MDO Title Appeal

[ryker1997]

I do agree that opening up to many DO schools only hurts the profession. It’s honestly sad and it’s a result of living in a capalistic society.

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[DO2015CA]

As someone who plans to go to an osteopathic school, I never fully understand why people go DO if the title bothers them so much. Also - idk I would assume that adults who have been training for awhile would have different priorities, then caring about the title of their degree.

Most of them from my class didn’t start out that way. They were excited but then over time when they realized that it might affect their matching potential that they became jaded.

 

[Ho0v-man]

As someone who plans to go to an osteopathic school, I never fully understand why people go DO if the title bothers them so much. Also - idk I would assume that adults who have been training for awhile would have different priorities, then caring about the title of their degree.

Once you get in school, you realize how freaking hard it is being a med student and that being a DO student a lot of times means doing more with less and for less.

Not a big deal unless you’re going for a competitive specialty. Or trying to match into a competitive location. Most medical students are trying to do at least one if not both of those things.

If you go in with eyes open to this reality, acknowledge you might have to be geographically flexible, and/or just want a non competitive specialty like FM, IM, psych, neuro, or peds then it’s fine.

 

[Konigstiger]

I do see your point, but "MDO" sounds even less 'doctor-like' than "DO" and makes things even more confusing for patients, a good portion of whom now know that DOs are medical doctors just like MDs are.

The true solution is that we should all just be MDs. The biggest opposition to this would be from MDs who like being separated from DOs and seeing themselves as 'superior,' but that viewpoint falls apart when you realize that Caribbean grads and IMGs are also MDs, and zero distinction is made between a US MD and an IMG MD unless you specifically ask someone where they went to school. Just make all DO schools into low-tier MD schools like Caribbean schools are, and then everyone can be happy - DOs no longer get people asking, "What's a DO?" and MDs still get to keep their advantage in residency applications because former DO schools will still have the same bad reputation among PDs regardless of whether you make them MD schools or not.

 

[pigsinacloth]

I do see your point, but "MDO" sounds even less 'doctor-like' than "DO" and makes things even more confusing for patients, a good portion of whom now know that DOs are medical doctors just like MDs are.

The true solution is that we should all just be MDs. The biggest opposition to this would be from MDs who like being separated from DOs and seeing themselves as 'superior,' but that viewpoint falls apart when you realize that Caribbean grads and IMGs are also MDs, and zero distinction is made between a US MD and an IMG MD unless you specifically ask someone where they went to school. Just make all DO schools into low-tier MD schools like Caribbean schools are, and then everyone can be happy - DOs no longer get people asking, "What's a DO?" and MDs still get to keep their advantage in residency applications because former DO schools will still have the same bad reputation among PDs regardless of whether you make them MD schools or not.

Hard disagree. The people who don't want DO to become MD are the DOs who profit off DO schools. John Gimpel and anyone that sides with him is the problem with the system. They try to say that being DOs makes us special. That our hands and our "holistic care" is what makes us great. These people keep the profession back and its purely to keep their own pockets full and their egos well fed.

Don't even get me started on OMM.

I am not ashamed to be a DO, but I am ashamed of some not all of the people that share my degree.

 

[DO2015CA]

Hard disagree. The people who don't want DO to become MD are the DOs who profit off DO schools. John Gimpel and anyone that sides with him is the problem with the system. They try to say that being DOs makes us special. That our hands and our "holistic care" is what makes us great. These people keep the profession back and its purely to keep their own pockets full and their egos well fed.

Don't even get me started on OMM.

I am not ashamed to be a DO, but I am ashamed of some not all of the people that share my degree.

Agree that it’s Gimpel and alike. MDs won’t care if the school meets their standard. It’s just another med school opening after all. What I will say is MD also have those black mark docs as well like Dr Oz and alike.

 

[SurgeDO]

I’m a practicing osteopathic physician. I care about this, as I HAVE experienced first hand the effect of being a DO in MD-dominated institutions. So your first statement is incorrect. Please don’t minimize the issue with unintentional condescension.

You’re so brave. Keep fighting against your discrimination in your MD dominated institution.

 

[AlbinoHawk DO]

My Questions to You:
1️⃣ How do you think these organizations will respond to my appeal?
2️⃣ Do you support or oppose the transition from DO to MDO? Why or why not?
3️⃣ Would this change benefit DOs, or could it create unintended consequences?

What about having both designation MD,DO?

1. I think they will ignore you
2 & 3. I oppose it because it's a useless change that won't fix any of the problems you state by having a DO degree but instead confuse patients with this new degree. The organizations already tried to accommodate by turning Doctor of Osteopathy to Doctor of Osteopathic Medicine, but that didn't help solve international problems and what not

Either we're all MD or we keep MD and DO. Any in between is ridiculous. Personally, I don't care to be MD

 

[AlbinoHawk DO]

New Proposal: Thoughts?

I’m advocating for a Texas-based initiative that would allow:

1. DOs who pass USMLE Step 1, Step 2 CK, and (optionally) Step 3 to apply for recognition of the MD title in Texas, allowing them to use "DO, MD-TX" in official documentation.


2. MDs who complete additional osteopathic training (e.g., OMM fellowship, structured coursework, or a residency in OMM) to receive state recognition of a DO designation, allowing them to use "MD, DO-TX."



This wouldn’t change the underlying degrees but would serve as a state-recognized credential for licensing purposes.

Why This Matters

DOs face unnecessary barriers due to the public’s misunderstanding of the degree, despite training alongside MDs in residency.

USMLE proves competency: If a DO passes USMLE just like an MD, why shouldn’t they be recognized equivalently?

Reciprocity for MDs: If an MD gets additional osteopathic training (e.g., OMM residency), they should also be able to claim a DO title.

Addresses physician shortages: By making Texas more attractive to DOs and MDs alike, this could increase recruitment in rural and underserved areas.


How It Would Work

Texas would recognize DOs who pass USMLE Step 1 & 2 CK as eligible to use "DO, MD-TX."

MDs who complete a state-approved OMM program could apply for "MD, DO-TX."

This wouldn’t replace the original degrees but would be an additional state-based credential for licensing purposes.


Challenges & Solutions

1. Accreditation Issues (COCA & LCME)

This wouldn’t alter the degree—it’s just a Texas-recognized licensing designation, so COCA and LCME don’t have jurisdiction.



2. AOA & AMA Opposition

Framing this as competency-based recognition, not a merger of degrees.

Ensuring osteopathic identity remains intact by making it reciprocal (MDs can earn DO as well).



3. Licensure Confusion Across States

Pilot it in Texas first.

Ensure the Texas Medical Board lists the dual designation transparently in physician profiles.



4. Legislative Barriers

Find Texas lawmakers willing to sponsor a bill.

Gain support from TOMA, TMA, and physician advocacy groups.

This is getting even more ridiculous where you're proposing that there will be two tiers of DOs where some will be seen as "worthy" of being pretend MDs with the designation "MD-TX." This will be especially unwelcomed by older DOs who didn't take the steps because residency was structured much differently back then.

My friend, if you want to be an MD, go to an MD school. Stop trying to make your degree something else. The discrimination DOs face is due to their own willingness to have allowed opening schools with poor rotations and research opportunities.

 

[Konigstiger]

Hard disagree. The people who don't want DO to become MD are the DOs who profit off DO schools. John Gimpel and anyone that sides with him is the problem with the system. They try to say that being DOs makes us special. That our hands and our "holistic care" is what makes us great. These people keep the profession back and its purely to keep their own pockets full and their egos well fed.

Don't even get me started on OMM.

I am not ashamed to be a DO, but I am ashamed of some not all of the people that share my degree.

That's also somewhat true, but it doesn't make what I said any less true either. And even if we just made everyone MDs, there's no reason why OMM has to disappear (though I would prefer if it did). The former DO schools can continue to teach OMM and continue to claim that they're 'special' for doing so.

 

[GoldenStarDoctor]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

 

[Nontrad_FL_LGBT]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

I have an MS degree.

Maybe I can combine it with my (future) DO degree and list it as
MS, DO? Would this create the illusion of an MD?

Or can I list my titles vertically?

MS
DO

Bro go to therapy, this is so wild.

 

[amoxicillin_resistant]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

I have an MS degree.

Maybe I can combine it with my (future) DO degree and list it as
MS, DO? Would this create the illusion of an MD?

Or can I list my titles vertically?

MS
DO

honestly the move is to just move your last name to a middle name and then change your last name to MD.

Technically dont even have to finish med school

 

[DO2015CA]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

Keep the same energy. When you’re strapped with student loans after school and some random off shore school wants 50k for this degree then you’ll prob change your mind.

 

[DOswag]

I have no problem at all with being a DO and stated earlier in this thread that I don't believe it has hindered me at all in regards to my career. I've only felt the bias against DO's while reading about it here on SDN. I have had more personal comments toward me (by seemingly a pretty large margin) about going into psychiatry (had an old radiologist when I was an intern tell me somewhat condescendingly that in his day psychiatrist were the docs who basically couldn't cut it in other specialties), cool thanks man and now I think I make as much as he probably did. Comments from extended family or even other doctors about psychiatrists being "not a real doctor" or viewed as less than compared other docs. If you want an MD, go to an MD school. If you want to be a neurosurgeon or want to go to an Ivy league residency program, you'll have less of a mountain to climb as an MD (but still a mountain regardless). I have a great job working along side MD's and DO's in practice. I work 40 hrs per week, no nights, no weekends, no call, 4 days per week with a 3 day weekend every weekend, and make above average for psychiatrists in an outpatient setting.

Go to school, study hard and try to be the best doc you can in whatever specialty you pursue. If you do that you'll be respected either way and when you get out as an attending you'll have autonomy over the way you want to practice and your work/life balance. If you want to go into primary care, I don't believe it matters at all which one you go into MD or DO. Now, as stated previously, I'm not affiliated with anything in regards to academia so I could be wrong as things may have changed since I graduated school in 2014. But seriously, arguing for an MD/DO combined degree seems pretty asinine to me.

 

[DocWinter]

Well, I'm happy we've helped this poor medical student refind their passion four different ways in this thread.

On the recap, looks like we solved this by the OP finding a quality embroiderrest to get their initials arranged in a pleasing manner on their lab coat, and become as good of a candidate as they can so as not to obtain any shameful initials on that said lab coat, but be saved by an FMG program.

Good talk.

 

[DOVinciRobot]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

Lol

 

[petomed]

I asked chatGPT’s new ‘Deep research’ feature to dig into more or less the heart of this discussion; accreditation standards and outcomes. Should be a relatively unbiased assessment here and something like 27% accurate. Comments should drown out the remaining 73%.



Prompt: Can you do a comparison on the rigor of acquiring and maintaining COCA vs. LCME accreditation as a medical school? My basic question is how they stack up when compared side-by-side on the key characteristics composing quality medical education in the pre-clinical and clinical years. Any major differences or deficits are important.

Initial Response: I will conduct a comprehensive comparison of the rigor involved in acquiring and maintaining COCA vs. LCME accreditation as a medical school. This will include an analysis of key quality indicators in medical education, covering pre-clinical and clinical curriculum requirements, faculty qualifications, student assessments, residency placement impact, resource and facilities standards, and governance oversight. I will provide insights into any major differences or potential deficits between the two accreditation systems. I’ll update you as soon as the findings are ready.


…10 mins later…


Abstract

The Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) are the respective accrediting bodies for MD-granting and DO-granting medical schools in the United States. This comparative analysis examines their accreditation standards in key areas, including pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placement outcomes, resources and facilities, and governance/oversight. Overall, LCME and COCA uphold very similar requirements and quality benchmarks, with both ensuring comprehensive medical education programs. Notable differences emerge in the inclusion of osteopathic-specific training (e.g., mandatory Osteopathic Manipulative Medicine training in DO programs), the emphasis on faculty scholarly activity, board examination requirements for students, and historical variations in governance (such as the allowance of for-profit institutions and student representation in accreditation bodies). These differences, however, do not appear to produce significant disparities in educational quality or graduate outcomes. The analysis concludes that while minor distinctions exist in focus and interpretation of standards, both accreditation systems are rigorous and effective, and recent trends point toward convergence in standards with a shared commitment to continuous improvement in medical education.



Introduction

Accreditation in medical education serves to ensure that medical schools meet established standards of quality and adequately prepare their students for residency and practice. In the United States, two parallel accreditation systems exist for undergraduate medical education: the LCME, which accredits allopathic (MD-degree) medical schools, and the COCA, which accredits osteopathic (DO-degree) medical schools (Ahmed et al., 2023). Both the LCME and COCA are recognized by the U.S. Department of Education as the official accrediting agencies for their respective types of medical schools (American Osteopathic Association [AOA], 2023; Association of American Medical Colleges [AAMC], 2023). Each agency develops comprehensive standards covering all aspects of medical education—ranging from curriculum design and clinical experiences to faculty credentials, student services, infrastructure, and institutional governance—to ensure that graduates attain the competencies required of a physician (Wood & Hahn, 2009).

Despite operating separately, the LCME and COCA share the common goal of assuring high-quality medical education. The content of their standards is largely parallel, addressing the same domains and often using similar language (Wood & Hahn, 2009). Historically, there have been perceptions that osteopathic medical schools might be of lower quality than allopathic schools, raising the question of whether differences in accreditation standards could lead to educational disparities (Wood & Hahn, 2009). However, detailed comparisons have found substantial similarities between LCME and COCA requirements and have not identified differences likely to affect educational quality in any significant way (Ahmed et al., 2023; Wood & Hahn, 2009). Both accreditation processes promote rigorous self-evaluation and continuous improvement within medical schools, and both types of schools must meet stringent criteria to maintain accreditation.

Nonetheless, some differences in emphasis and interpretation do exist. For example, osteopathic programs incorporate training in osteopathic principles and manipulative medicine as a distinctive element of their curriculum, reflecting the holistic philosophy of osteopathic medicine. The accrediting bodies themselves historically differed in composition (e.g., LCME included student members whereas COCA did not until recently) and in certain policies (such as the acceptance of for-profit medical schools) (Ahmed et al., 2023; Wood & Hahn, 2009). This paper provides a structured, side-by-side analysis of LCME vs. COCA accreditation across several key areas: pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placements and outcomes, resources and facilities, and governance/institutional oversight. By examining these areas, we highlight where LCME and COCA align, where they diverge, and discuss the implications of these differences. Understanding these nuances is increasingly important as the medical education community considers the evolving landscape of medical school accreditation and the potential for greater integration between the two systems (Ahmed et al., 2023).


Comparison of Key Areas

Pre-Clinical Curriculum

Structure and Content: Both LCME and COCA require that the early phase of medical education (traditionally the first two years) provides a strong foundation in biomedical sciences and fundamental clinical skills. In LCME-accredited MD programs, the pre-clinical curriculum is expected to cover core scientific disciplines (anatomy, physiology, biochemistry, pharmacology, pathology, etc.) integrated with introductions to clinical reasoning, ethics, and communication skills (LCME, 2021). COCA-accredited DO programs follow a similar structure, ensuring students attain competency in basic sciences and introductory clinical knowledge (AACOM, 2019). In practice, the content of pre-clinical coursework is very similar between MD and DO schools—both types of programs teach the human organ systems, disease mechanisms, and patient interview/physical exam skills in the first half of the curriculum (Ahmed et al., 2023). Thus, all medical students, whether MD or DO, receive comparable scientific training during the pre-clinical years.

