ACGME Merger and USMLE/COMLEX

[22031 Alum]

I would argue that you'll get more out of being first-assist with a surgeon than you would with surgical interns where you might not even be scrubbing into many cases.

Perfect summary of how what medical students think is important to do in rotations, doesn't line up with what people like me, who teach, think is important to do in rotations. You absolutely must be a resident before you are a practicing physician. That is where you learn first the foundation, and then the advanced principles, of your specialty. There's no getting around it. So what kind of sense does it make as a student, to skip straight to the "assisting in surgery" part, without seeing and learning about the "managing a list of floor patients" part? Intern year is a terrible time to get your first taste of that. Sub-Is aren't much better.

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[IsWhat]

Where did you get such a statement that I placed in bold above? Academic medicine sits on a foundation of teaching. Preceptor based teaching at a community hospital with loose ties to a DO school have no incentive and really no need to go crazy in terms of having solid teaching experiences. I'm not stating community hospitals with GME are of "lesser degree" because on the contrary there has been some evidence to show that non centralized teaching on third year improved clinical exam scores (http://www.ncbi.nlm.nih.gov/pubmed/27064717)

I disagree. A 3rd year or 4th year student should be learning to become a INTERN...not a full fledge physician whom which they will learn from in an preceptor based setting. In many cases, these attending docs are light years out from their intern and really have no idea what "the basics" nor how to teach them as well as a PGY-2 or PGY-3 who truly understands the system of teaching in an academic environment.

In regards to the surgical service utilizing preceptors: obv I may be riding the slippery slope here with your statement but just because Mayo Clinic has focused their srugery service to be preceptor based does not illustrate it as an effective way of teaching medical students. What you also need to bring into question is the risk that occurs in a preceptor based model in becoming a "make or break" type of career decision factor since you're only with one person that whole time. (http://www.sciencedirect.com/science/article/pii/S1072751506015870?np=y)

Fair points.

I would counter by saying undergraduate medical education is extremely archaic, and medical students are entering intern year with little clinical competence. IM rounds - for example - has ballooned into this overly long drawn out process which feels more like a group of actors practicing their monologues with a few critiques at the end. There simply isn't enough real clinical training for medical students in a setting where you round all day with 12 other people - most of whom are senior to you. Ask any old time doc and they will tell you clinical competence is at an all time low - and the problem starts in undergraduate medical education. There have been plenty of articles written about this problem, so it's not a new revelation.

While a strictly preceptor-based education may leave some holes in a students education, I applaud any university or medical center for trying to cut out the fat in undergraduate and graduate medical education in order to get to the real learning. The academic model has taught physicians for decades, but it has grown too cumbersome and leaves a lot to be desired.

 

[Sai111394]

Very good explanation. I myself have only seen preceptor-based rotations work in a solid way and that was at UCSD at an outpatient endocrinology clinic with one fellow and two medical students. Said attending spent time b/t consults to teach, allowed the student to perform the interview, present the pt to us and asked them how they would manage with solid clinical pearls tied in. Without a doubt, these students also had a very strong inpatient experience with a resident team.

That's why I feel so strongly that the casual affiliations that the majority of DO schools make with small community hospitals needs to become a lot more stringent....but sadly there's still a huge variability on the aspect of those expectations and as you said, it comes with the justification for PD's to hone in on US MD students because the clinical training is structured and the checks and balances in place to ensure such training goes beyond a SINGLE core site director who throws you to the wolves with really no guidance at all.

Don't a majority of the more well established DO schools have affiliations with a number of hospitals that have a residency structure or at least inpatient exposure?

 

[Instatewaiter]

Not sure why we have to knock on preceptor-based rotations under all circumstances. I think for certain specialties it's probably better to be with a preceptor than on wards at an academic hospital. My pediatrics rotation was on a teaching service and entirely inpatient and I missed out on some basic stuff because of it. My FM rotation was with a preceptor at her office and I think that was better than if it had been at a teaching hospital. My classmates who did inpatient FM at a teaching hospital said it was pretty much just another IM rotation and they didn't actually learn any family medicine.

