back in the days of Flexner, they would have killed osteopathic medicine by standing in the way of necessary and needed reform.

 

[group_theory]

These changes have no practical affect on IM fellowship applicants. As it has always been the case, although currently one could technically enter ACGME fellowship through AOA residency, that person would NEVER be eligible for board certification for their subspecialty by the ABIM, since its core requirement for subspecialty board certification was first obtaining ABIM board certification in IM which one would be ineligible to sit for, unless one had completed an ACGME IM residency. Therefore, even though you are/were "allowed" to enter the ACGME fellowship through AOA residency you could never become board certified (i.e. waste of fellowship years). So, this will have minimal (to no) affect on IM residents (AOA or ACGME kind).

Again, comments above ONLY apply to IM subspecialty fellowships.

True ... a DO who did an AOA IM residency could not be ABIM boarded in a subspecialty. However, in the past (and current case) , AOA-trained residents can petition the AOA to accept the ACGME Fellowship as "AOA equivalent" (via Resolution 56) and take the AOA fellowship board, thereby being board-certified through the AOBIM (and not ABIM)

If the new ACGME proposal is adopted and implemented, then the ACGME fellowship cannot take an AOA-trained resident since it would violate ACGME rules (unless the RRC for that fellowship grants the exception) so it closes that option for residents in AOA programs.



As for Step 3 - as others have commented, the USMLE requirements is just one of the litany of requirements if you want to be granted an exception to the fellowship requirement. If you are in an ACGME accredited program, you do not have to worry about USMLE*. And even if you finish out the USMLE in hopes of being eligible for an ACGME fellowship, you still need to satisfy the other "exceptionally qualified applicant" criteria. And I think it is a big deal if you decide to finish out the USMLE Series. USMLE 2CS is $1230 (for 2014 dates). You still need to take COMLEX 2 and COMLEX PE to graduate so that's an extra fee. USMLE 3 is $780 (for 2013 dates) and it is 2 days exam. COMLEX 3 is just a 1 day exam ($750 for 2013 exam). If you finish out COMLEX 3, you're eligible for licensure in all 50 states. If you finish out USMLE 3 and choose not to complete the COMLEX series, you cannot be licensed in several states that requires COMLEX (eg California, Florida, Pennsylvania, etc).

*there may be other reasons to take USMLE besides licensure purposes (being competitive for ACGME residency, being competitive for ACGME fellowships, etc)


As of right now - the best advice I would give to someone in med school, or premed about to start med school with goals of doing a fellowship in the future ... is to aim for an ACGME accredited residency so you don't have to worry about qualifying for the "exceptionally qualified candidate" status. Just get your PGY1 year approved via Resolution 42, and you're good to go for all 50 states. Plus, if you are boarded through the ABMS instead of AOA, you're not required (mandated) to maintain AOA membership in order to maintain board certifications. Current AOA policy is that you must remain a member in good standing with the AOA to continue to hold AOA board certification. If you let that membership lapse, you are no longer board certified.

 

[Siggy]

The town hall was coordinated in order to try to provide clarity on these issues and I'm sorry if you weren't happy with the answers that were given. It may be difficult to understand but we (as student leaders) are doing our best to take on these issues in a professional and productive manner. Being emotional and reactionary is not a productive way to accomplish our goals. It's not easy to be in a position such as this at a time when changes of this magnitude are being considered. We will do our best to stay in touch with students and request feedback just as I've offered to do above.

Being emotional and reactionary isn't a productive way, but neither is being a patsy for the group you are supposed to be representing us to. Instead of holding the AOA's feet to the fire regarding specifics of their reasoning, you let them give what ever reason they wanted, nodded your head, and moved on. Being a representative means that you can't just accept what ever the AOA says without question and without critique.

 

[Igor4sugry]

See update bellow:

OK, I will revise that number based on the following:
USMLE performance data:
http://www.usmle.org/performance-data/default.aspx#2012_step-1
Osteopathic 1st takers % passing: 92% (2012)

I think this 92% reflects the competitiveness in MD residency market right now. DO students are much more aware of the need to get into an MD residency and so are studying their butts off.
The date is quite interesting; in 2001 they started including separate passing rate for osteopathic students. The passing rate was in 70%s from 2001-2007. Then passing rate really took off;
2010: 82% (1,964 takers)
2011: 89% (2,145)
2012: 92% (2,496 i.e. 57% of all DOs that took COMLEX that year) 27% rise of takers compared to 2010

This data just adds to how competitive MD residencies are. DO students are taking USMLE very seriously and raising their passing rate to level of MD students (96%). It is only going to get worse as more DO schools are popping up (e.g. Ohio University is opening two branches (Columbus and Cleveland); http://www.oucom.ohiou.edu/communications/News/DublinCampus/

In terms of COMLEX scores: http://docboard.org/aim/pdf/nbometurner.pdf (page 14)
-While our MD counterparts have pass rate of 96%, the DOs on an easier test cannot break 91%. This also suggests that high passing rate of DOs on USMLE is due to factors beyond osteopathic curriculum, and has more to do with personal drive and competitiveness of residency market place. So I'm skeptical that if osteopathic schools switch to USMLE that the pass rate will be any higher than 80%.