Osteopathic Distinction: A key difference in the pre-clinical phase is the incorporation of osteopathic principles and Osteopathic Manipulative Medicine (OMM) in DO programs. COCA standards mandate that colleges of osteopathic medicine provide training in osteopathic philosophy, palpatory diagnosis, and OMM techniques throughout the curriculum (AOA COCA, 2019). Osteopathic medical students typically receive 200 to 300+ hours of OMM trainingduring their four years of medical school, with a significant portion of that in the first two years (American College of Osteopathic Internists [ACOI], n.d.). This is in addition to the standard medical coursework that parallels MD programs. By contrast, LCME standards do not include any requirement analogous to OMM, as allopathic curricula do not teach manipulative medicine. Instead, MD programs may offer electives or content on manual medicine or integrative health at their discretion, but it is not a universal or required component. The presence of OMM in DO curricula reflects the osteopathic commitment to a holistic, hands-on approach to diagnosis and therapy; COCA’s accreditation standards ensure that this distinctive element is consistently integrated into osteopathic medical education (ACOI, n.d.). Aside from OMM, the overall objectives of the pre-clinical curriculum—such as understanding normal and abnormal human biology, developing clinical reasoning, and learning professional ethics—are essentially equivalent under both accreditation systems.

Early Clinical Exposure: Both LCME and COCA recognize the value of early clinical exposure and require that students have some form of patient or healthcare system contact during the pre-clinical years. LCME standards encourage early clinical experiences (e.g., through a longitudinal patient care course or preceptorships) to help students contextualize their learning and begin developing clinical skills (LCME, 2021). COCA similarly expects that osteopathic programs provide early clinical or community-based experiences, often aligning with the osteopathic focus on primary care and community health (AACOM, 2019). In many DO schools, students may start interacting with patients or volunteer in community clinics within the first year, consistent with COCA’s emphasis on producing physicians who are attuned to community and preventive medicine needs. While the specifics vary by school, accreditation standards from both bodies ensure that by the end of the pre-clinical phase, students have not only learned scientific concepts but also started to apply them in real-world or simulated clinical contexts.


Clinical Training

Core Clinical Rotations: Both LCME and COCA require a comprehensive set of core clinical clerkships in the latter half of the medical school curriculum (typically years 3 and 4). Under LCME standards, an MD program must ensure that all students complete required rotations in the major disciplines of medicine, commonly including internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, and family medicine (or other primary care rotations) (LCME, 2021). Similarly, COCA standards mandate that DO programs provide core clinical experiences covering internal medicine, surgery, OB/GYN, pediatrics, family medicine, psychiatry, as well as exposure to emergency medicine, radiology, and preventive medicine/public health (AACOM, 2019). In essence, both types of schools require students to get broad clinical training across organ systems and patient populations. The number of weeks and structure of each rotation might differ slightly by school, but accreditation ensures that every graduate—MD or DO—has participated in all key areas of clinical practice. Both LCME and COCA also require mechanisms to monitor that clinical sites provide appropriate educational experiences and that students are evaluated consistently during clerkships.



Clinical Training Model and Settings: Historically, one difference between MD and DO programs has been the model of clinical education. LCME-accredited schools have often been associated with a traditional academic medical center model: an integrated teaching hospital (or hospitals) where students do most of their rotations, often alongside residency training programs. LCME standards emphasize that the medical school maintains control over the educational quality at all clinical sites and that faculty (including attending physicians and residents) are prepared for their teaching roles (LCME, 2021). In fact, until recently, LCME standards effectively required that core clinical education occur at sites with Graduate Medical Education (GME) programs (i.e., where residents train), to ensure a robust teaching environment (Ahmed et al., 2023). Osteopathic medical schools, in contrast, have long used a distributed or community-based model for clinical education. COCA standards allow DO programs to partner with a network of hospitals and clinics, often community hospitals or private practice settings, sometimes geographically dispersed from the main campus (AACOM, 2019). Many osteopathic schools do not own a primary teaching hospital; instead, they affiliate with multiple clinical sites, which can include small hospitals without residency programs, rural clinics, and larger regional medical centers. This model has enabled osteopathic schools to expand into rural or underserved areas and to offer clinical education in diverse healthcare environments, consistent with the osteopathic mission of community-oriented care.



Recent Convergence in Standards: In the last decade, LCME and COCA standards for clinical training have converged significantly. COCA updated its requirements to ensure that osteopathic students also experience training in environments with residency programs. Currently, COCA standards specify that each student must have at least one core clinical rotation in a setting where an ACGME-accredited GME program is present (Ahmed et al., 2023). This change mirrors the LCME’s long-standing expectation regarding exposure to teaching hospitals with residents. The rationale is that interaction with resident physicians and training in a teaching hospital environment provide important learning opportunities (e.g., being part of a larger clinical team, seeing complex cases). At the same time, LCME has become more open to innovation in clinical training settings. Some newer LCME-accredited schools (for example, the Florida State University College of Medicine) also use distributed community-based clerkships and do not rely solely on a single teaching hospital (Ahmed et al., 2023). Both accreditation bodies now place strong emphasis on adequate supervision and teaching at all clinical sites. For instance, they require affiliation agreements that give the medical school authority over the education at the site and ensure students are supervised by credentialed physicians (LCME, 2021; COCA, 2019). In summary, while MD programs have traditionally been hospital-centered and DO programs community-distributed, both LCME and COCA standards ensure that students receive a well-rounded set of clinical experiences. The differences in settings are narrowing, and both models are recognized as valid as long as educational quality is maintained. The core outcome is that graduates of either system have engaged in hands-on patient care across a variety of core disciplines by the time of graduation.



Faculty Qualifications

Faculty Credentials and Composition: Both LCME and COCA stipulate that a medical school must have a sufficient number of qualified faculty to deliver the curriculum and fulfill the school’s educational, research, and service missions. Faculty members, particularly those teaching clinical subjects, are generally required to hold appropriate professional qualifications (e.g., M.D. or D.O. degrees, valid medical licensure) and, where applicable, be board certified in their specialties (Ahmed et al., 2023). Each accreditor expects that faculty appointments and promotions at the medical school follow rigorous standards and that faculty are competent in teaching their subjects. For clinical teaching, this means MD programs and DO programs alike hire or affiliate with physicians who are experts in their fields and capable of supervising students. Both LCME and COCA also require that the medical school maintain faculty development programs to continually improve teaching skills and ensure faculty are up-to-date (Ahmed et al., 2023).

Scholarship and Research Expectations: A subtle yet oft-cited difference lies in the emphasis on faculty scholarly activity. LCME standards encourage an academic environment of inquiry and expect that faculty members engage in scholarly work (which could be research, whether basic, clinical, or educational research) as part of their roles (Wood & Hahn, 2009). Many LCME-accredited schools, especially research-intensive ones, expect faculty to spend a significant portion of time on research and to demonstrate a commitment to advancing knowledge. The LCME’s position is that scholarly productivity is “characteristic of an institution of higher learning” and thus part of maintaining quality (Ahmed et al., 2023). In contrast, COCA standards also mention scholarly activity but have historically been viewed as less stringent in this area, reflecting the osteopathic educational model that prioritizes teaching and clinical service. Many osteopathic colleges are teaching-oriented institutions where faculty have heavier teaching loads and may have fewer resources or expectations for research. As Cummings (2015) observed, the wording of LCME and COCA standards regarding scholarship is similar, but the threshold for compliance is interpreted differently. COCA’s threshold for faculty scholarly activity has traditionally been lower or more flexible, which is considered appropriate given the mission and context of osteopathic schools (Cummings, 2015). This does not imply that osteopathic faculty do no research—some do, and increasingly DO schools are bolstering research—but it means that a DO school is less likely to be found noncompliant for not having a robust research enterprise, whereas an MD school might be held to a higher implicit benchmark in this area.

Special Faculty Requirements: COCA has a few specific requirements for faculty composition that LCME does not explicitly have. For instance, COCA standards require that osteopathic schools have faculty and leaders who are themselves trained in osteopathic medicine to uphold the distinctiveness of the curriculum. COCA expects each college to have an osteopathic physician in a key leadership role (often a chief academic officer or dean for clinical education) who ensures that osteopathic principles are integrated (COCA, 2019). Additionally, DO programs must have dedicated OMM faculty – specialists in osteopathic manipulative medicine – to teach and oversee that portion of the curriculum. LCME does not have an analog to this because it accredits allopathic schools where OMM is not taught. Instead, LCME focuses on having department chairs or course directors that are appropriately qualified in the disciplines they lead (e.g., an MD or PhD scientist leading basic science courses, board-certified physicians leading clinical departments). Both LCME and COCA require that clinical faculty (those teaching students in hospitals/clinics) are sufficient in number relative to the student class size. In fact, a newer COCA element (implemented in recent years) specifies a ratio or formula for the number of clinical rotation sites or faculty preceptors per student cohort to ensure adequacy (Ahmed et al., 2023). This was likely in response to the rapid expansion of class sizes and new DO schools, to guarantee that every student can be accommodated with quality clinical preceptorships. In conclusion, the faculty qualifications standards under LCME and COCA mostly align in insisting on well-qualified, board-certified instructors and ample faculty development. Differences lie mainly in the area of expected scholarly activity (with LCME placing more emphasis on research productivity) and the requirement for osteopathic-specific faculty roles in DO schools.



Student Assessments

Examinations and Evaluations: Both accreditation systems require that medical schools implement robust student assessment programs that ensure students are attaining the necessary knowledge, skills, and professional behaviors. This includes having a system of frequent formative and summative assessments throughout the curriculum. In practical terms, MD and DO students all take regular course exams during pre-clinical courses, undergo objective structured clinical examinations (OSCEs) to assess clinical skills, and are evaluated during clinical clerkships by supervising physicians. LCME standards emphasize assessing all competencies (medical knowledge, patient care, communication, ethics, etc.) and using diverse methods, including written exams, direct observation of clinical skills, and others (LCME, 2021). COCA standards similarly require that colleges employ appropriate methods to evaluate student performance in all domains, including osteopathic manipulative technique competency for DO students (COCA, 2019).

Licensing Examinations (USMLE vs. COMLEX): A significant difference in accreditation requirements concerns the national licensing examinations. Allopathic students traditionally take the United States Medical Licensing Examination (USMLE) series (Step 1, Step 2 CK, and Step 3 after graduation), while osteopathic students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) series (Level 1, Level 2 CE and PE, and Level 3 post-graduation). The LCME does not require that students pass any particular licensing exam as a condition of graduation or accreditation compliance. In other words, the LCME leaves it to individual MD schools (and state medical boards) to decide how USMLE results factor into promotion or graduation. Many MD programs do require students to take USMLE Step 1 and Step 2 CK for graduation, but a passing score is often not explicitly required by the school for the MD degree (though practically, students must eventually pass for medical licensure). By contrast, COCA has explicitly required that DO students pass the first two levels of COMLEX as a graduation requirement (Ahmed et al., 2023). COCA accreditation Element 6.5 mandates that osteopathic colleges ensure all graduates have passed COMLEX-USA Level 1 and Level 2 (both Cognitive Evaluation and the now-suspended Performance Evaluation when it was active) prior to issuing the D.O. degree. This difference means that the stakes of licensing exams are formally higher in DO programs: a DO student cannot graduate without passing COMLEX, whereas an MD student could technically graduate without passing USMLE (if their school permits it). However, because virtually all students from both pathways need to pass their respective exams for eventual licensure, in practice this difference mainly reflects an administrative policy rather than a disparity in competence.

Another implication is that DO students historically had to balance preparation for COMLEX (required) and often USMLE as well (since many took USMLE for residency applications), whereas MD students only take USMLE. The accreditation difference is that LCME has no standard compelling a school to have a certain board pass rate, while COCA monitors COMLEX pass rates closely as a quality metric. COCA may place a school on warning or probation if its students’ first-time COMLEX pass rates fall below a threshold. LCME similarly expects schools to track USMLE performance as one measure of outcomes, but it doesn’t codify a minimum pass rate. Both systems want to see that graduates perform well on licensing exams; indeed, the outcomes data from recent years indicate that pass rates on USMLE Step 1 for MD students and COMLEX Level 1 for DO students are comparable (typically in the 90-95% first-time pass range), indicating high standards are maintained across both (NBME, 2021; NBOME, 2021).

Assessment of Clinical Skills and Competencies: Beyond standardized exams, LCME and COCA standards require comprehensive assessment of clinical skills. Both accrediting bodies necessitate that by graduation, students demonstrate competence in history-taking, physical examination, clinical reasoning, procedural skills, and interpersonal communication. This is usually accomplished via clinical skills exams (OSCEs) and evaluations during clerkships. DO programs also specifically assess students on osteopathic manipulative treatment skills. In the past, the COMLEX Level 2 included a Performance Evaluation (a hands-on exam with standardized patients), which was somewhat analogous to the USMLE Step 2 CS (Clinical Skills) that MD students took until it was discontinued in 2020. Both of those exams have been eliminated as separate requirements now, but schools themselves have filled the gap with internal clinical skills exams. Accreditation standards from both LCME and COCA require those internal assessments to be in place to ensure students are ready for residency (LCME, 2021; COCA, 2019). In summary, while COCA’s mandate that students pass COMLEX is a formal difference, the overall approach to student assessment is alike, focusing on verifying that all graduates meet defined competencies. Both systems use assessments as a tool for continuous improvement as well—schools must use data on exam performance, course grades, and outcomes to identify curricular strengths and weaknesses as part of the accreditation quality improvement framework.



Residency Placement and Outcomes

Residency Match Rates: Securing residency positions (graduate medical education) for graduates is a critical outcome for any medical school. Both LCME and COCA expect schools to monitor and facilitate their students’ success in the residency match. In terms of accreditation, a low residency placement rate could be a red flag indicating potential issues with the program’s preparation of students or its reputation among residency programs. Historically, graduates of LCME-accredited schools (MDs) participated in the National Resident Matching Program (NRMP) match, and those of COCA-accredited schools (DOs) had the option of the AOA Match (for osteopathic residencies) or the NRMP (for ACGME residencies). Since 2020, the residency accreditation systems have unified, and all graduates compete in a single Match for ACGME residencies. Data indicate that MD and DO graduates have had relatively comparable overall match rates in recent years, although MD seniors have a somewhat higher match rate in the NRMP Main Match compared to DO seniors (AAMC, 2022; NRMP, 2022). Both accrediting bodies have noted that graduation and residency placement rates are similar across for-profit vs. non-profit institutions and across MD vs. DO schools (Ahmed et al., 2023). In other words, attending a COCA-accredited osteopathic school versus an LCME-accredited school does not inherently disadvantage a student in obtaining a residency. The preparation is slightly different (DO students must take COMLEX, and often USMLE for certain specialties), but when looking at aggregate outcomes, residency placement is strong for graduates of both systems (Ahmed et al., 2023).

