AACOM Response to "The Unintended Consequences of the ACGME Merger"

Discussion in 'Osteopathic' started by OCDEMS, 05.19.14.

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  1. OCDEMS

    OCDEMS 2+ Year Member

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    http://www.aacom.org/news/latest/Documents/Gevitz_05192014.pdf

    I suggest reading both in their entirety, but here are some interesting highlights:

    "FACT: GME is a publicly funded resource. To date, there have not been any stated
    policy justifications that would warrant the closure of the very schools that policy
    makers have recognized are producing the type of physicians that the nation needs,
    especially when they are less costly to taxpayers and recognized as a real benefit to the
    communities in which they serve. The osteopathic profession today is in a much more
    advanced state of political presence than it was a century ago, and is recognized as a
    successful and valued resource. It would be very surprising, and highly self-defeating,
    for the AMA and the AAMC to challenge the value of osteopathic medical schools as a
    resource in this country. "

    "FACT: Under the implemented single accreditation system, AACOM and AOA will
    hold eight seats on the governing board of ACGME, which is 28% of the governing
    board members from sponsoring organizations
    (AAMC, AMA, CMSS, AHA, and
    ABMS). DOs are 7-8% of the practicing physicians in the U.S., and DO graduates are
    rapidly approaching 20% of all U.S. medical school graduates. In this circumstance,
    how likely is it that ACGME’s board would vote to limit access to their programs to
    only LCME graduates? If such limits were even considered, wouldn’t it be more likely
    to occur if AOA and AACOM were not member organizations and had no presence
    within the organization?"


    Original letter from Dr. Gevitz: http://www.oucom.ohiou.edu/hpf/pdf/...intended Consequences of the ACGME Merger.pdf
     
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  3. Awesome Sauceome

    Awesome Sauceome SDN Gold Donor Gold Donor 2+ Year Member

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    Wow they are 28% of the governing board. I think that is generous considering that only 7-8% of the practicing physicians are DOs. I definitely see that as good news.
     
  4. Ibn Alnafis MD

    Ibn Alnafis MD 7+ Year Member

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    Great response letter. I love it!
     
  5. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Agreed. I love that it is based on facts, and not rumor or hearsay.
     
  6. UTsksk

    UTsksk 7+ Year Member

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    Worth the read. I liked it.
     
  7. Spikebd

    Spikebd 5+ Year Member

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    Thank God, outstanding reply by our leadership. DO's and MD's coming closer together is good news for the medical profession, which is facing serious threats in the future.
     
  8. BMSc2DO

    BMSc2DO 2+ Year Member

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    Good response by AACOM... I am impressed.
     
  9. MUSCULOSKELETAL23

    MUSCULOSKELETAL23

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    well I think AACOM responses are simple regurgitation not really mentioning how to prevent the fall outs and just plenty of assumptions.
    I actually Do agree with Gevitz's statement.
    As a resident transitioning between AOA internship(Traditional Rotating Internship) and ACGME residency, I have noticed MD attendings mocking attitudes toward DO programs in the hospitals.
     
  10. MUSCULOSKELETAL23

    MUSCULOSKELETAL23

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  11. Dr. Zombie

    Dr. Zombie 2+ Year Member

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    Can you elaborate?
     
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  12. abolt18

    abolt18 Turkey can never beat cow 2+ Year Member

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    A lot of 'what if' and doom and gloom in Gevitzs writing. Much seems unwarranted (or not bad).
     
  13. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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  14. NeuroLAX

    NeuroLAX Discere faciendo 2+ Year Member

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    Oh, I do love a good conspiracy theory.

    [​IMG]
     
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  15. Awesome Sauceome

    Awesome Sauceome SDN Gold Donor Gold Donor 2+ Year Member

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    My problem is that Gevitz is fighting that the merger will cause a loss of Osteopathic residencies (roughly 20%) due to ACGME likely not accrediting them. But the reality is, that if those residencies are threatened to close (due to not being up to the ACGME's standards), then they should not be open in the first place. Why should Osteopathic professional training not be up to the standards that the majority of physicians in this country ( roughly 90% MD) have to go through? I can see where he is coming from, but this is not even a question of "equal but different" when it comes to practicing differences (though he briefly tries to argue it). It is a question of creating physicians of a certain caliber that are respected not due to their title, but their excellent training.

    He then continues that if DO students go on into ACGME residencies then they will have no reason to have AOA certification... well obviously? Why would they want to join something that is recognized as being inferior? Instead of trying to force DOs to join an inferior medical licensing board. Why not bring the AOA up to where the ACGME is in quality and quantity of residencies (relative to DOs graduating) and then let the DOs decide for themselves. That would be the best for their medical training because it would give them the best options available. But I bet it would be bad for the AOA's pocket book (especially during the initial transition period), which is why there are arguments like this. If you make enough residencies, and you make them really solid so that people would not see it as a backup, then I imagine that AOA membership would remain at its current percentage or even grow. But in the end it all comes down to money.