So while it's probably not ideal to do all rotations with preceptors, I don't agree that preceptor-based rotations are necessarily inferior, especially for certain specialties.

I think you serve as a nice example of how certain schools can have crap rotations. How on earth could you have a rotation for a specialty that splits both outpatient and inpatient and not have both experiences. For instance our Peds rotation was split in half between inpatient rotations and outpatient rotations. Our medicine rotation was 1 month outpatient, 1 month at the VA and 1 month at the big house. Everyone at the school had the same experience. That is another concerning thing about your experience the variability between students.

One of the hallmarks of solid clinical education, whether DO or MD is delivering a uniform education for all students in addition to producing a strong product.

 

[IslandStyle808]

Don't a majority of the more well established DO schools have affiliations with a number of hospitals that have a residency structure or at least inpatient exposure?

One thing @AlteredScale stated to me a while back is that there are those rare exceptions that don't necessarily get the prescribed experience. For example, he told me of one rotation at his school where there is a residency program, but the students rotate with the preceptor only. This right here blew my mind that something like this is happening at an established school. Then you might have the occasional student that is learning his entire rotation in an outpatient setting.

People state that the older schools do have a great overall education. However, the equality is not exactly there for everyone nor is a good system to checks and balances that most MD schools have.

 

[GUH]

I think you serve as a nice example of how certain schools can have crap rotations. How on earth could you have a rotation for a specialty that splits both outpatient and inpatient and not have both experiences. For instance our Peds rotation was split in half between inpatient rotations and outpatient rotations. Our medicine rotation was 1 month outpatient, 1 month at the VA and 1 month at the big house. Everyone at the school had the same experience. That is another concerning thing about your experience the variability between students.

One of the hallmarks of solid clinical education, whether DO or MD is delivering a uniform education for all students in addition to producing a strong product.

I agree that it was not ideal and an example where an inpatient, wards-based teaching rotation at a teaching hospital is not the best. There were also MD students (including US MD) on the same rotation with me doing it as their core pediatrics rotation.

Overall though I am pretty satisfied with the quality of my core clinical education, although admittedly I have not gone through internship yet.

 

[Instatewaiter]

Fair points.

I would counter by saying undergraduate medical education is extremely archaic, and medical students are entering intern year with little clinical competence. IM rounds - for example - has ballooned into this overly long drawn out process which feels more like a group of actors practicing their monologues with a few critiques at the end. There simply isn't enough real clinical training for medical students in a setting where you round all day with 12 other people - most of whom are senior to you. Ask any old time doc and they will tell you clinical competence is at an all time low - and the problem starts in undergraduate medical education. There have been plenty of articles written about this problem, so it's not a new revelation.

While a strictly preceptor-based education may leave some holes in a students education, I applaud any university or medical center for trying to cut out the fat in undergraduate and graduate medical education in order to get to the real learning. The academic model has taught physicians for decades, but it has grown too cumbersome and leaves a lot to be desired.

Wow, you're pretty sure of the problems with medical education for someone who has literally spent zero time as a medical student, much less one getting clinical education during third year. Please, tell me more about the problems with clinical education and why preceptorships are much better than structured learning that you learned from your shadowing experience.

Next your assertion about the old time doc is wrong for 3 reasons. First, those old time docs were taught in the same medical structure you are lamenting so they wouldn't be blaming poor clinical accumen on the structure of education. Second, those old time docs took care of healthy patients with 1 medical problem, not the disasters with 20 comorbidities we have today. That patients are living longer despite these comorbidities is is a testament that our clinical training, competence and treatment modalities are actually improving. Finally, what some of these old-timers are alluding to are outdated modalities. While Dr. Oldtimer is using that tube attached to their ears to tell me that he thinks the patient might have mitral stenosis and that it could explain the dyspnea she is having, I have already slapped a probe on the chest, quantified their mitral stenosis and demonstrated whether surgery or BMV would be the appropriate treatment option.