Specialty and Geographic Trends: One often-discussed difference is the specialty distribution and geographic placement of DO vs. MD graduates. Osteopathic medical schools, by tradition and often by mission, emphasize primary care and serving rural or underserved communities. As a result, a higher proportion of DO graduates enter primary care fields (family medicine, general internal medicine, etc.) and practice in rural or underserved areas compared to MD graduates (Gray et al., 2020). COCA standards require that a college of osteopathic medicine has a mission statement often highlighting primary care or community health, and schools must report outcomes such as the percentage of graduates going into primary care residencies. LCME schools vary widely in mission (some are research-oriented, others focus on primary care), but collectively MD graduates fill more specialty residency positions and are somewhat less likely to choose family medicine (AAMC, 2022). However, these tendencies are not rigid rules – many DOs enter subspecialties and many MDs pursue primary care. Accreditation per se does not force these outcomes, but the cultural and mission differences of the schools can influence student career choices. Importantly, both LCME and COCA are concerned with producing physicians to meet societal needs. Each accreditor might collect data on where graduates practice to see if they align with the school’s stated mission (for example, a DO school that claims to serve rural healthcare should show a good number of graduates in rural practice, which COCA would view favorably). According to Ahmed et al. (2023), evidence suggests DO graduates tend to serve in underserved areas and in primary care at higher rates than MD graduates, contributing positively to addressing physician shortages in those areas.

Graduate Performance: Beyond the match, both accreditation systems consider other outcome measures like graduation rates, licensure exam performance (discussed above), and alumni career achievements. LCME and COCA require schools to track their graduation rates and attrition. Typically, both MD and DO programs have high graduation rates (on average around 95% of students graduate within 4-5 years of matriculation). If a school had a significantly lower graduation rate, it would draw scrutiny from accreditors. So far, no systemic difference between DO and MD schools in this regard has been found; once admitted, the vast majority of students in both pathways successfully complete their training (Wood & Hahn, 2009). Another outcome of interest is board certification rates after residency, but that is farther down the line and not directly within the purview of LCME/COCA (it’s more relevant to GME accreditation). However, both LCME and COCA ultimately aim to produce well-qualified physicians, and the metrics from both sets of schools suggest equivalent quality. A 2009 study by Wood and Hahn (and reaffirmed by later commentary) concluded that there were no major differences in the quality outcomes of graduates attributable to accreditation standards (Wood & Hahn, 2009; Ahmed et al., 2023). In summary, when it comes to residency placements and early career outcomes, LCME and COCA accreditation are both effective at ensuring their graduates can transition into the next phase of medical training successfully. Differences in specialties chosen or practice locations seem to stem from institutional mission and student interests more than from accreditation limitations.



Resources and Facilities

Infrastructure Requirements: Both accreditation bodies have standards pertaining to the physical and informational resources that a medical school must have. This includes adequate classrooms, laboratories, clinical skills/simulation centers, libraries or learning resource centers, technology for teaching, and study space for students. LCME standards explicitly require that a medical school ensure access to appropriate resources to support the curriculum and independent learning (LCME, 2021). COCA standards likewise mandate that colleges of osteopathic medicine have the necessary facilities and equipment to meet their educational objectives (COCA, 2019). In practice, modern medical schools whether MD or DO have quite similar facilities: anatomy labs (though some schools now use digital anatomy or virtual dissection tables), simulation labs with manikins and OSCE rooms, and extensive electronic library resources. Both LCME and COCA survey teams inspect these resources during accreditation site visits to verify they are sufficient.

Financial and Support Resources: Accreditation also looks at the financial sustainability and student support services of a school. Both LCME and COCA require evidence that the institution has stable funding and budgets to carry out the medical education program. They also require academic support services (tutoring, academic counseling), mental health and wellness services for students, and career advising, including for the residency application process (LCME, 2021; COCA, 2019). There is no significant difference here; the expectations are equivalent. One distinction is that COCA has accredited a number of new, private osteopathic schools in the past two decades, including some without large university endowments or affiliate hospitals. As such, COCA closely reviews those schools’ resource plans (especially during provisional accreditation) to ensure they can provide everything students need. LCME also accredits new schools and similarly scrutinizes their resources. Both have put schools on hold or probation if resources were lacking.

Research and Laboratories: While not all medical schools are research-intensive, LCME accreditation (given its tie to the AAMC and the traditional academic model) might implicitly expect a certain level of research infrastructure, especially if the school claims a research mission. COCA has accredited schools with minimal research facilities (some DO schools historically focused almost entirely on teaching). As noted earlier in faculty qualifications, LCME’s standards about the academic environment are more expansive regarding research and scholarship (Wood & Hahn, 2009). For example, an LCME survey will check if students have opportunities for research or if the school encourages scientific inquiry. COCA surveys might focus more on clinical training resources than on bench research labs. However, this difference is again one of degree and mission: some DO schools now have significant research labs, and some newer MD schools are more focused on community health than lab research. Accreditation standards per se do not force a school to have a huge research enterprise, but they do require that if research is part of the mission, it should be appropriately supported. In both systems, students must have appropriate library resources (often electronic databases, journal access, etc.) to learn evidence-based medicine.

In summary, LCME and COCA both enforce robust standards for educational resources and facilities. There is no major divergence in requirements here; any differences come from the nature of the institutions themselves (e.g., DO schools being standalone colleges vs. many MD programs embedded in larger universities or academic health centers). Both accreditors share the fundamental expectation that students have access to the tools, spaces, and support necessary to become competent physicians.



Governance and Institutional Oversight

Accrediting Bodies’ Composition and Policies: The governance of the accrediting agencies themselves has differed in some respects. The LCME is a committee sponsored by two organizations (the AAMC and the AMA) and traditionally has included representatives appointed by those bodies, including medical educators, practitioners, and at least one medical student member with voting rights. The presence of a student on the LCME has long been cited as a way to include the learner’s perspective in accreditation decisions. COCA, which operates under the AOA, historically did not include a medical student in its voting membership (Wood & Hahn, 2009). This was noted as a governance difference: LCME had student representation, COCA did not. However, in recent years COCA has made changes to incorporate student input. As of the late 2010s, COCA added positions for student representatives on certain committees and even on the COCA board (Ahmed et al., 2023). Ahmed et al. (2023) report that COCA now has a student board member with full voting rights, bringing it in line with LCME’s practice and eliminating that particular difference in governance. Aside from student involvement, the basic structure of both accrediting bodies is functionally similar – both are composed of educators and professionals who establish standards, review self-study documents, and conduct site visits to make accreditation decisions (Wood & Hahn, 2009).

Non-Profit vs. For-Profit Institutional Status: In the realm of institutional oversight, one major historical difference was the stance on for-profit medical schools. The LCME had a standard indicating that a medical school should be part of a not-for-profit institution, unless under exceptional circumstances (Wood & Hahn, 2009). This effectively meant that for decades all LCME-accredited MD schools were non-profit (either state institutions or private non-profits). In contrast, COCA, under the AOA, allowed for-profit entities; indeed, the first for-profit osteopathic medical school (Rocky Vista University College of Osteopathic Medicine) was established in 2006 with COCA accreditation. Wood and Hahn (2009) highlighted this as a governance difference — osteopathic accreditation had opened the door to investor-owned schools, whereas LCME standards discouraged it. However, this gap has narrowed. In the 2010s, LCME did grant accreditation to at least one for-profit MD program (for example, a new school in Florida, if certain justifications were met), and by the late 2010s, LCME formally revised or reinterpreted its standard to allow accreditation of for-profit schools given proper oversight (Ahmed et al., 2023). Now both COCA and LCME accredit a small number of for-profit medical schools. Accreditation reports so far indicate that these for-profit schools have similar tuition levels and student outcomes (graduation rates, residency match rates) as traditional non-profits (Ahmed et al., 2023). The long-term implications of for-profit medical education continue to be debated, but from an accreditation standpoint, both agencies hold these schools to the same standards of quality as any other medical school.

Institutional Governance Requirements: LCME and COCA each require that the medical school have an effective governance structure and academic leadership. For example, both require that the school’s dean is qualified by education and experience to lead a medical education program (LCME, 2021; COCA, 2019). They also require that there be defined roles for faculty in governance (e.g., curriculum committees), that there are bylaws outlining responsibilities, and that the school has appropriate autonomy to direct the medical education program (even if it’s part of a larger university or health system). Both accreditors monitor things like conflicts of interest in governance, whether the school’s sponsoring institution provides sufficient support, and whether there is stability in leadership. One notable difference is in how new schools are approved and monitored. COCA, due to the rapid growth of osteopathic schools, has an established process for provisional accreditation and enhanced oversight for new COMs to ensure they develop properly through their first graduating class. The LCME similarly has a candidacy and provisional status for new MD schools. Both processes are rigorous, but the sheer number of new DO schools in the last 20 years has been higher, so COCA has dealt with more start-up institutions. This perhaps gives COCA more experience with guiding new schools and maybe a slightly different approach, but fundamentally the principles (ensuring a sound plan, resources, and progressive development) are alike.

Oversight and Continuous Quality Improvement: Modern accreditation places a strong emphasis on continuous quality improvement (CQI) within institutions. LCME explicitly requires schools to engage in strategic planning and CQI to address any areas of noncompliance or concern proactively (LCME, 2021). COCA also emphasizes ongoing self-assessment and improvement, expecting schools to not just attain standards but to continuously monitor their performance (COCA, 2019). Both accreditation bodies schedule periodic full reviews (typically every 7-8 years for LCME, and a similar cycle for COCA), with progress reports or interim reports in between as needed. If standards are not met, both can take actions such as warning, probation, or in extreme cases, withdrawal of accreditation. These enforcement mechanisms are essentially the same. There have been examples of both LCME and COCA putting schools on probation for issues like inadequate faculty or unstable finances. Each situation is handled per the accreditor’s procedures, but the commitment to enforcing standards is equally strong.

In summary, the governance and oversight aspects of LCME vs. COCA show more similarity than difference. Early differences (student involvement in accreditor governance and non-profit status preferences) have diminished over time. Both accreditation systems rely on peer review and uphold integrity in medical education. The presence of two separate accreditors is historically rooted in the distinct allopathic and osteopathic professions, but as this analysis shows, they now function in very comparable ways, and there is ongoing dialogue about possibly moving toward a more unified approach (Ahmed et al., 2023).



Conclusion

In comparing the LCME and COCA accreditation systems, it becomes evident that the two share a common foundation in ensuring quality medical education, with only nuanced differences reflecting the traditions of allopathic vs. osteopathic medicine. Curriculum: Both accreditors mandate comprehensive curricula that produce competent physicians, with DO programs distinguished by additional OMM training to uphold osteopathic principles. Clinical training: Both require broad clinical experiences, and recent changes have aligned their expectations for clinical learning environments, bridging a historical gap between academic medical center training (MD) and community-based training (DO). Faculty: Both insist on qualified faculty and adequate teaching staff; LCME places greater emphasis on research activity, whereas COCA focuses on maintaining osteopathic expertise among faculty. Assessments: Both ensure robust student assessment systems; a notable difference is COCA’s requirement for COMLEX passage, contrasting with LCME’s more hands-off approach to USMLE (relying on but not requiring it). Outcomes: Both types of schools achieve similar outcomes in terms of graduation rates and residency placement, suggesting that neither accreditation pathway is inherently superior in producing successful doctors. DO graduates often gravitate to primary care and underserved areas, aligning with osteopathic school missions, while MD outcomes vary by school mission, but these trends are not products of accreditation standards per se. Resources: Both LCME and COCA require that medical schools have the physical, financial, and support resources to provide a quality education; there is no major discrepancy here aside from the varying contexts of institutions. Governance: Initially different in philosophy on student roles and for-profit institutions, the two accreditors have grown more similar, with COCA incorporating student representation and LCME accepting diverse funding models.

Crucially, none of the differences identified appear to create a deficit in educational quality. Studies and expert analyses have concluded that the accreditation standards of LCME and COCA are more alike than different, and that both produce graduates well-equipped for the next steps of training (Wood & Hahn, 2009; Ahmed et al., 2023). In other words, attending an LCME-accredited MD program versus a COCA-accredited DO program, from an accreditation standpoint, should not significantly affect the quality of one’s education or one’s readiness to become a physician. The distinctions that do exist—such as learning osteopathic manipulation or taking a particular board exam—reflect the distinct identities of the two professions rather than disparities in rigor.

The implications of this comparison are especially relevant as the medical education community considers future directions. With graduate medical education now under a single accreditation system (ACGME for all residencies), some have speculated whether undergraduate medical education could eventually move toward a unified accreditation process (Ahmed et al., 2023). Proponents argue that a single accreditor could streamline the system and ensure even more consistency, while others emphasize the importance of preserving the unique aspects of osteopathic education. The evidence from this analysis suggests that merging the systems would not require major changes to standards, since LCME and COCA already overlap extensively. However, it would require careful governance to give equal voice to DO and MD interests. Ultimately, whether separate or unified, the focus of accreditation remains on protecting students and the public by holding medical schools to high standards. Both LCME and COCA have demonstrated commitment to that mission. Going forward, continued sharing of best practices between the two accreditors can further minimize any meaningful differences in quality, ensuring that all medical graduates—MD and DO alike—enter residency training with a strong and equivalent foundation.



References

AACOM. (2019). Osteopathic Medical Education and Accreditation. American Association of Colleges of Osteopathic Medicine. Retrieved from AACOM website: Osteopathic Medical Education and Accreditation

AAMC. (2022). Results of the 2022 NRMP Main Residency Match. Association of American Medical Colleges. (Data report).

Ahmed, H., Kortz, M., & Carmody, J. B. (2023). An update on medical school accreditation in the United States: Implications for the single graduate medical education (GME) era. Cureus, 15(2), e34884. An Update on Medical School Accreditation in the United States: Implications for the Single Graduate Medical Education (GME) Era

American College of Osteopathic Internists (ACOI). (n.d.). How is osteopathic medicine different? [Web article]. Retrieved from How is Osteopathic Medicine Different? | American College of Osteopathic Internists

American Osteopathic Association (AOA) COCA. (2019). Commission on Osteopathic College Accreditation: Accreditation Standards – Effective July 1, 2019. [PDF]. Chicago, IL: AOA.

Cummings, M. (2015, December 22). Understanding the differences and similarities between LCME and COCA accreditation standards. AM Rounds – Academic Medicine Blog. Retrieved from Understanding the Differences and Similarities Between LCME and COCA Accreditation Standards

Gray, K. E., Evins, A. E., Boscardin, C. K., & Julian, K. A. (2020). The geographic distribution of DO vs MD primary care physicians in the United States: A re-evaluation. Journal of the American Osteopathic Association, 120(3), 175–183. Platelet-Rich Plasma and Epidural Platelet Lysate: Novel Treatment for Lumbar Disk Herniation

Liaison Committee on Medical Education (LCME). (2021). Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Washington, DC and Chicago, IL: LCME.