    He remarks on how his MD colleagues share that they are excited about the unified match because it is in the best interest of the public health. I fully agree with this. If the standards are set at an equally high bar across the country for both MDs and DOs, then the outcome will be physicians that are well trained. Thats what the country needs, quality trained physicians, not a bunch of medical boards that the public does not even know exists, constantly fighting with each other.

    Dont even get me started on his argument about a lack of MD residency spots. The ACGME has had enough spots every year to not only fill up from their own schools, but have also graciously given spots for DOs and IMGs. Those 500 students that did not match are likely for some other reason, not a lack of available positions. If the ACGME closed its doors to DOs, then future osteopathic students would be screwed, the AOA simply does not have enough spots for their students. He further argues about how they are opening too many MD schools to quickly.... well thats calling the kettle black isnt it... I cant even find the words for this argument in light of some of the DO schools that have been proposed or have sprouted up as of late.

    I can mildly understand his apprehension about how the merger will effect medical schools themselves (not just the GME training). I can see his concern for the differences in how COCA and the LCME recognize schools. This is one of his only arguments that I can mildly agree with. He sort of brings on a doom and gloom viewpoint for if COCA joins the LCME, but at the same time, its not terribly unreasonable the method he argues by which osteopathic medicine is slowly transformed into allopathic. His argument for some DO schools closing is factual... while he sees it as a bad thing, maybe some DO schools should not be open in the first place? (At least that is what is argued heavily on SDN for some schools). So would it be a massive problem if some of the weaker schools close their doors?

    I can also agree with his final statement summarizing the whole merger problem. I do appreciate the differences in DO and MD schools and teaching. And it does seem that the AOA feels that they have no choice but to join and conform. Maybe that is the only way for this unique medical profession to move forward? But maybe there is another way by which they can create and provide more residencies for their graduating students and continue to maintain their own identity? Who knows....

    I realize that seems like a rant and I apologize. I am applying to DO this cycle and am super pumped at the opportunity to learn at any school I would be accepted at. But just as a normal person and someone mildly interested in politics, the stuff that some of the people argue and think high up in the AOA and elsewhere, just baffles my mind. At least that is what I have gathered from those links, now that I have had the time to read them.
     
    Last edited: 05.20.14
  16. BMSc2DO

    BMSc2DO 2+ Year Member

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  17. ChrisGriffen

    ChrisGriffen Banned Banned 2+ Year Member

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    If you just trim down your post, you will notice that you answered your own question.

    AOA programs cant just magically improve to ACGME standards without increased GME funding.
     
  18. Awesome Sauceome

    Awesome Sauceome SDN Gold Donor Gold Donor 2+ Year Member

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    Sadly not... its a pickle to be in... My rant is more towards Gevitz, not AOA or AACOM. You cant change the situation we are in, I think the AOA and AACOM finally appreciate that. Especially now after reading AACOM's response, I am glad to see that they agree with a lot of my arguments against Gevitz. Basically in a nutshell my rant was suggesting that Gevitz was being unreasonable/unrealistic, as well as simply being inaccurate about a few things.

    AACOM is definitely more eloquent than I am about it though haha
     
    Last edited: 05.20.14
  19. hallowmann

    hallowmann 2+ Year Member

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    Could you explain how the attitudes of some MDs even plays into this?

    If it does (it doesn't), how do you expect their attitudes to change when those programs become ACGME accredited? Or alternatively, how do you think their attitudes will change if DOs pull out of the agreement out of fear that our residencies can't hack it and won't make the cut, and when all DOs who complete an AOA residencies are blocked out from ACGME fellowships (i.e. the majority of fellowships)?
     
    Last edited: 05.20.14
  20. iamthelaw

    iamthelaw

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  21. Drrrrrr. Celty

    Drrrrrr. Celty Osteo Dullahan 7+ Year Member

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  22. GUH

    GUH Underdawg 5+ Year Member

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    The response does nothing at all to address most of Dr. Gevitz's core arguments, including the impending redundancy of the AOA specialty colleges. Nor does it address the concern of many in the DO world that respected PD's will no longer be able to retain leadership over their programs if they were trained by the AOA, or any of the other issues which have been brought up, such as the fact that the ACGME had made no assurances whatsoever that programs will stop discriminating against DO applicants.

    And awesomewhatever: there are reasons why good programs might not meet ACGME standards which have nothing to do with the program's outcomes. Likewise, there are reasons why solid DO schools (again in terms of actual outcomes) may not meet LCME standards. Please do some research on this before making long posts on the topic.
     