Cutting the fat is laudable. However, there is more fat in a solely preceptor based system than a solely team-based structure. That said, a combination would get benefits of both.

 

[235009]

Very good explanation. I myself have only seen preceptor-based rotations work in a solid way and that was at UCSD at an outpatient endocrinology clinic with one fellow and two medical students. Said attending spent time b/t consults to teach, allowed the student to perform the interview, present the pt to us and asked them how they would manage with solid clinical pearls tied in. Without a doubt, these students also had a very strong inpatient experience with a resident team.

This is not what I think of when we say "preceptor based rotations". There are inpatient and outpatient components to many specialties and you should be exposed to both. As a med student and resident the best way to be exposed to the outpatient component is in a structured setting like the one you described where the student can see the patient independently, present to the attending and discuss the case. I don't want you guys to get the impression that all inpatient = good and all outpatient = bad but certainly a peds/IM/surgery rotation without any inpatient component where you are rounding on patients with a team is insufficient.

Fair points.

I would counter by saying undergraduate medical education is extremely archaic, and medical students are entering intern year with little clinical competence. IM rounds - for example - has ballooned into this overly long drawn out process which feels more like a group of actors practicing their monologues with a few critiques at the end. There simply isn't enough real clinical training for medical students in a setting where you round all day with 12 other people - most of whom are senior to you. Ask any old time doc and they will tell you clinical competence is at an all time low - and the problem starts in undergraduate medical education. There have been plenty of articles written about this problem, so it's not a new revelation.

While a strictly preceptor-based education may leave some holes in a students education, I applaud any university or medical center for trying to cut out the fat in undergraduate and graduate medical education in order to get to the real learning. The academic model has taught physicians for decades, but it has grown too cumbersome and leaves a lot to be desired.

You're making some really bold statements for someone who hasn't set foot in a medical school. Everything in this post is plain wrong and it would serve you well to purge all of this misinformation from your brain before you get to med school. You have absolutely no understanding of the purpose of rounds in IM... it's not about monologues and critiques it's about succinctly communicating relevant information to your superiors, synthesizing the patient's acute medical conditions out loud and coming up with a reasonable plan and contingencies that further the patient's path to recovery and discharge from the hospital.

There were also MD students (including US MD) on the same rotation with me doing it as their core pediatrics rotation.

Was this their only experience though? As mentioned earlier US MD students usually rotate through multiple sites and get both inpatient and outpatient (+/- sub-specialty) components of core rotations.

 

[GUH]

Was this their only experience though? As mentioned earlier US MD students usually rotate through multiple sites and get both inpatient and outpatient (+/- sub-specialty) components of core rotations.

Good question. For the US MD students, their rotation was also entirely inpatient. Strangely enough, the caribbean MD students got to spend time in the outpatient clinic.
The US MD students on that service were also completely off the hook for night and weekend call and would often get to leave early for didactics at their home school, which I thought was interesting.
It was only one experience but I mostly gave it as an example where there could be a good balance between traditional rotations and preceptor-based.

 

[hallowmann]

Perfect summary of how what medical students think is important to do in rotations, doesn't line up with what people like me, who teach, think is important to do in rotations. You absolutely must be a resident before you are a practicing physician. That is where you learn first the foundation, and then the advanced principles, of your specialty. There's no getting around it. So what kind of sense does it make as a student, to skip straight to the "assisting in surgery" part, without seeing and learning about the "managing a list of floor patients" part? Intern year is a terrible time to get your first taste of that. Sub-Is aren't much better.

My point was that you manage patients on the floors in almost every other rotation. If you do IM, OB/Gyn, Peds, that's what you're doing everyday. You're not going to get any surgical skill there, so I hope your surgery rotation has at least some component of surgery beyond standing in the corner of the OR. The point was if you want to learn how to be a surgical intern, you should be learning how to at least close, because based on what I saw with all early surgical interns, you'll be expected to do at least that starting in July. I wouldn't be able to do that with my surgery core experience, but many people I know at other sites would.