National Board of Medical Examiners (NBME). (2021). USMLE Performance Data. Retrieved from NBME website: Performance Data | USMLE

National Board of Osteopathic Medical Examiners (NBOME). (2021). COMLEX-USA Exam Performance Data.Retrieved from NBOME website: https://www.nbome.org/assessments/comlex-usa/comlex-usa-performance-data/

National Resident Matching Program (NRMP). (2022). 2022 NRMP Main Match Results and Data. Washington, DC: NRMP.

Wood, D. L., & Hahn, M. B. (2009). Accreditation standards of osteopathic and allopathic medical schools: could they affect educational quality? Academic Medicine, 84(6), 724–728. Accreditation Standards of Osteopathic and Allopathic... : Academic Medicine

 

[DO2015CA]

I asked chatGPT’s new ‘Deep research’ feature to dig into more or less the heart of this discussion; accreditation standards and outcomes. Should be a relatively unbiased assessment here and something like 27% accurate. Comments should drown out the remaining 73%.



Prompt: Can you do a comparison on the rigor of acquiring and maintaining COCA vs. LCME accreditation as a medical school? My basic question is how they stack up when compared side-by-side on the key characteristics composing quality medical education in the pre-clinical and clinical years. Any major differences or deficits are important.

Initial Response: I will conduct a comprehensive comparison of the rigor involved in acquiring and maintaining COCA vs. LCME accreditation as a medical school. This will include an analysis of key quality indicators in medical education, covering pre-clinical and clinical curriculum requirements, faculty qualifications, student assessments, residency placement impact, resource and facilities standards, and governance oversight. I will provide insights into any major differences or potential deficits between the two accreditation systems. I’ll update you as soon as the findings are ready.


…10 mins later…


Abstract

The Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) are the respective accrediting bodies for MD-granting and DO-granting medical schools in the United States. This comparative analysis examines their accreditation standards in key areas, including pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placement outcomes, resources and facilities, and governance/oversight. Overall, LCME and COCA uphold very similar requirements and quality benchmarks, with both ensuring comprehensive medical education programs. Notable differences emerge in the inclusion of osteopathic-specific training (e.g., mandatory Osteopathic Manipulative Medicine training in DO programs), the emphasis on faculty scholarly activity, board examination requirements for students, and historical variations in governance (such as the allowance of for-profit institutions and student representation in accreditation bodies). These differences, however, do not appear to produce significant disparities in educational quality or graduate outcomes. The analysis concludes that while minor distinctions exist in focus and interpretation of standards, both accreditation systems are rigorous and effective, and recent trends point toward convergence in standards with a shared commitment to continuous improvement in medical education.



Introduction

Accreditation in medical education serves to ensure that medical schools meet established standards of quality and adequately prepare their students for residency and practice. In the United States, two parallel accreditation systems exist for undergraduate medical education: the LCME, which accredits allopathic (MD-degree) medical schools, and the COCA, which accredits osteopathic (DO-degree) medical schools (Ahmed et al., 2023). Both the LCME and COCA are recognized by the U.S. Department of Education as the official accrediting agencies for their respective types of medical schools (American Osteopathic Association [AOA], 2023; Association of American Medical Colleges [AAMC], 2023). Each agency develops comprehensive standards covering all aspects of medical education—ranging from curriculum design and clinical experiences to faculty credentials, student services, infrastructure, and institutional governance—to ensure that graduates attain the competencies required of a physician (Wood & Hahn, 2009).

Despite operating separately, the LCME and COCA share the common goal of assuring high-quality medical education. The content of their standards is largely parallel, addressing the same domains and often using similar language (Wood & Hahn, 2009). Historically, there have been perceptions that osteopathic medical schools might be of lower quality than allopathic schools, raising the question of whether differences in accreditation standards could lead to educational disparities (Wood & Hahn, 2009). However, detailed comparisons have found substantial similarities between LCME and COCA requirements and have not identified differences likely to affect educational quality in any significant way (Ahmed et al., 2023; Wood & Hahn, 2009). Both accreditation processes promote rigorous self-evaluation and continuous improvement within medical schools, and both types of schools must meet stringent criteria to maintain accreditation.

Nonetheless, some differences in emphasis and interpretation do exist. For example, osteopathic programs incorporate training in osteopathic principles and manipulative medicine as a distinctive element of their curriculum, reflecting the holistic philosophy of osteopathic medicine. The accrediting bodies themselves historically differed in composition (e.g., LCME included student members whereas COCA did not until recently) and in certain policies (such as the acceptance of for-profit medical schools) (Ahmed et al., 2023; Wood & Hahn, 2009). This paper provides a structured, side-by-side analysis of LCME vs. COCA accreditation across several key areas: pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placements and outcomes, resources and facilities, and governance/institutional oversight. By examining these areas, we highlight where LCME and COCA align, where they diverge, and discuss the implications of these differences. Understanding these nuances is increasingly important as the medical education community considers the evolving landscape of medical school accreditation and the potential for greater integration between the two systems (Ahmed et al., 2023).


Comparison of Key Areas

Pre-Clinical Curriculum

Structure and Content: Both LCME and COCA require that the early phase of medical education (traditionally the first two years) provides a strong foundation in biomedical sciences and fundamental clinical skills. In LCME-accredited MD programs, the pre-clinical curriculum is expected to cover core scientific disciplines (anatomy, physiology, biochemistry, pharmacology, pathology, etc.) integrated with introductions to clinical reasoning, ethics, and communication skills (LCME, 2021). COCA-accredited DO programs follow a similar structure, ensuring students attain competency in basic sciences and introductory clinical knowledge (AACOM, 2019). In practice, the content of pre-clinical coursework is very similar between MD and DO schools—both types of programs teach the human organ systems, disease mechanisms, and patient interview/physical exam skills in the first half of the curriculum (Ahmed et al., 2023). Thus, all medical students, whether MD or DO, receive comparable scientific training during the pre-clinical years.

Osteopathic Distinction: A key difference in the pre-clinical phase is the incorporation of osteopathic principles and Osteopathic Manipulative Medicine (OMM) in DO programs. COCA standards mandate that colleges of osteopathic medicine provide training in osteopathic philosophy, palpatory diagnosis, and OMM techniques throughout the curriculum (AOA COCA, 2019). Osteopathic medical students typically receive 200 to 300+ hours of OMM trainingduring their four years of medical school, with a significant portion of that in the first two years (American College of Osteopathic Internists [ACOI], n.d.). This is in addition to the standard medical coursework that parallels MD programs. By contrast, LCME standards do not include any requirement analogous to OMM, as allopathic curricula do not teach manipulative medicine. Instead, MD programs may offer electives or content on manual medicine or integrative health at their discretion, but it is not a universal or required component. The presence of OMM in DO curricula reflects the osteopathic commitment to a holistic, hands-on approach to diagnosis and therapy; COCA’s accreditation standards ensure that this distinctive element is consistently integrated into osteopathic medical education (ACOI, n.d.). Aside from OMM, the overall objectives of the pre-clinical curriculum—such as understanding normal and abnormal human biology, developing clinical reasoning, and learning professional ethics—are essentially equivalent under both accreditation systems.

Early Clinical Exposure: Both LCME and COCA recognize the value of early clinical exposure and require that students have some form of patient or healthcare system contact during the pre-clinical years. LCME standards encourage early clinical experiences (e.g., through a longitudinal patient care course or preceptorships) to help students contextualize their learning and begin developing clinical skills (LCME, 2021). COCA similarly expects that osteopathic programs provide early clinical or community-based experiences, often aligning with the osteopathic focus on primary care and community health (AACOM, 2019). In many DO schools, students may start interacting with patients or volunteer in community clinics within the first year, consistent with COCA’s emphasis on producing physicians who are attuned to community and preventive medicine needs. While the specifics vary by school, accreditation standards from both bodies ensure that by the end of the pre-clinical phase, students have not only learned scientific concepts but also started to apply them in real-world or simulated clinical contexts.


Clinical Training

Core Clinical Rotations: Both LCME and COCA require a comprehensive set of core clinical clerkships in the latter half of the medical school curriculum (typically years 3 and 4). Under LCME standards, an MD program must ensure that all students complete required rotations in the major disciplines of medicine, commonly including internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, and family medicine (or other primary care rotations) (LCME, 2021). Similarly, COCA standards mandate that DO programs provide core clinical experiences covering internal medicine, surgery, OB/GYN, pediatrics, family medicine, psychiatry, as well as exposure to emergency medicine, radiology, and preventive medicine/public health (AACOM, 2019). In essence, both types of schools require students to get broad clinical training across organ systems and patient populations. The number of weeks and structure of each rotation might differ slightly by school, but accreditation ensures that every graduate—MD or DO—has participated in all key areas of clinical practice. Both LCME and COCA also require mechanisms to monitor that clinical sites provide appropriate educational experiences and that students are evaluated consistently during clerkships.



Clinical Training Model and Settings: Historically, one difference between MD and DO programs has been the model of clinical education. LCME-accredited schools have often been associated with a traditional academic medical center model: an integrated teaching hospital (or hospitals) where students do most of their rotations, often alongside residency training programs. LCME standards emphasize that the medical school maintains control over the educational quality at all clinical sites and that faculty (including attending physicians and residents) are prepared for their teaching roles (LCME, 2021). In fact, until recently, LCME standards effectively required that core clinical education occur at sites with Graduate Medical Education (GME) programs (i.e., where residents train), to ensure a robust teaching environment (Ahmed et al., 2023). Osteopathic medical schools, in contrast, have long used a distributed or community-based model for clinical education. COCA standards allow DO programs to partner with a network of hospitals and clinics, often community hospitals or private practice settings, sometimes geographically dispersed from the main campus (AACOM, 2019). Many osteopathic schools do not own a primary teaching hospital; instead, they affiliate with multiple clinical sites, which can include small hospitals without residency programs, rural clinics, and larger regional medical centers. This model has enabled osteopathic schools to expand into rural or underserved areas and to offer clinical education in diverse healthcare environments, consistent with the osteopathic mission of community-oriented care.



Recent Convergence in Standards: In the last decade, LCME and COCA standards for clinical training have converged significantly. COCA updated its requirements to ensure that osteopathic students also experience training in environments with residency programs. Currently, COCA standards specify that each student must have at least one core clinical rotation in a setting where an ACGME-accredited GME program is present (Ahmed et al., 2023). This change mirrors the LCME’s long-standing expectation regarding exposure to teaching hospitals with residents. The rationale is that interaction with resident physicians and training in a teaching hospital environment provide important learning opportunities (e.g., being part of a larger clinical team, seeing complex cases). At the same time, LCME has become more open to innovation in clinical training settings. Some newer LCME-accredited schools (for example, the Florida State University College of Medicine) also use distributed community-based clerkships and do not rely solely on a single teaching hospital (Ahmed et al., 2023). Both accreditation bodies now place strong emphasis on adequate supervision and teaching at all clinical sites. For instance, they require affiliation agreements that give the medical school authority over the education at the site and ensure students are supervised by credentialed physicians (LCME, 2021; COCA, 2019). In summary, while MD programs have traditionally been hospital-centered and DO programs community-distributed, both LCME and COCA standards ensure that students receive a well-rounded set of clinical experiences. The differences in settings are narrowing, and both models are recognized as valid as long as educational quality is maintained. The core outcome is that graduates of either system have engaged in hands-on patient care across a variety of core disciplines by the time of graduation.



Faculty Qualifications

Faculty Credentials and Composition: Both LCME and COCA stipulate that a medical school must have a sufficient number of qualified faculty to deliver the curriculum and fulfill the school’s educational, research, and service missions. Faculty members, particularly those teaching clinical subjects, are generally required to hold appropriate professional qualifications (e.g., M.D. or D.O. degrees, valid medical licensure) and, where applicable, be board certified in their specialties (Ahmed et al., 2023). Each accreditor expects that faculty appointments and promotions at the medical school follow rigorous standards and that faculty are competent in teaching their subjects. For clinical teaching, this means MD programs and DO programs alike hire or affiliate with physicians who are experts in their fields and capable of supervising students. Both LCME and COCA also require that the medical school maintain faculty development programs to continually improve teaching skills and ensure faculty are up-to-date (Ahmed et al., 2023).

Scholarship and Research Expectations: A subtle yet oft-cited difference lies in the emphasis on faculty scholarly activity. LCME standards encourage an academic environment of inquiry and expect that faculty members engage in scholarly work (which could be research, whether basic, clinical, or educational research) as part of their roles (Wood & Hahn, 2009). Many LCME-accredited schools, especially research-intensive ones, expect faculty to spend a significant portion of time on research and to demonstrate a commitment to advancing knowledge. The LCME’s position is that scholarly productivity is “characteristic of an institution of higher learning” and thus part of maintaining quality (Ahmed et al., 2023). In contrast, COCA standards also mention scholarly activity but have historically been viewed as less stringent in this area, reflecting the osteopathic educational model that prioritizes teaching and clinical service. Many osteopathic colleges are teaching-oriented institutions where faculty have heavier teaching loads and may have fewer resources or expectations for research. As Cummings (2015) observed, the wording of LCME and COCA standards regarding scholarship is similar, but the threshold for compliance is interpreted differently. COCA’s threshold for faculty scholarly activity has traditionally been lower or more flexible, which is considered appropriate given the mission and context of osteopathic schools (Cummings, 2015). This does not imply that osteopathic faculty do no research—some do, and increasingly DO schools are bolstering research—but it means that a DO school is less likely to be found noncompliant for not having a robust research enterprise, whereas an MD school might be held to a higher implicit benchmark in this area.

Special Faculty Requirements: COCA has a few specific requirements for faculty composition that LCME does not explicitly have. For instance, COCA standards require that osteopathic schools have faculty and leaders who are themselves trained in osteopathic medicine to uphold the distinctiveness of the curriculum. COCA expects each college to have an osteopathic physician in a key leadership role (often a chief academic officer or dean for clinical education) who ensures that osteopathic principles are integrated (COCA, 2019). Additionally, DO programs must have dedicated OMM faculty – specialists in osteopathic manipulative medicine – to teach and oversee that portion of the curriculum. LCME does not have an analog to this because it accredits allopathic schools where OMM is not taught. Instead, LCME focuses on having department chairs or course directors that are appropriately qualified in the disciplines they lead (e.g., an MD or PhD scientist leading basic science courses, board-certified physicians leading clinical departments). Both LCME and COCA require that clinical faculty (those teaching students in hospitals/clinics) are sufficient in number relative to the student class size. In fact, a newer COCA element (implemented in recent years) specifies a ratio or formula for the number of clinical rotation sites or faculty preceptors per student cohort to ensure adequacy (Ahmed et al., 2023). This was likely in response to the rapid expansion of class sizes and new DO schools, to guarantee that every student can be accommodated with quality clinical preceptorships. In conclusion, the faculty qualifications standards under LCME and COCA mostly align in insisting on well-qualified, board-certified instructors and ample faculty development. Differences lie mainly in the area of expected scholarly activity (with LCME placing more emphasis on research productivity) and the requirement for osteopathic-specific faculty roles in DO schools.