    Last edited: 05.21.14
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  23. Drrrrrr. Celty

    Drrrrrr. Celty Osteo Dullahan 7+ Year Member

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    Honestly if they don't meet ACGME standards then they probably really aren't good programs. But again, they've said they're not killing programs based on size.

    Schools will have to rethink themselves and will be stronger in the long run by meeting LCME standards.
     
  24. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    The specialty colleges are already redundant.

    I think the PD concern is a valid one. I hope they're able to at least grandfather the current PD's in. The ACGME should concede that.
     
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  25. Apprands31

    Apprands31

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    I think what everyone is missing here is that DO PDs have other jobs. Being a PD is a part-time job for these folks. The prestige that these fellows get is to be able to tell their patients that they train residents. That's it. So if they can't be a PD they won't be destitute.

    There are DOs who are ACGME trained in every specialty. The ACGME requires that the PD be ACGME trained . The PD does not necessarily have to be an MD. Hence, ACGME trained DOs can be recruited to be PDs.

    A graduating physician needs to complete a residency in order to practice. There are more DO graduates than AOA residency slots. When, not if, the ACGME closes its residencies to DOs, there will be half of the graduating DOs who will be without a position. The merger MUST happen.
     
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  26. GUH

    GUH Underdawg 5+ Year Member

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    There was no indication that the ACGME had immediate plans to close all programs to DOs and there is no indication that all programs currently closed to DO's will start admitting DOs on an equal basis with MDs with the merger. The merger did not fix anything in that regard. At best you can argue that it allows us to continue to apply to fellowships. And removing qualified PDs from their positions (or forcing them to work with an ACGME-trained babysitter) just because they were trained in AOA programs is blatant discrimination and should be condemned.
     
  27. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    :thumbup:

    The merger will guarantee that ACGME residencies will always be open to DOs. This alone makes it worth it.

    Dr. Gevitz says the solution is for the AOA to open "ambulatory-based primary care residency programs which mirror the real-life practices of family physicians, general pediatricians, general internists..."

    In other words, he wants to solve the residency crunch by training DOs in random doctors' offices. Nice.
     
    Last edited: 05.21.14
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  28. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Because that's like, not a big deal at all.
     
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  29. Drrrrrr. Celty

    Drrrrrr. Celty Osteo Dullahan 7+ Year Member

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    Gevitz interest is in maintain power and money. If it means dragging osteopathic medial graduates through the dirt then he's more than happy.
    .
     
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  30. GUH

    GUH Underdawg 5+ Year Member

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    Do you have any proof?
     
  31. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Well since the AOA and AACOM will be part of the ACGME...

    Edit: Note that I didn't say all ACGME residencies will be open to DOs or that all ACGME PD's will rank them. I simply said ACGME residencies as a whole will be open to DOs.
     
  32. dyspareunia

    dyspareunia

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    ACGME residencies already are open to DOs. A merger doesn't guarantee that they remain open. Unless you slap ACGME programs with a "DO Quota" there is nothing preventing PDs from discriminating against DOs.

    I'm used to seeing pre-meds saying things like that, but I'd expect better of colleagues (i.e. you, a fellow med student).
     
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  33. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    Read what I said above (in the edited part.) I didn't say or mean that the merger would prevent ACGME PD's from discriminating. I said that it would prevent the ACGME from ever restricting DO's from their residencies as a matter of overall policy.
     
  34. Epicspadias

    Epicspadias

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    This person cites the closure of homeopathic schools as a reason that DO schools will be closed.

    I can't begin to list all of the reasons that this makes him an idiot and the DO profession look bad.
     
  35. DermViser

    DermViser 5+ Year Member

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    Yup, nothing like quoting a PhD historian and sociologist on medical education.
     
  36. dyspareunia

    dyspareunia

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    The ACGME already doesn't have an overall policy restricting DOs from their residencies. Even without a merger, the ACGME would never be able to pass open policy preventing DOs from applying, ranking, and matching.

    However, I'll humor your implied suggestion that prior to the merger the ACGME could (some years down the line) place an outright ban on DOs. Just because the ACGME and AOA merge does not mean that DOs can't still be banned from applying to certain residencies. The majority of the board is still controlled by ACGME guys and there's nothing new preventing them from doing what they want. If the AOA has the right to keep their programs "osteopathic focused", then the ACGME programs have the right to keep their programs "osteopathic free". So status quo is maintained, except that the AOA programs have to answer to the LCME.

    In other words, the merger has no effect on what the ACGME could, would, or should do about policies regarding DOs and residency eligibility.
     