Also, as I said in a later post, you should be seeking out a rotation where you'll both manage and have time scrubbed in the OR. You want both on a surgical rotation, not exclusively one or the other. At no point did I say, "forget the whole learning how to deal with patients on the floor" you just assumed that. Maybe I should have been more clear in the first post, but I figured that was obvious.

This is not what I think of when we say "preceptor based rotations". There are inpatient and outpatient components to many specialties and you should be exposed to both. As a med student and resident the best way to be exposed to the outpatient component is in a structured setting like the one you described where the student can see the patient independently, present to the attending and discuss the case. I don't want you guys to get the impression that all inpatient = good and all outpatient = bad but certainly a peds/IM/surgery rotation without any inpatient component where you are rounding on patients with a team is insufficient...

See, now I'm confused. I've never had a rotation where I do nothing but follow around the preceptor or the team. It's like that the first day or two at most, then you're seeing patients on your own, precepting, then going in with the preceptor. Or you're pre-rounding, meeting the preceptor in the surgery center for procedures, then rounding with the attending. If all you do is shadow, what the heck kind of rotation is that? If that's what we're talking about when we say "preceptor-based rotations", then yeah, that's terrible.

I've also never had an outpatient only rotation with the exception of one FM rotation where I was with both residents and attendings at the clinic. All the preceptors I've ever had also rounded in hospitals at least part of the time (i.e. you had to round in the hospital before or after). Does shadowing only outpatient rotations really make up the experience of most students?

 

[67552931811]

My point was that you manage patients on the floors in almost every other rotation. If you do IM, OB/Gyn, Peds, that's what you're doing everyday. You're not going to get any surgical skill there, so I hope your surgery rotation has at least some component of surgery beyond standing in the corner of the OR. The point was if you want to learn how to be a surgical intern, you should be learning how to at least close, because based on what I saw with all early surgical interns, you'll be expected to do at least that starting in July. I wouldn't be able to do that with my surgery core experience, but many people I know at other sites would.

Also, as I said in a later post, you should be seeking out a rotation where you'll both manage and have time scrubbed in the OR. You want both on a surgical rotation, not exclusively one or the other. At no point did I say, "forget the whole learning how to deal with patients on the floor" you just assumed that. Maybe I should have been more clear in the first post, but I figured that was obvious.



See, now I'm confused. I've never had a rotation where I do nothing but follow around the preceptor or the team. It's like that the first day or two at most, then you're seeing patients on your own, precepting, then going in with the preceptor. Or you're pre-rounding, meeting the preceptor in the surgery center for procedures, then rounding with the attending. If all you do is shadow, what the heck kind of rotation is that? If that's what we're talking about when we say "preceptor-based rotations", then yeah, that's terrible.

I've also never had an outpatient only rotation with the exception of one FM rotation where I was with both residents and attendings at the clinic. All the preceptors I've ever had also rounded in hospitals at least part of the time (i.e. you had to round in the hospital before or after). Does shadowing only outpatient rotations really make up the experience of most students?

I'd be willing to wager this is what 99% of premeds, and sadly, preclinical DO students think preceptor-based is. It's why I stay out of these topics. The foundational misunderstanding is a futuristic non sequitur.

 

[IslandStyle808]

The reason why pre-med and to some degree preclinical DO students think of preceptor-based as some sort of shadowing experiences, is because of the horror stories they hear either from upperclassmen from their schools or here on SDN. This would be from those few who had been dropped from a rotation and then had to follow a preceptor in a clinic or office (and all they do is follow the doctor around, help with the scut, etc.). It becomes this perpetuated misconception.

I understand there are differences in the way preceptorship is done. For instance, I had a discussion with an attending on SDN about being under a preceptor with a team of medical students (no residents) in a ward based setting. They still did didactics, rounded on patients, wrote patient notes, presented on patients etc. She also went on to state that she honored all her sub-i rotations where there were residents.