Student Assessments

Examinations and Evaluations: Both accreditation systems require that medical schools implement robust student assessment programs that ensure students are attaining the necessary knowledge, skills, and professional behaviors. This includes having a system of frequent formative and summative assessments throughout the curriculum. In practical terms, MD and DO students all take regular course exams during pre-clinical courses, undergo objective structured clinical examinations (OSCEs) to assess clinical skills, and are evaluated during clinical clerkships by supervising physicians. LCME standards emphasize assessing all competencies (medical knowledge, patient care, communication, ethics, etc.) and using diverse methods, including written exams, direct observation of clinical skills, and others (LCME, 2021). COCA standards similarly require that colleges employ appropriate methods to evaluate student performance in all domains, including osteopathic manipulative technique competency for DO students (COCA, 2019).

Licensing Examinations (USMLE vs. COMLEX): A significant difference in accreditation requirements concerns the national licensing examinations. Allopathic students traditionally take the United States Medical Licensing Examination (USMLE) series (Step 1, Step 2 CK, and Step 3 after graduation), while osteopathic students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) series (Level 1, Level 2 CE and PE, and Level 3 post-graduation). The LCME does not require that students pass any particular licensing exam as a condition of graduation or accreditation compliance. In other words, the LCME leaves it to individual MD schools (and state medical boards) to decide how USMLE results factor into promotion or graduation. Many MD programs do require students to take USMLE Step 1 and Step 2 CK for graduation, but a passing score is often not explicitly required by the school for the MD degree (though practically, students must eventually pass for medical licensure). By contrast, COCA has explicitly required that DO students pass the first two levels of COMLEX as a graduation requirement (Ahmed et al., 2023). COCA accreditation Element 6.5 mandates that osteopathic colleges ensure all graduates have passed COMLEX-USA Level 1 and Level 2 (both Cognitive Evaluation and the now-suspended Performance Evaluation when it was active) prior to issuing the D.O. degree. This difference means that the stakes of licensing exams are formally higher in DO programs: a DO student cannot graduate without passing COMLEX, whereas an MD student could technically graduate without passing USMLE (if their school permits it). However, because virtually all students from both pathways need to pass their respective exams for eventual licensure, in practice this difference mainly reflects an administrative policy rather than a disparity in competence.

Another implication is that DO students historically had to balance preparation for COMLEX (required) and often USMLE as well (since many took USMLE for residency applications), whereas MD students only take USMLE. The accreditation difference is that LCME has no standard compelling a school to have a certain board pass rate, while COCA monitors COMLEX pass rates closely as a quality metric. COCA may place a school on warning or probation if its students’ first-time COMLEX pass rates fall below a threshold. LCME similarly expects schools to track USMLE performance as one measure of outcomes, but it doesn’t codify a minimum pass rate. Both systems want to see that graduates perform well on licensing exams; indeed, the outcomes data from recent years indicate that pass rates on USMLE Step 1 for MD students and COMLEX Level 1 for DO students are comparable (typically in the 90-95% first-time pass range), indicating high standards are maintained across both (NBME, 2021; NBOME, 2021).

Assessment of Clinical Skills and Competencies: Beyond standardized exams, LCME and COCA standards require comprehensive assessment of clinical skills. Both accrediting bodies necessitate that by graduation, students demonstrate competence in history-taking, physical examination, clinical reasoning, procedural skills, and interpersonal communication. This is usually accomplished via clinical skills exams (OSCEs) and evaluations during clerkships. DO programs also specifically assess students on osteopathic manipulative treatment skills. In the past, the COMLEX Level 2 included a Performance Evaluation (a hands-on exam with standardized patients), which was somewhat analogous to the USMLE Step 2 CS (Clinical Skills) that MD students took until it was discontinued in 2020. Both of those exams have been eliminated as separate requirements now, but schools themselves have filled the gap with internal clinical skills exams. Accreditation standards from both LCME and COCA require those internal assessments to be in place to ensure students are ready for residency (LCME, 2021; COCA, 2019). In summary, while COCA’s mandate that students pass COMLEX is a formal difference, the overall approach to student assessment is alike, focusing on verifying that all graduates meet defined competencies. Both systems use assessments as a tool for continuous improvement as well—schools must use data on exam performance, course grades, and outcomes to identify curricular strengths and weaknesses as part of the accreditation quality improvement framework.



Residency Placement and Outcomes

Residency Match Rates: Securing residency positions (graduate medical education) for graduates is a critical outcome for any medical school. Both LCME and COCA expect schools to monitor and facilitate their students’ success in the residency match. In terms of accreditation, a low residency placement rate could be a red flag indicating potential issues with the program’s preparation of students or its reputation among residency programs. Historically, graduates of LCME-accredited schools (MDs) participated in the National Resident Matching Program (NRMP) match, and those of COCA-accredited schools (DOs) had the option of the AOA Match (for osteopathic residencies) or the NRMP (for ACGME residencies). Since 2020, the residency accreditation systems have unified, and all graduates compete in a single Match for ACGME residencies. Data indicate that MD and DO graduates have had relatively comparable overall match rates in recent years, although MD seniors have a somewhat higher match rate in the NRMP Main Match compared to DO seniors (AAMC, 2022; NRMP, 2022). Both accrediting bodies have noted that graduation and residency placement rates are similar across for-profit vs. non-profit institutions and across MD vs. DO schools (Ahmed et al., 2023). In other words, attending a COCA-accredited osteopathic school versus an LCME-accredited school does not inherently disadvantage a student in obtaining a residency. The preparation is slightly different (DO students must take COMLEX, and often USMLE for certain specialties), but when looking at aggregate outcomes, residency placement is strong for graduates of both systems (Ahmed et al., 2023).

Specialty and Geographic Trends: One often-discussed difference is the specialty distribution and geographic placement of DO vs. MD graduates. Osteopathic medical schools, by tradition and often by mission, emphasize primary care and serving rural or underserved communities. As a result, a higher proportion of DO graduates enter primary care fields (family medicine, general internal medicine, etc.) and practice in rural or underserved areas compared to MD graduates (Gray et al., 2020). COCA standards require that a college of osteopathic medicine has a mission statement often highlighting primary care or community health, and schools must report outcomes such as the percentage of graduates going into primary care residencies. LCME schools vary widely in mission (some are research-oriented, others focus on primary care), but collectively MD graduates fill more specialty residency positions and are somewhat less likely to choose family medicine (AAMC, 2022). However, these tendencies are not rigid rules – many DOs enter subspecialties and many MDs pursue primary care. Accreditation per se does not force these outcomes, but the cultural and mission differences of the schools can influence student career choices. Importantly, both LCME and COCA are concerned with producing physicians to meet societal needs. Each accreditor might collect data on where graduates practice to see if they align with the school’s stated mission (for example, a DO school that claims to serve rural healthcare should show a good number of graduates in rural practice, which COCA would view favorably). According to Ahmed et al. (2023), evidence suggests DO graduates tend to serve in underserved areas and in primary care at higher rates than MD graduates, contributing positively to addressing physician shortages in those areas.

Graduate Performance: Beyond the match, both accreditation systems consider other outcome measures like graduation rates, licensure exam performance (discussed above), and alumni career achievements. LCME and COCA require schools to track their graduation rates and attrition. Typically, both MD and DO programs have high graduation rates (on average around 95% of students graduate within 4-5 years of matriculation). If a school had a significantly lower graduation rate, it would draw scrutiny from accreditors. So far, no systemic difference between DO and MD schools in this regard has been found; once admitted, the vast majority of students in both pathways successfully complete their training (Wood & Hahn, 2009). Another outcome of interest is board certification rates after residency, but that is farther down the line and not directly within the purview of LCME/COCA (it’s more relevant to GME accreditation). However, both LCME and COCA ultimately aim to produce well-qualified physicians, and the metrics from both sets of schools suggest equivalent quality. A 2009 study by Wood and Hahn (and reaffirmed by later commentary) concluded that there were no major differences in the quality outcomes of graduates attributable to accreditation standards (Wood & Hahn, 2009; Ahmed et al., 2023). In summary, when it comes to residency placements and early career outcomes, LCME and COCA accreditation are both effective at ensuring their graduates can transition into the next phase of medical training successfully. Differences in specialties chosen or practice locations seem to stem from institutional mission and student interests more than from accreditation limitations.



Resources and Facilities

Infrastructure Requirements: Both accreditation bodies have standards pertaining to the physical and informational resources that a medical school must have. This includes adequate classrooms, laboratories, clinical skills/simulation centers, libraries or learning resource centers, technology for teaching, and study space for students. LCME standards explicitly require that a medical school ensure access to appropriate resources to support the curriculum and independent learning (LCME, 2021). COCA standards likewise mandate that colleges of osteopathic medicine have the necessary facilities and equipment to meet their educational objectives (COCA, 2019). In practice, modern medical schools whether MD or DO have quite similar facilities: anatomy labs (though some schools now use digital anatomy or virtual dissection tables), simulation labs with manikins and OSCE rooms, and extensive electronic library resources. Both LCME and COCA survey teams inspect these resources during accreditation site visits to verify they are sufficient.

Financial and Support Resources: Accreditation also looks at the financial sustainability and student support services of a school. Both LCME and COCA require evidence that the institution has stable funding and budgets to carry out the medical education program. They also require academic support services (tutoring, academic counseling), mental health and wellness services for students, and career advising, including for the residency application process (LCME, 2021; COCA, 2019). There is no significant difference here; the expectations are equivalent. One distinction is that COCA has accredited a number of new, private osteopathic schools in the past two decades, including some without large university endowments or affiliate hospitals. As such, COCA closely reviews those schools’ resource plans (especially during provisional accreditation) to ensure they can provide everything students need. LCME also accredits new schools and similarly scrutinizes their resources. Both have put schools on hold or probation if resources were lacking.

Research and Laboratories: While not all medical schools are research-intensive, LCME accreditation (given its tie to the AAMC and the traditional academic model) might implicitly expect a certain level of research infrastructure, especially if the school claims a research mission. COCA has accredited schools with minimal research facilities (some DO schools historically focused almost entirely on teaching). As noted earlier in faculty qualifications, LCME’s standards about the academic environment are more expansive regarding research and scholarship (Wood & Hahn, 2009). For example, an LCME survey will check if students have opportunities for research or if the school encourages scientific inquiry. COCA surveys might focus more on clinical training resources than on bench research labs. However, this difference is again one of degree and mission: some DO schools now have significant research labs, and some newer MD schools are more focused on community health than lab research. Accreditation standards per se do not force a school to have a huge research enterprise, but they do require that if research is part of the mission, it should be appropriately supported. In both systems, students must have appropriate library resources (often electronic databases, journal access, etc.) to learn evidence-based medicine.

In summary, LCME and COCA both enforce robust standards for educational resources and facilities. There is no major divergence in requirements here; any differences come from the nature of the institutions themselves (e.g., DO schools being standalone colleges vs. many MD programs embedded in larger universities or academic health centers). Both accreditors share the fundamental expectation that students have access to the tools, spaces, and support necessary to become competent physicians.



Governance and Institutional Oversight

Accrediting Bodies’ Composition and Policies: The governance of the accrediting agencies themselves has differed in some respects. The LCME is a committee sponsored by two organizations (the AAMC and the AMA) and traditionally has included representatives appointed by those bodies, including medical educators, practitioners, and at least one medical student member with voting rights. The presence of a student on the LCME has long been cited as a way to include the learner’s perspective in accreditation decisions. COCA, which operates under the AOA, historically did not include a medical student in its voting membership (Wood & Hahn, 2009). This was noted as a governance difference: LCME had student representation, COCA did not. However, in recent years COCA has made changes to incorporate student input. As of the late 2010s, COCA added positions for student representatives on certain committees and even on the COCA board (Ahmed et al., 2023). Ahmed et al. (2023) report that COCA now has a student board member with full voting rights, bringing it in line with LCME’s practice and eliminating that particular difference in governance. Aside from student involvement, the basic structure of both accrediting bodies is functionally similar – both are composed of educators and professionals who establish standards, review self-study documents, and conduct site visits to make accreditation decisions (Wood & Hahn, 2009).

Non-Profit vs. For-Profit Institutional Status: In the realm of institutional oversight, one major historical difference was the stance on for-profit medical schools. The LCME had a standard indicating that a medical school should be part of a not-for-profit institution, unless under exceptional circumstances (Wood & Hahn, 2009). This effectively meant that for decades all LCME-accredited MD schools were non-profit (either state institutions or private non-profits). In contrast, COCA, under the AOA, allowed for-profit entities; indeed, the first for-profit osteopathic medical school (Rocky Vista University College of Osteopathic Medicine) was established in 2006 with COCA accreditation. Wood and Hahn (2009) highlighted this as a governance difference — osteopathic accreditation had opened the door to investor-owned schools, whereas LCME standards discouraged it. However, this gap has narrowed. In the 2010s, LCME did grant accreditation to at least one for-profit MD program (for example, a new school in Florida, if certain justifications were met), and by the late 2010s, LCME formally revised or reinterpreted its standard to allow accreditation of for-profit schools given proper oversight (Ahmed et al., 2023). Now both COCA and LCME accredit a small number of for-profit medical schools. Accreditation reports so far indicate that these for-profit schools have similar tuition levels and student outcomes (graduation rates, residency match rates) as traditional non-profits (Ahmed et al., 2023). The long-term implications of for-profit medical education continue to be debated, but from an accreditation standpoint, both agencies hold these schools to the same standards of quality as any other medical school.

Institutional Governance Requirements: LCME and COCA each require that the medical school have an effective governance structure and academic leadership. For example, both require that the school’s dean is qualified by education and experience to lead a medical education program (LCME, 2021; COCA, 2019). They also require that there be defined roles for faculty in governance (e.g., curriculum committees), that there are bylaws outlining responsibilities, and that the school has appropriate autonomy to direct the medical education program (even if it’s part of a larger university or health system). Both accreditors monitor things like conflicts of interest in governance, whether the school’s sponsoring institution provides sufficient support, and whether there is stability in leadership. One notable difference is in how new schools are approved and monitored. COCA, due to the rapid growth of osteopathic schools, has an established process for provisional accreditation and enhanced oversight for new COMs to ensure they develop properly through their first graduating class. The LCME similarly has a candidacy and provisional status for new MD schools. Both processes are rigorous, but the sheer number of new DO schools in the last 20 years has been higher, so COCA has dealt with more start-up institutions. This perhaps gives COCA more experience with guiding new schools and maybe a slightly different approach, but fundamentally the principles (ensuring a sound plan, resources, and progressive development) are alike.

Oversight and Continuous Quality Improvement: Modern accreditation places a strong emphasis on continuous quality improvement (CQI) within institutions. LCME explicitly requires schools to engage in strategic planning and CQI to address any areas of noncompliance or concern proactively (LCME, 2021). COCA also emphasizes ongoing self-assessment and improvement, expecting schools to not just attain standards but to continuously monitor their performance (COCA, 2019). Both accreditation bodies schedule periodic full reviews (typically every 7-8 years for LCME, and a similar cycle for COCA), with progress reports or interim reports in between as needed. If standards are not met, both can take actions such as warning, probation, or in extreme cases, withdrawal of accreditation. These enforcement mechanisms are essentially the same. There have been examples of both LCME and COCA putting schools on probation for issues like inadequate faculty or unstable finances. Each situation is handled per the accreditor’s procedures, but the commitment to enforcing standards is equally strong.