    Last edited: 05.21.14
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  37. YouWithTheHair

    YouWithTheHair 2+ Year Member

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    Last edited: 05.21.14
  38. YouWithTheHair

    YouWithTheHair 2+ Year Member

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    Last edited: 05.21.14
  39. dyspareunia

    dyspareunia

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    I don't think you read my post correctly. I do think the merger is a positive, but it isn't changing the existing bias that some people feel towards DOs.

    I'm an MD student.. maybe that clears things up for you?
     
  40. dyspareunia

    dyspareunia

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    Here's some proof. Many of the "low tier" MD schools have been open and ACGME eligible for many decades. Places like WashU, HMS, JHU, etc still discriminate against "low tier" MD graduates. What makes you think DO schools will have a better fate?

    The same is true for MD schools discriminating against community college graduates. Maybe it's because PDs and administrators think students from "lesser" schools are of lower quality, or maybe it's because the better/best programs have their pick of the litter and there's no reason to take a chance on a student from a "lesser" school. Regardless of the motive the merger does not change the factors that discrimination is based on.
     
  41. YouWithTheHair

    YouWithTheHair 2+ Year Member

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    Last edited: 05.21.14
  42. YouWithTheHair

    YouWithTheHair 2+ Year Member

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    Gotcha. I misunderstood your intention with the previous post. Coming from one of the founding DO schools(I will not mention which), I hear a decent amount of complaints of doom and gloom about the merger. I miss read your post and thought I was hearing the same old song again. I definitely agree with you though. Discrimination is still going to exist for a while. These things take time.
     
  43. Spikebd

    Spikebd 5+ Year Member

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    Yea I don't see biases going away very quickly, and I doubt they'll ever really go away at "elite" med schools. It's pretty lame if they discriminate against "low" tier MD school applicants anyway. I don't know who'd wanna train with people that arrogant.

    Edit - People who are more concerned with what their mom or mom's friends think of them probably go for that ***t
     
  44. Trannie

    Trannie A-List Celebrity

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    There's a reason elite schools are left in their own bubble, and it's not because they discriminate against allopathic "commoners" (wait...they do).
     
  45. SurgeDO

    SurgeDO 2+ Year Member

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    it is in inalienable right that comes with a higher MCAT average.
     
  46. Trannie

    Trannie A-List Celebrity

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    trust me, those egos were in place before their MCAT score was released on a typical Tuesday afternoon.
     
  47. costales

    costales 2+ Year Member

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    Which should be embroidered in neon - to be lit up whenever they say "Ahem, when I was at HOPKINS blah blah blah zzzzzzzz" and everyone bows in unison, of course. LOL
     
  48. da Vincis World

    da Vincis World 7+ Year Member

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    It's not that the merger was the best option......the merger was likely the only option. The AOA put themselves in a really tough position by (1)not having enough fellowships developed for residencies that typically go that route and (2) expanding the number of DO graduates far beyond the available AOA PGY1 positions. ---> osteopathic medicine in its current state cannot exist without ACGME fellowships and residencies.

    Until these two problems are addressed the ACGME will continue to have the upper hand on the AOA when it comes to negotiations.

    I think it is incredible that the AOA got 28% of governing board members with what appears to be ZERO leverage.
     
  49. Drrrrrr. Celty

    Drrrrrr. Celty Osteo Dullahan 7+ Year Member

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    Chances are the ACGME is more than willing to share power as long as it gets control of the AOA residencies. This will likely also include eventually bringing the entire profession closer as a whole to push out IMGs and consolidate power against nurse expansion and etc.

    Idk, I'm optimistic. The MDs want to acquire us. They don't want to destroy us, that much is clear.
     
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  50. MS114

    MS114

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    Basically you were right that it was the only option, but not just for the reasons stated above. Essentially the ACGME forced the AOA's hand by saying they would lock us out of fellowships, then told the AOA that if they joined, basically we would get access to fellowships again….however with the caveat that essentially they would strip the AOA of most of its powers. This is the main reason it fell apart in the first place…

    What a lot of people don't know is that some serious power brokers brought them back to the table….and guess who it was?….The Feds. They basically told both sides that since THEY are the one's paying for it….they want a unified system. Essentially some high-ups in the government told the ACGME and AOA to play nice, get along, and fix the problem….or they were going to do it for them. Hence why they sat back at the table and hammered out an agreement so quickly (the second time around). The federal government finally had enough of both sides acting like children (ironic in today's political climate) and strong armed them into an agreement….

    Lol why they can do this but DO NOT RAISE GME FUNDING is beyond me….but a discussion for another day haha
     
  51. NurWollen

    NurWollen Strong with the Force 7+ Year Member

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    A while back, after the first attempt at a merger fell through, but before it was successfully worked out the second time around, I heard an AOA PD mention basically the same thing. He said that he saw the possibility of the government getting involved because the feds wanted there to be one system of accreditation.

    That was a while ago but it does back up what you are saying.
     

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