I would also argue that USMLE is a much more analytical, intense, higher level of knowledge test than COMLEX is. If you remember, COMLEX just has one word answers to everything. While each USMLE question is long, has a lot of information to analyze and often times 3rd level answers.

 

[Dharma]

Being emotional and reactionary isn't a productive way, but neither is being a patsy for the group you are supposed to be representing us to. Instead of holding the AOA's feet to the fire regarding specifics of their reasoning, you let them give what ever reason they wanted, nodded your head, and moved on. Being a representative means that you can't just accept what ever the AOA says without question and without critique.

 

[Orthojoe]

I think they care.......... having disagreements on how policy and professional education is delineated does not demonstrate a non caring atittude. Maybe since I've been married for 8 years I understand this concept of two groups(people) seeing the same situation so differently.

Screaming, yelling, calling for their resignation will not solve the issue. A salve of understanding, calm discussions (consistenly) to maintain an open dialogue, using our student representatives, showing our ACGME preceptors/staff,etc a professional attitude will go much further.

Mark my words.... this will be a non issue. It will be resolved, an agreement will come together, cooler heads will prevail and "QUALIFIED" AOA residents will have access to ACGME fellowships. BUT you cannot expect the ACGME to make exceptions. We need to live up to their standards for acceptance ie - taking USMLE steps, publishing research, obtaining good grades, etc. It makes no sense to whine and cry about not obtaining an ACGME fellowship if you dont meet the standards that they have for their own residents. Dont use the D.O discrimination fall back......

 

[Dharma]

IThe town hall was coordinated in order to try to provide clarity on these issues and I'm sorry if you weren't happy with the answers that were given. It may be difficult to understand but we (as student leaders) are doing our best to take on these issues in a professional and productive manner. Being emotional and reactionary is not a productive way to accomplish our goals. It's not easy to be in a position such as this at a time when changes of this magnitude are being considered. We will do our best to stay in touch with students and request feedback just as I've offered to do above.

It's not so much the answers that were given, but the questions that were not asked! As someone mentioned on the night of the town hall in another thread, "softball" questions were being lobbed left and right. Long, drawn-out, redundant answers were repeated ad nauseum after the time-filler questions were tossed up for easy whackings. The entire discussion danced around any real issues- issues that as our representative, you should have been well familiar with, regardless of access (or lack of) to the real time online questions. Maybe that was your opportunity to put the big wigs on the spot and ask the difficult questions. Or maybe you don't want to step on any higher-ups toes for the sake of self-preservation?


I just kept hearing this the whole time: [YOUTUBE]http://www.youtube.com/watch?v=b1GrOwI7EBM[/YOUTUBE]

That was a big chance for the AOA to be put on the spot in front of its students and on the record. That opportunity was lost. Instead, the distrust (and disgust) future DOs have for their so-called "representatives" has grown to a point possibly beyond repair.

 

[brnfabolous]

I just feel bad for those DO students that matched this year planning to do an AOA internship year and then go directly into an advanced position at an ACGME program. They are probably screwed.[/QUOTE]

I am one of those resident who is doing DO TRI and doing ACGME next yr.
Your statement scared the Sxxt outta me

LOOK
Focused revision proposed effective date: July 1, 2015
So I thank god

Now Let's look at fellowship info
All required
Prerequisite clinical education for entry into ACGME accredited fellowship programs must meet the following qualifications:Be completed in an ACGME accredited residency program, an ACGME International accredited residency program, or an RCPSC

So it gives me wonder, I still technically will finish ACGME residency and only INTERN year is AOA. so Does ACGME fellowship shut me out because of INTERNSHIP yr??

 

[THH]

Why? Its their programs. They haven't abandoned them. It just wasn't the success they expected. They can't really expand it... The handful of programs is 100% of all of them. They won't likely expand and make new programs because they haven't done so in a while and have no reason to start now. They just want equal standing for their random 7-ish hospitals with the other 500ish they run.

What makes you think it won't be expanded? These programs aren't exactly old. They have come around in the last few years. Hell, ACGME-I wasn't even established at all until 2009.