In summary, the governance and oversight aspects of LCME vs. COCA show more similarity than difference. Early differences (student involvement in accreditor governance and non-profit status preferences) have diminished over time. Both accreditation systems rely on peer review and uphold integrity in medical education. The presence of two separate accreditors is historically rooted in the distinct allopathic and osteopathic professions, but as this analysis shows, they now function in very comparable ways, and there is ongoing dialogue about possibly moving toward a more unified approach (Ahmed et al., 2023).



Conclusion

In comparing the LCME and COCA accreditation systems, it becomes evident that the two share a common foundation in ensuring quality medical education, with only nuanced differences reflecting the traditions of allopathic vs. osteopathic medicine. Curriculum: Both accreditors mandate comprehensive curricula that produce competent physicians, with DO programs distinguished by additional OMM training to uphold osteopathic principles. Clinical training: Both require broad clinical experiences, and recent changes have aligned their expectations for clinical learning environments, bridging a historical gap between academic medical center training (MD) and community-based training (DO). Faculty: Both insist on qualified faculty and adequate teaching staff; LCME places greater emphasis on research activity, whereas COCA focuses on maintaining osteopathic expertise among faculty. Assessments: Both ensure robust student assessment systems; a notable difference is COCA’s requirement for COMLEX passage, contrasting with LCME’s more hands-off approach to USMLE (relying on but not requiring it). Outcomes: Both types of schools achieve similar outcomes in terms of graduation rates and residency placement, suggesting that neither accreditation pathway is inherently superior in producing successful doctors. DO graduates often gravitate to primary care and underserved areas, aligning with osteopathic school missions, while MD outcomes vary by school mission, but these trends are not products of accreditation standards per se. Resources: Both LCME and COCA require that medical schools have the physical, financial, and support resources to provide a quality education; there is no major discrepancy here aside from the varying contexts of institutions. Governance: Initially different in philosophy on student roles and for-profit institutions, the two accreditors have grown more similar, with COCA incorporating student representation and LCME accepting diverse funding models.

Crucially, none of the differences identified appear to create a deficit in educational quality. Studies and expert analyses have concluded that the accreditation standards of LCME and COCA are more alike than different, and that both produce graduates well-equipped for the next steps of training (Wood & Hahn, 2009; Ahmed et al., 2023). In other words, attending an LCME-accredited MD program versus a COCA-accredited DO program, from an accreditation standpoint, should not significantly affect the quality of one’s education or one’s readiness to become a physician. The distinctions that do exist—such as learning osteopathic manipulation or taking a particular board exam—reflect the distinct identities of the two professions rather than disparities in rigor.

The implications of this comparison are especially relevant as the medical education community considers future directions. With graduate medical education now under a single accreditation system (ACGME for all residencies), some have speculated whether undergraduate medical education could eventually move toward a unified accreditation process (Ahmed et al., 2023). Proponents argue that a single accreditor could streamline the system and ensure even more consistency, while others emphasize the importance of preserving the unique aspects of osteopathic education. The evidence from this analysis suggests that merging the systems would not require major changes to standards, since LCME and COCA already overlap extensively. However, it would require careful governance to give equal voice to DO and MD interests. Ultimately, whether separate or unified, the focus of accreditation remains on protecting students and the public by holding medical schools to high standards. Both LCME and COCA have demonstrated commitment to that mission. Going forward, continued sharing of best practices between the two accreditors can further minimize any meaningful differences in quality, ensuring that all medical graduates—MD and DO alike—enter residency training with a strong and equivalent foundation.



References

AACOM. (2019). Osteopathic Medical Education and Accreditation. American Association of Colleges of Osteopathic Medicine. Retrieved from AACOM website: Osteopathic Medical Education and Accreditation

AAMC. (2022). Results of the 2022 NRMP Main Residency Match. Association of American Medical Colleges. (Data report).

Ahmed, H., Kortz, M., & Carmody, J. B. (2023). An update on medical school accreditation in the United States: Implications for the single graduate medical education (GME) era. Cureus, 15(2), e34884. An Update on Medical School Accreditation in the United States: Implications for the Single Graduate Medical Education (GME) Era

American College of Osteopathic Internists (ACOI). (n.d.). How is osteopathic medicine different? [Web article]. Retrieved from How is Osteopathic Medicine Different? | American College of Osteopathic Internists

American Osteopathic Association (AOA) COCA. (2019). Commission on Osteopathic College Accreditation: Accreditation Standards – Effective July 1, 2019. [PDF]. Chicago, IL: AOA.

Cummings, M. (2015, December 22). Understanding the differences and similarities between LCME and COCA accreditation standards. AM Rounds – Academic Medicine Blog. Retrieved from Understanding the Differences and Similarities Between LCME and COCA Accreditation Standards

Gray, K. E., Evins, A. E., Boscardin, C. K., & Julian, K. A. (2020). The geographic distribution of DO vs MD primary care physicians in the United States: A re-evaluation. Journal of the American Osteopathic Association, 120(3), 175–183. Platelet-Rich Plasma and Epidural Platelet Lysate: Novel Treatment for Lumbar Disk Herniation

Liaison Committee on Medical Education (LCME). (2021). Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree. Washington, DC and Chicago, IL: LCME.

National Board of Medical Examiners (NBME). (2021). USMLE Performance Data. Retrieved from NBME website: Performance Data | USMLE

National Board of Osteopathic Medical Examiners (NBOME). (2021). COMLEX-USA Exam Performance Data.Retrieved from NBOME website: https://www.nbome.org/assessments/comlex-usa/comlex-usa-performance-data/

National Resident Matching Program (NRMP). (2022). 2022 NRMP Main Match Results and Data. Washington, DC: NRMP.

Wood, D. L., & Hahn, M. B. (2009). Accreditation standards of osteopathic and allopathic medical schools: could they affect educational quality? Academic Medicine, 84(6), 724–728. Accreditation Standards of Osteopathic and Allopathic... : Academic Medicine

Bro you need a tldr. What the heck… well guess abstract is enough. But jeez a couple fine bullet points would help lol

 

[GoldenStarDoctor]

I use read-aloud extension function! It is very helpful!

Bro you need a tldr. What the heck… well guess abstract is enough. But jeez a couple fine bullet points would help lol

Thank you for the detailed analysis on how both accreditation systems strive to produce well-qualified medical graduates.

I asked chatGPT’s new ‘Deep research’ feature to dig into more or less the heart of this discussion; accreditation standards and outcomes. Should be a relatively unbiased assessment here and something like 27% accurate. Comments should drown out the remaining 73%.



Prompt: Can you do a comparison on the rigor of acquiring and maintaining COCA vs. LCME accreditation as a medical school? My basic question is how they stack up when compared side-by-side on the key characteristics composing quality medical education in the pre-clinical and clinical years. Any major differences or deficits are important.

Initial Response: I will conduct a comprehensive comparison of the rigor involved in acquiring and maintaining COCA vs. LCME accreditation as a medical school. This will include an analysis of key quality indicators in medical education, covering pre-clinical and clinical curriculum requirements, faculty qualifications, student assessments, residency placement impact, resource and facilities standards, and governance oversight. I will provide insights into any major differences or potential deficits between the two accreditation systems. I’ll update you as soon as the findings are ready.


…10 mins later…


Abstract

The Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) are the respective accrediting bodies for MD-granting and DO-granting medical schools in the United States. This comparative analysis examines their accreditation standards in key areas, including pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placement outcomes, resources and facilities, and governance/oversight. Overall, LCME and COCA uphold very similar requirements and quality benchmarks, with both ensuring comprehensive medical education programs. Notable differences emerge in the inclusion of osteopathic-specific training (e.g., mandatory Osteopathic Manipulative Medicine training in DO programs), the emphasis on faculty scholarly activity, board examination requirements for students, and historical variations in governance (such as the allowance of for-profit institutions and student representation in accreditation bodies). These differences, however, do not appear to produce significant disparities in educational quality or graduate outcomes. The analysis concludes that while minor distinctions exist in focus and interpretation of standards, both accreditation systems are rigorous and effective, and recent trends point toward convergence in standards with a shared commitment to continuous improvement in medical education.

 

[DO2015CA]

View attachment 399673
I use read-aloud extension function! It is very helpful!


Thank you for the detailed analysis on how both accreditation systems strive to produce well-qualified medical graduates.

Good idea!

 

[Drrrrrr. Celty]

They just need to have one degree.

 

[SLC]

You will be a doctor with the same hospital privileges, duties and responsibilities as MDs.
Once you are past the board exams and have graduated from school you will not notice a difference.
You will prove yourself by your capability, confidence, and competence.

This 100%

My patients know me as “Dr. SLC”. Almost none care or even know what DO means. My institution (a very large and respected one in this parts of the country) cares even less. None of our badges have credentials other than “Dr. SLC, physician” OR “Jim, PA”.


The few patients that do know what DO be MD means, seem to pick me because of the DO credentials.

This MDO nonsense just reeks of insecurity IMO.

 

[Goro]

And then there's this!

Is Nova next????

MSU looking at merging its two medical schools

Michigan State is looking for ways to create a more collaborative learning environment in the health sciences.

www.freep.com

 

[MDMechEngr]

I asked chatGPT’s new ‘Deep research’ feature to dig into more or less the heart of this discussion; accreditation standards and outcomes. Should be a relatively unbiased assessment here and something like 27% accurate. Comments should drown out the remaining 73%.



Prompt: Can you do a comparison on the rigor of acquiring and maintaining COCA vs. LCME accreditation as a medical school? My basic question is how they stack up when compared side-by-side on the key characteristics composing quality medical education in the pre-clinical and clinical years. Any major differences or deficits are important.

Initial Response: I will conduct a comprehensive comparison of the rigor involved in acquiring and maintaining COCA vs. LCME accreditation as a medical school. This will include an analysis of key quality indicators in medical education, covering pre-clinical and clinical curriculum requirements, faculty qualifications, student assessments, residency placement impact, resource and facilities standards, and governance oversight. I will provide insights into any major differences or potential deficits between the two accreditation systems. I’ll update you as soon as the findings are ready.


…10 mins later…


Abstract

The Liaison Committee on Medical Education (LCME) and the Commission on Osteopathic College Accreditation (COCA) are the respective accrediting bodies for MD-granting and DO-granting medical schools in the United States. This comparative analysis examines their accreditation standards in key areas, including pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placement outcomes, resources and facilities, and governance/oversight. Overall, LCME and COCA uphold very similar requirements and quality benchmarks, with both ensuring comprehensive medical education programs. Notable differences emerge in the inclusion of osteopathic-specific training (e.g., mandatory Osteopathic Manipulative Medicine training in DO programs), the emphasis on faculty scholarly activity, board examination requirements for students, and historical variations in governance (such as the allowance of for-profit institutions and student representation in accreditation bodies). These differences, however, do not appear to produce significant disparities in educational quality or graduate outcomes. The analysis concludes that while minor distinctions exist in focus and interpretation of standards, both accreditation systems are rigorous and effective, and recent trends point toward convergence in standards with a shared commitment to continuous improvement in medical education.



Introduction

Accreditation in medical education serves to ensure that medical schools meet established standards of quality and adequately prepare their students for residency and practice. In the United States, two parallel accreditation systems exist for undergraduate medical education: the LCME, which accredits allopathic (MD-degree) medical schools, and the COCA, which accredits osteopathic (DO-degree) medical schools (Ahmed et al., 2023). Both the LCME and COCA are recognized by the U.S. Department of Education as the official accrediting agencies for their respective types of medical schools (American Osteopathic Association [AOA], 2023; Association of American Medical Colleges [AAMC], 2023). Each agency develops comprehensive standards covering all aspects of medical education—ranging from curriculum design and clinical experiences to faculty credentials, student services, infrastructure, and institutional governance—to ensure that graduates attain the competencies required of a physician (Wood & Hahn, 2009).

Despite operating separately, the LCME and COCA share the common goal of assuring high-quality medical education. The content of their standards is largely parallel, addressing the same domains and often using similar language (Wood & Hahn, 2009). Historically, there have been perceptions that osteopathic medical schools might be of lower quality than allopathic schools, raising the question of whether differences in accreditation standards could lead to educational disparities (Wood & Hahn, 2009). However, detailed comparisons have found substantial similarities between LCME and COCA requirements and have not identified differences likely to affect educational quality in any significant way (Ahmed et al., 2023; Wood & Hahn, 2009). Both accreditation processes promote rigorous self-evaluation and continuous improvement within medical schools, and both types of schools must meet stringent criteria to maintain accreditation.

Nonetheless, some differences in emphasis and interpretation do exist. For example, osteopathic programs incorporate training in osteopathic principles and manipulative medicine as a distinctive element of their curriculum, reflecting the holistic philosophy of osteopathic medicine. The accrediting bodies themselves historically differed in composition (e.g., LCME included student members whereas COCA did not until recently) and in certain policies (such as the acceptance of for-profit medical schools) (Ahmed et al., 2023; Wood & Hahn, 2009). This paper provides a structured, side-by-side analysis of LCME vs. COCA accreditation across several key areas: pre-clinical curriculum, clinical training, faculty qualifications, student assessments, residency placements and outcomes, resources and facilities, and governance/institutional oversight. By examining these areas, we highlight where LCME and COCA align, where they diverge, and discuss the implications of these differences. Understanding these nuances is increasingly important as the medical education community considers the evolving landscape of medical school accreditation and the potential for greater integration between the two systems (Ahmed et al., 2023).


Comparison of Key Areas

Pre-Clinical Curriculum

Structure and Content: Both LCME and COCA require that the early phase of medical education (traditionally the first two years) provides a strong foundation in biomedical sciences and fundamental clinical skills. In LCME-accredited MD programs, the pre-clinical curriculum is expected to cover core scientific disciplines (anatomy, physiology, biochemistry, pharmacology, pathology, etc.) integrated with introductions to clinical reasoning, ethics, and communication skills (LCME, 2021). COCA-accredited DO programs follow a similar structure, ensuring students attain competency in basic sciences and introductory clinical knowledge (AACOM, 2019). In practice, the content of pre-clinical coursework is very similar between MD and DO schools—both types of programs teach the human organ systems, disease mechanisms, and patient interview/physical exam skills in the first half of the curriculum (Ahmed et al., 2023). Thus, all medical students, whether MD or DO, receive comparable scientific training during the pre-clinical years.

Osteopathic Distinction: A key difference in the pre-clinical phase is the incorporation of osteopathic principles and Osteopathic Manipulative Medicine (OMM) in DO programs. COCA standards mandate that colleges of osteopathic medicine provide training in osteopathic philosophy, palpatory diagnosis, and OMM techniques throughout the curriculum (AOA COCA, 2019). Osteopathic medical students typically receive 200 to 300+ hours of OMM trainingduring their four years of medical school, with a significant portion of that in the first two years (American College of Osteopathic Internists [ACOI], n.d.). This is in addition to the standard medical coursework that parallels MD programs. By contrast, LCME standards do not include any requirement analogous to OMM, as allopathic curricula do not teach manipulative medicine. Instead, MD programs may offer electives or content on manual medicine or integrative health at their discretion, but it is not a universal or required component. The presence of OMM in DO curricula reflects the osteopathic commitment to a holistic, hands-on approach to diagnosis and therapy; COCA’s accreditation standards ensure that this distinctive element is consistently integrated into osteopathic medical education (ACOI, n.d.). Aside from OMM, the overall objectives of the pre-clinical curriculum—such as understanding normal and abnormal human biology, developing clinical reasoning, and learning professional ethics—are essentially equivalent under both accreditation systems.

Early Clinical Exposure: Both LCME and COCA recognize the value of early clinical exposure and require that students have some form of patient or healthcare system contact during the pre-clinical years. LCME standards encourage early clinical experiences (e.g., through a longitudinal patient care course or preceptorships) to help students contextualize their learning and begin developing clinical skills (LCME, 2021). COCA similarly expects that osteopathic programs provide early clinical or community-based experiences, often aligning with the osteopathic focus on primary care and community health (AACOM, 2019). In many DO schools, students may start interacting with patients or volunteer in community clinics within the first year, consistent with COCA’s emphasis on producing physicians who are attuned to community and preventive medicine needs. While the specifics vary by school, accreditation standards from both bodies ensure that by the end of the pre-clinical phase, students have not only learned scientific concepts but also started to apply them in real-world or simulated clinical contexts.


Clinical Training

Core Clinical Rotations: Both LCME and COCA require a comprehensive set of core clinical clerkships in the latter half of the medical school curriculum (typically years 3 and 4). Under LCME standards, an MD program must ensure that all students complete required rotations in the major disciplines of medicine, commonly including internal medicine, surgery, pediatrics, obstetrics/gynecology, psychiatry, and family medicine (or other primary care rotations) (LCME, 2021). Similarly, COCA standards mandate that DO programs provide core clinical experiences covering internal medicine, surgery, OB/GYN, pediatrics, family medicine, psychiatry, as well as exposure to emergency medicine, radiology, and preventive medicine/public health (AACOM, 2019). In essence, both types of schools require students to get broad clinical training across organ systems and patient populations. The number of weeks and structure of each rotation might differ slightly by school, but accreditation ensures that every graduate—MD or DO—has participated in all key areas of clinical practice. Both LCME and COCA also require mechanisms to monitor that clinical sites provide appropriate educational experiences and that students are evaluated consistently during clerkships.



Clinical Training Model and Settings: Historically, one difference between MD and DO programs has been the model of clinical education. LCME-accredited schools have often been associated with a traditional academic medical center model: an integrated teaching hospital (or hospitals) where students do most of their rotations, often alongside residency training programs. LCME standards emphasize that the medical school maintains control over the educational quality at all clinical sites and that faculty (including attending physicians and residents) are prepared for their teaching roles (LCME, 2021). In fact, until recently, LCME standards effectively required that core clinical education occur at sites with Graduate Medical Education (GME) programs (i.e., where residents train), to ensure a robust teaching environment (Ahmed et al., 2023). Osteopathic medical schools, in contrast, have long used a distributed or community-based model for clinical education. COCA standards allow DO programs to partner with a network of hospitals and clinics, often community hospitals or private practice settings, sometimes geographically dispersed from the main campus (AACOM, 2019). Many osteopathic schools do not own a primary teaching hospital; instead, they affiliate with multiple clinical sites, which can include small hospitals without residency programs, rural clinics, and larger regional medical centers. This model has enabled osteopathic schools to expand into rural or underserved areas and to offer clinical education in diverse healthcare environments, consistent with the osteopathic mission of community-oriented care.



Recent Convergence in Standards: In the last decade, LCME and COCA standards for clinical training have converged significantly. COCA updated its requirements to ensure that osteopathic students also experience training in environments with residency programs. Currently, COCA standards specify that each student must have at least one core clinical rotation in a setting where an ACGME-accredited GME program is present (Ahmed et al., 2023). This change mirrors the LCME’s long-standing expectation regarding exposure to teaching hospitals with residents. The rationale is that interaction with resident physicians and training in a teaching hospital environment provide important learning opportunities (e.g., being part of a larger clinical team, seeing complex cases). At the same time, LCME has become more open to innovation in clinical training settings. Some newer LCME-accredited schools (for example, the Florida State University College of Medicine) also use distributed community-based clerkships and do not rely solely on a single teaching hospital (Ahmed et al., 2023). Both accreditation bodies now place strong emphasis on adequate supervision and teaching at all clinical sites. For instance, they require affiliation agreements that give the medical school authority over the education at the site and ensure students are supervised by credentialed physicians (LCME, 2021; COCA, 2019). In summary, while MD programs have traditionally been hospital-centered and DO programs community-distributed, both LCME and COCA standards ensure that students receive a well-rounded set of clinical experiences. The differences in settings are narrowing, and both models are recognized as valid as long as educational quality is maintained. The core outcome is that graduates of either system have engaged in hands-on patient care across a variety of core disciplines by the time of graduation.



Faculty Qualifications

Faculty Credentials and Composition: Both LCME and COCA stipulate that a medical school must have a sufficient number of qualified faculty to deliver the curriculum and fulfill the school’s educational, research, and service missions. Faculty members, particularly those teaching clinical subjects, are generally required to hold appropriate professional qualifications (e.g., M.D. or D.O. degrees, valid medical licensure) and, where applicable, be board certified in their specialties (Ahmed et al., 2023). Each accreditor expects that faculty appointments and promotions at the medical school follow rigorous standards and that faculty are competent in teaching their subjects. For clinical teaching, this means MD programs and DO programs alike hire or affiliate with physicians who are experts in their fields and capable of supervising students. Both LCME and COCA also require that the medical school maintain faculty development programs to continually improve teaching skills and ensure faculty are up-to-date (Ahmed et al., 2023).

Scholarship and Research Expectations: A subtle yet oft-cited difference lies in the emphasis on faculty scholarly activity. LCME standards encourage an academic environment of inquiry and expect that faculty members engage in scholarly work (which could be research, whether basic, clinical, or educational research) as part of their roles (Wood & Hahn, 2009). Many LCME-accredited schools, especially research-intensive ones, expect faculty to spend a significant portion of time on research and to demonstrate a commitment to advancing knowledge. The LCME’s position is that scholarly productivity is “characteristic of an institution of higher learning” and thus part of maintaining quality (Ahmed et al., 2023). In contrast, COCA standards also mention scholarly activity but have historically been viewed as less stringent in this area, reflecting the osteopathic educational model that prioritizes teaching and clinical service. Many osteopathic colleges are teaching-oriented institutions where faculty have heavier teaching loads and may have fewer resources or expectations for research. As Cummings (2015) observed, the wording of LCME and COCA standards regarding scholarship is similar, but the threshold for compliance is interpreted differently. COCA’s threshold for faculty scholarly activity has traditionally been lower or more flexible, which is considered appropriate given the mission and context of osteopathic schools (Cummings, 2015). This does not imply that osteopathic faculty do no research—some do, and increasingly DO schools are bolstering research—but it means that a DO school is less likely to be found noncompliant for not having a robust research enterprise, whereas an MD school might be held to a higher implicit benchmark in this area.

Special Faculty Requirements: COCA has a few specific requirements for faculty composition that LCME does not explicitly have. For instance, COCA standards require that osteopathic schools have faculty and leaders who are themselves trained in osteopathic medicine to uphold the distinctiveness of the curriculum. COCA expects each college to have an osteopathic physician in a key leadership role (often a chief academic officer or dean for clinical education) who ensures that osteopathic principles are integrated (COCA, 2019). Additionally, DO programs must have dedicated OMM faculty – specialists in osteopathic manipulative medicine – to teach and oversee that portion of the curriculum. LCME does not have an analog to this because it accredits allopathic schools where OMM is not taught. Instead, LCME focuses on having department chairs or course directors that are appropriately qualified in the disciplines they lead (e.g., an MD or PhD scientist leading basic science courses, board-certified physicians leading clinical departments). Both LCME and COCA require that clinical faculty (those teaching students in hospitals/clinics) are sufficient in number relative to the student class size. In fact, a newer COCA element (implemented in recent years) specifies a ratio or formula for the number of clinical rotation sites or faculty preceptors per student cohort to ensure adequacy (Ahmed et al., 2023). This was likely in response to the rapid expansion of class sizes and new DO schools, to guarantee that every student can be accommodated with quality clinical preceptorships. In conclusion, the faculty qualifications standards under LCME and COCA mostly align in insisting on well-qualified, board-certified instructors and ample faculty development. Differences lie mainly in the area of expected scholarly activity (with LCME placing more emphasis on research productivity) and the requirement for osteopathic-specific faculty roles in DO schools.



Student Assessments

Examinations and Evaluations: Both accreditation systems require that medical schools implement robust student assessment programs that ensure students are attaining the necessary knowledge, skills, and professional behaviors. This includes having a system of frequent formative and summative assessments throughout the curriculum. In practical terms, MD and DO students all take regular course exams during pre-clinical courses, undergo objective structured clinical examinations (OSCEs) to assess clinical skills, and are evaluated during clinical clerkships by supervising physicians. LCME standards emphasize assessing all competencies (medical knowledge, patient care, communication, ethics, etc.) and using diverse methods, including written exams, direct observation of clinical skills, and others (LCME, 2021). COCA standards similarly require that colleges employ appropriate methods to evaluate student performance in all domains, including osteopathic manipulative technique competency for DO students (COCA, 2019).

Licensing Examinations (USMLE vs. COMLEX): A significant difference in accreditation requirements concerns the national licensing examinations. Allopathic students traditionally take the United States Medical Licensing Examination (USMLE) series (Step 1, Step 2 CK, and Step 3 after graduation), while osteopathic students take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) series (Level 1, Level 2 CE and PE, and Level 3 post-graduation). The LCME does not require that students pass any particular licensing exam as a condition of graduation or accreditation compliance. In other words, the LCME leaves it to individual MD schools (and state medical boards) to decide how USMLE results factor into promotion or graduation. Many MD programs do require students to take USMLE Step 1 and Step 2 CK for graduation, but a passing score is often not explicitly required by the school for the MD degree (though practically, students must eventually pass for medical licensure). By contrast, COCA has explicitly required that DO students pass the first two levels of COMLEX as a graduation requirement (Ahmed et al., 2023). COCA accreditation Element 6.5 mandates that osteopathic colleges ensure all graduates have passed COMLEX-USA Level 1 and Level 2 (both Cognitive Evaluation and the now-suspended Performance Evaluation when it was active) prior to issuing the D.O. degree. This difference means that the stakes of licensing exams are formally higher in DO programs: a DO student cannot graduate without passing COMLEX, whereas an MD student could technically graduate without passing USMLE (if their school permits it). However, because virtually all students from both pathways need to pass their respective exams for eventual licensure, in practice this difference mainly reflects an administrative policy rather than a disparity in competence.

Another implication is that DO students historically had to balance preparation for COMLEX (required) and often USMLE as well (since many took USMLE for residency applications), whereas MD students only take USMLE. The accreditation difference is that LCME has no standard compelling a school to have a certain board pass rate, while COCA monitors COMLEX pass rates closely as a quality metric. COCA may place a school on warning or probation if its students’ first-time COMLEX pass rates fall below a threshold. LCME similarly expects schools to track USMLE performance as one measure of outcomes, but it doesn’t codify a minimum pass rate. Both systems want to see that graduates perform well on licensing exams; indeed, the outcomes data from recent years indicate that pass rates on USMLE Step 1 for MD students and COMLEX Level 1 for DO students are comparable (typically in the 90-95% first-time pass range), indicating high standards are maintained across both (NBME, 2021; NBOME, 2021).

Assessment of Clinical Skills and Competencies: Beyond standardized exams, LCME and COCA standards require comprehensive assessment of clinical skills. Both accrediting bodies necessitate that by graduation, students demonstrate competence in history-taking, physical examination, clinical reasoning, procedural skills, and interpersonal communication. This is usually accomplished via clinical skills exams (OSCEs) and evaluations during clerkships. DO programs also specifically assess students on osteopathic manipulative treatment skills. In the past, the COMLEX Level 2 included a Performance Evaluation (a hands-on exam with standardized patients), which was somewhat analogous to the USMLE Step 2 CS (Clinical Skills) that MD students took until it was discontinued in 2020. Both of those exams have been eliminated as separate requirements now, but schools themselves have filled the gap with internal clinical skills exams. Accreditation standards from both LCME and COCA require those internal assessments to be in place to ensure students are ready for residency (LCME, 2021; COCA, 2019). In summary, while COCA’s mandate that students pass COMLEX is a formal difference, the overall approach to student assessment is alike, focusing on verifying that all graduates meet defined competencies. Both systems use assessments as a tool for continuous improvement as well—schools must use data on exam performance, course grades, and outcomes to identify curricular strengths and weaknesses as part of the accreditation quality improvement framework.



Residency Placement and Outcomes

Residency Match Rates: Securing residency positions (graduate medical education) for graduates is a critical outcome for any medical school. Both LCME and COCA expect schools to monitor and facilitate their students’ success in the residency match. In terms of accreditation, a low residency placement rate could be a red flag indicating potential issues with the program’s preparation of students or its reputation among residency programs. Historically, graduates of LCME-accredited schools (MDs) participated in the National Resident Matching Program (NRMP) match, and those of COCA-accredited schools (DOs) had the option of the AOA Match (for osteopathic residencies) or the NRMP (for ACGME residencies). Since 2020, the residency accreditation systems have unified, and all graduates compete in a single Match for ACGME residencies. Data indicate that MD and DO graduates have had relatively comparable overall match rates in recent years, although MD seniors have a somewhat higher match rate in the NRMP Main Match compared to DO seniors (AAMC, 2022; NRMP, 2022). Both accrediting bodies have noted that graduation and residency placement rates are similar across for-profit vs. non-profit institutions and across MD vs. DO schools (Ahmed et al., 2023). In other words, attending a COCA-accredited osteopathic school versus an LCME-accredited school does not inherently disadvantage a student in obtaining a residency. The preparation is slightly different (DO students must take COMLEX, and often USMLE for certain specialties), but when looking at aggregate outcomes, residency placement is strong for graduates of both systems (Ahmed et al., 2023).

Specialty and Geographic Trends: One often-discussed difference is the specialty distribution and geographic placement of DO vs. MD graduates. Osteopathic medical schools, by tradition and often by mission, emphasize primary care and serving rural or underserved communities. As a result, a higher proportion of DO graduates enter primary care fields (family medicine, general internal medicine, etc.) and practice in rural or underserved areas compared to MD graduates (Gray et al., 2020). COCA standards require that a college of osteopathic medicine has a mission statement often highlighting primary care or community health, and schools must report outcomes such as the percentage of graduates going into primary care residencies. LCME schools vary widely in mission (some are research-oriented, others focus on primary care), but collectively MD graduates fill more specialty residency positions and are somewhat less likely to choose family medicine (AAMC, 2022). However, these tendencies are not rigid rules – many DOs enter subspecialties and many MDs pursue primary care. Accreditation per se does not force these outcomes, but the cultural and mission differences of the schools can influence student career choices. Importantly, both LCME and COCA are concerned with producing physicians to meet societal needs. Each accreditor might collect data on where graduates practice to see if they align with the school’s stated mission (for example, a DO school that claims to serve rural healthcare should show a good number of graduates in rural practice, which COCA would view favorably). According to Ahmed et al. (2023), evidence suggests DO graduates tend to serve in underserved areas and in primary care at higher rates than MD graduates, contributing positively to addressing physician shortages in those areas.

Graduate Performance: Beyond the match, both accreditation systems consider other outcome measures like graduation rates, licensure exam performance (discussed above), and alumni career achievements. LCME and COCA require schools to track their graduation rates and attrition. Typically, both MD and DO programs have high graduation rates (on average around 95% of students graduate within 4-5 years of matriculation). If a school had a significantly lower graduation rate, it would draw scrutiny from accreditors. So far, no systemic difference between DO and MD schools in this regard has been found; once admitted, the vast majority of students in both pathways successfully complete their training (Wood & Hahn, 2009). Another outcome of interest is board certification rates after residency, but that is farther down the line and not directly within the purview of LCME/COCA (it’s more relevant to GME accreditation). However, both LCME and COCA ultimately aim to produce well-qualified physicians, and the metrics from both sets of schools suggest equivalent quality. A 2009 study by Wood and Hahn (and reaffirmed by later commentary) concluded that there were no major differences in the quality outcomes of graduates attributable to accreditation standards (Wood & Hahn, 2009; Ahmed et al., 2023). In summary, when it comes to residency placements and early career outcomes, LCME and COCA accreditation are both effective at ensuring their graduates can transition into the next phase of medical training successfully. Differences in specialties chosen or practice locations seem to stem from institutional mission and student interests more than from accreditation limitations.



Resources and Facilities

Infrastructure Requirements: Both accreditation bodies have standards pertaining to the physical and informational resources that a medical school must have. This includes adequate classrooms, laboratories, clinical skills/simulation centers, libraries or learning resource centers, technology for teaching, and study space for students. LCME standards explicitly require that a medical school ensure access to appropriate resources to support the curriculum and independent learning (LCME, 2021). COCA standards likewise mandate that colleges of osteopathic medicine have the necessary facilities and equipment to meet their educational objectives (COCA, 2019). In practice, modern medical schools whether MD or DO have quite similar facilities: anatomy labs (though some schools now use digital anatomy or virtual dissection tables), simulation labs with manikins and OSCE rooms, and extensive electronic library resources. Both LCME and COCA survey teams inspect these resources during accreditation site visits to verify they are sufficient.

Financial and Support Resources: Accreditation also looks at the financial sustainability and student support services of a school. Both LCME and COCA require evidence that the institution has stable funding and budgets to carry out the medical education program. They also require academic support services (tutoring, academic counseling), mental health and wellness services for students, and career advising, including for the residency application process (LCME, 2021; COCA, 2019). There is no significant difference here; the expectations are equivalent. One distinction is that COCA has accredited a number of new, private osteopathic schools in the past two decades, including some without large university endowments or affiliate hospitals. As such, COCA closely reviews those schools’ resource plans (especially during provisional accreditation) to ensure they can provide everything students need. LCME also accredits new schools and similarly scrutinizes their resources. Both have put schools on hold or probation if resources were lacking.

Research and Laboratories: While not all medical schools are research-intensive, LCME accreditation (given its tie to the AAMC and the traditional academic model) might implicitly expect a certain level of research infrastructure, especially if the school claims a research mission. COCA has accredited schools with minimal research facilities (some DO schools historically focused almost entirely on teaching). As noted earlier in faculty qualifications, LCME’s standards about the academic environment are more expansive regarding research and scholarship (Wood & Hahn, 2009). For example, an LCME survey will check if students have opportunities for research or if the school encourages scientific inquiry. COCA surveys might focus more on clinical training resources than on bench research labs. However, this difference is again one of degree and mission: some DO schools now have significant research labs, and some newer MD schools are more focused on community health than lab research. Accreditation standards per se do not force a school to have a huge research enterprise, but they do require that if research is part of the mission, it should be appropriately supported. In both systems, students must have appropriate library resources (often electronic databases, journal access, etc.) to learn evidence-based medicine.

In summary, LCME and COCA both enforce robust standards for educational resources and facilities. There is no major divergence in requirements here; any differences come from the nature of the institutions themselves (e.g., DO schools being standalone colleges vs. many MD programs embedded in larger universities or academic health centers). Both accreditors share the fundamental expectation that students have access to the tools, spaces, and support necessary to become competent physicians.



Governance and Institutional Oversight

Accrediting Bodies’ Composition and Policies: The governance of the accrediting agencies themselves has differed in some respects. The LCME is a committee sponsored by two organizations (the AAMC and the AMA) and traditionally has included representatives appointed by those bodies, including medical educators, practitioners, and at least one medical student member with voting rights. The presence of a student on the LCME has long been cited as a way to include the learner’s perspective in accreditation decisions. COCA, which operates under the AOA, historically did not include a medical student in its voting membership (Wood & Hahn, 2009). This was noted as a governance difference: LCME had student representation, COCA did not. However, in recent years COCA has made changes to incorporate student input. As of the late 2010s, COCA added positions for student representatives on certain committees and even on the COCA board (Ahmed et al., 2023). Ahmed et al. (2023) report that COCA now has a student board member with full voting rights, bringing it in line with LCME’s practice and eliminating that particular difference in governance. Aside from student involvement, the basic structure of both accrediting bodies is functionally similar – both are composed of educators and professionals who establish standards, review self-study documents, and conduct site visits to make accreditation decisions (Wood & Hahn, 2009).

Non-Profit vs. For-Profit Institutional Status: In the realm of institutional oversight, one major historical difference was the stance on for-profit medical schools. The LCME had a standard indicating that a medical school should be part of a not-for-profit institution, unless under exceptional circumstances (Wood & Hahn, 2009). This effectively meant that for decades all LCME-accredited MD schools were non-profit (either state institutions or private non-profits). In contrast, COCA, under the AOA, allowed for-profit entities; indeed, the first for-profit osteopathic medical school (Rocky Vista University College of Osteopathic Medicine) was established in 2006 with COCA accreditation. Wood and Hahn (2009) highlighted this as a governance difference — osteopathic accreditation had opened the door to investor-owned schools, whereas LCME standards discouraged it. However, this gap has narrowed. In the 2010s, LCME did grant accreditation to at least one for-profit MD program (for example, a new school in Florida, if certain justifications were met), and by the late 2010s, LCME formally revised or reinterpreted its standard to allow accreditation of for-profit schools given proper oversight (Ahmed et al., 2023). Now both COCA and LCME accredit a small number of for-profit medical schools. Accreditation reports so far indicate that these for-profit schools have similar tuition levels and student outcomes (graduation rates, residency match rates) as traditional non-profits (Ahmed et al., 2023). The long-term implications of for-profit medical education continue to be debated, but from an accreditation standpoint, both agencies hold these schools to the same standards of quality as any other medical school.

Institutional Governance Requirements: LCME and COCA each require that the medical school have an effective governance structure and academic leadership. For example, both require that the school’s dean is qualified by education and experience to lead a medical education program (LCME, 2021; COCA, 2019). They also require that there be defined roles for faculty in governance (e.g., curriculum committees), that there are bylaws outlining responsibilities, and that the school has appropriate autonomy to direct the medical education program (even if it’s part of a larger university or health system). Both accreditors monitor things like conflicts of interest in governance, whether the school’s sponsoring institution provides sufficient support, and whether there is stability in leadership. One notable difference is in how new schools are approved and monitored. COCA, due to the rapid growth of osteopathic schools, has an established process for provisional accreditation and enhanced oversight for new COMs to ensure they develop properly through their first graduating class. The LCME similarly has a candidacy and provisional status for new MD schools. Both processes are rigorous, but the sheer number of new DO schools in the last 20 years has been higher, so COCA has dealt with more start-up institutions. This perhaps gives COCA more experience with guiding new schools and maybe a slightly different approach, but fundamentally the principles (ensuring a sound plan, resources, and progressive development) are alike.

Oversight and Continuous Quality Improvement: Modern accreditation places a strong emphasis on continuous quality improvement (CQI) within institutions. LCME explicitly requires schools to engage in strategic planning and CQI to address any areas of noncompliance or concern proactively (LCME, 2021). COCA also emphasizes ongoing self-assessment and improvement, expecting schools to not just attain standards but to continuously monitor their performance (COCA, 2019). Both accreditation bodies schedule periodic full reviews (typically every 7-8 years for LCME, and a similar cycle for COCA), with progress reports or interim reports in between as needed. If standards are not met, both can take actions such as warning, probation, or in extreme cases, withdrawal of accreditation. These enforcement mechanisms are essentially the same. There have been examples of both LCME and COCA putting schools on probation for issues like inadequate faculty or unstable finances. Each situation is handled per the accreditor’s procedures, but the commitment to enforcing standards is equally strong.

In summary, the governance and oversight aspects of LCME vs. COCA show more similarity than difference. Early differences (student involvement in accreditor governance and non-profit status preferences) have diminished over time. Both accreditation systems rely on peer review and uphold integrity in medical education. The presence of two separate accreditors is historically rooted in the distinct allopathic and osteopathic professions, but as this analysis shows, they now function in very comparable ways, and there is ongoing dialogue about possibly moving toward a more unified approach (Ahmed et al., 2023).



Conclusion

In comparing the LCME and COCA accreditation systems, it becomes evident that the two share a common foundation in ensuring quality medical education, with only nuanced differences reflecting the traditions of allopathic vs. osteopathic medicine. Curriculum: Both accreditors mandate comprehensive curricula that produce competent physicians, with DO programs distinguished by additional OMM training to uphold osteopathic principles. Clinical training: Both require broad clinical experiences, and recent changes have aligned their expectations for clinical learning environments, bridging a historical gap between academic medical center training (MD) and community-based training (DO). Faculty: Both insist on qualified faculty and adequate teaching staff; LCME places greater emphasis on research activity, whereas COCA focuses on maintaining osteopathic expertise among faculty. Assessments: Both ensure robust student assessment systems; a notable difference is COCA’s requirement for COMLEX passage, contrasting with LCME’s more hands-off approach to USMLE (relying on but not requiring it). Outcomes: Both types of schools achieve similar outcomes in terms of graduation rates and residency placement, suggesting that neither accreditation pathway is inherently superior in producing successful doctors. DO graduates often gravitate to primary care and underserved areas, aligning with osteopathic school missions, while MD outcomes vary by school mission, but these trends are not products of accreditation standards per se. Resources: Both LCME and COCA require that medical schools have the physical, financial, and support resources to provide a quality education; there is no major discrepancy here aside from the varying contexts of institutions. Governance: Initially different in philosophy on student roles and for-profit institutions, the two accreditors have grown more similar, with COCA incorporating student representation and LCME accepting diverse funding models.

Crucially, none of the differences identified appear to create a deficit in educational quality. Studies and expert analyses have concluded that the accreditation standards of LCME and COCA are more alike than different, and that both produce graduates well-equipped for the next steps of training (Wood & Hahn, 2009; Ahmed et al., 2023). In other words, attending an LCME-accredited MD program versus a COCA-accredited DO program, from an accreditation standpoint, should not significantly affect the quality of one’s education or one’s readiness to become a physician. The distinctions that do exist—such as learning osteopathic manipulation or taking a particular board exam—reflect the distinct identities of the two professions rather than disparities in rigor.

The implications of this comparison are especially relevant as the medical education community considers future directions. With graduate medical education now under a single accreditation system (ACGME for all residencies), some have speculated whether undergraduate medical education could eventually move toward a unified accreditation process (Ahmed et al., 2023). Proponents argue that a single accreditor could streamline the system and ensure even more consistency, while others emphasize the importance of preserving the unique aspects of osteopathic education. The evidence from this analysis suggests that merging the systems would not require major changes to standards, since LCME and COCA already overlap extensively. However, it would require careful governance to give equal voice to DO and MD interests. Ultimately, whether separate or unified, the focus of accreditation remains on protecting students and the public by holding medical schools to high standards. Both LCME and COCA have demonstrated commitment to that mission. Going forward, continued sharing of best practices between the two accreditors can further minimize any meaningful differences in quality, ensuring that all medical graduates—MD and DO alike—enter residency training with a strong and equivalent foundation.



References

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AAMC. (2022). Results of the 2022 NRMP Main Residency Match. Association of American Medical Colleges. (Data report).

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LMAO. Nothing like a good CACA spin.

 

[DO2015CA]

LMAO. Nothing like a good CACA spin.

Are you saying AI isn’t ready to replace us all?!? Idkkkk chatGPT says so.

/s

 

[petomed]

Are you saying AI isn’t ready to replace us all?!? Idkkkk chatGPT says so.

/s

27% ready

 

[AlbinoHawk DO]

My conclusion from this discussion is that I will study hard, do extensive research, perform well on the Steps and rotations, and match into my desired specialty. Then, once I am settled, I will work with a foreign medical school to obtain the MD title since it matters to me so much. Thank you.

I don't know if you're joking or not, but just so you know, there are places (everywhere?) where it would be illegal for you to use the MD because you are licensed as a DO. You'd be misrepresenting/trying to falsify, your title. This is why some foreign grads who can't get into residency and do PA or NP can't list themselves as MD, PA or MD, NP

 

[DocWinter]

I don't know if you're joking or not, but just so you know, there are places (everywhere?) where it would be illegal for you to use the MD because you are licensed as a DO. You'd be misrepresenting/trying to falsify, your title. This is why some foreign grads who can't get into residency and do PA or NP can't list themselves as MD, PA or MD, NP

Are you talking about countries? Governments? Certain Hospitals?

I feel like a lot of generic paperwork has "MD" next to where I sign my name despite being a DO, and it is more of a level of care thing.

It's not misrepresenting if there is no check box for DO and you click MD, because that's the level of care you are fulfilling. The lack of public understanding doesn't make my degree less qualified.

I guess I don't quite understand what you're referring to by "places".

 

[AlbinoHawk DO]

Are you talking about countries? Governments? Certain Hospitals?

I feel like a lot of generic paperwork has "MD" next to where I sign my name despite being a DO, and it is more of a level of care thing.

It's not misrepresenting if there is no check box for DO and you click MD, because that's the level of care you are fulfilling. The lack of public understanding doesn't make my degree less qualified.

I guess I don't quite understand what you're referring to by "places".

In certain situations you have no choice but to check a box, but when given the option, you obviously check the correct box. My point is about the fact that you can't advertise yourself as an MD by having licensure as a DO. I don't think any organization or licensing board would come after you if your hospital writes you up as "MD," but they would if you start calling yourself DocWinter, MD at your your office, business cards, etc. when you have the clear ability to put your actual credentials