In the end, I still believe that residents are still necessary even in this winning formula (she still state that it was an uphill battle adjusting to being a part of a resident team). One still needs to see how they function and how they think (it is not to say that working with a preceptor in an outpatient setting is a bad thing, it has its benefits also).

 

[67552931811]

The reason why pre-med and to some degree preclinical DO students think of preceptor-based as some sort of shadowing experiences, is because of the horror stories they hear either from upperclassmen from their schools or here on SDN. This would be from those few who had been dropped from a rotation and then had to follow a preceptor in a clinic or office (and all they do is follow the doctor around, help with the scut, etc.). It becomes this perpetuated misconception.

I understand there are differences in the way preceptorship is done. For instance, I had a discussion with an attending on SDN about being under a preceptor with a team of medical students (no residents) in a ward based setting. They still did didactics, rounded on patients, wrote patient notes, presented on patients etc. She also went on to state that she honored all her sub-i rotations where there were residents.

In the end, I still believe that residents are still necessary even in this winning formula (she still state that it was an uphill battle adjusting to being a part of a resident team). One still needs to see how they function and how they think (it is not to say that working with a preceptor in an outpatient setting is a bad thing, it has its benefits also).

A family member, who is an attending, gave me salient advice before I started med school. This person said, "Never in my X years of medical education have I ever found anything to be true that started with the phrase, 'I heard'."

 

[Goro]

Mods, sticky this one, please!!!

A family member, who is an attending, gave me salient advice before I started med school. This person said, "Never in my X years of medical education have I ever found anything to be true that started with the phrase, 'I heard'."

 

[NurWollen]

News drop:
http://thedo.osteopathic.org/2016/05/single-gme-update-successes-challenges-and-a-possible-solution/

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[kenjixshadow]

News drop:
http://thedo.osteopathic.org/2016/05/single-gme-update-successes-challenges-and-a-possible-solution/

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

OGME?
Osteopathic recognition?
AOA think that future DOs want to deal with this b.s.?
Parker, you're fired.

 

[hallowmann]

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

OGME?
Osteopathic recognition?
AOA think that future DOs want to deal with this b.s.?
Parker, you're fired.

They're quoting an AACOM survey of DO MS3s that showed 7/10 were interested in residency programs with osteopathic focus.

"Osteopathic recognition" is the designation for programs that apply for osteopathic focus.

OGME is the designation for those programs, and more specifically the programs created and/or affiliated with OPTIs and COMs.

Whether future DOs want to deal with it or not, it's in the best interest of COMs to continue to establish OGME that their students can fall back on, in the same way that MD schools have programs for their students.


On a separate note, I'm actually surprised that 23/24 RRCs had OK'ed DO PDs, because last I heard it was 21/24. I guess a couple of the surgical RRCs caved.

It's also a smart move for the AOA to devote effort to assisting programs apply for ACGME accreditation. Hopefully it'll actually be useful to programs, and make the process easier. Only time will tell.

As of now 166 of the 770-some odd AOA programs have applied for ACGME accreditation. In the last 1.5 months 40 programs applied, so as I suspected, as the deadline for some programs approaches we'll see more procrastinators applying. It also probably includes programs who hope to be accredited before the coming residency app cycle. My guess is we'll see surges in apps every spring during the transition.

 

[IslandStyle808]

They're quoting an AACOM survey of DO MS3s that showed 7/10 were interested in residency programs with osteopathic focus.

"Osteopathic recognition" is the designation for programs that apply for osteopathic focus.

OGME is the designation for those programs, and more specifically the programs created and/or affiliated with OPTIs and COMs.

Whether future DOs want to deal with it or not, it's in the best interest of COMs to continue to establish OGME that their students can fall back on, in the same way that MD schools have programs for their students.


On a separate note, I'm actually surprised that 23/24 RRCs had OK'ed DO PDs, because last I heard it was 21/24. I guess a couple of the surgical RRCs caved.

It's also a smart move for the AOA to devote effort to assisting programs apply for ACGME accreditation. Hopefully it'll actually be useful to programs, and make the process easier. Only time will tell.

As of now 166 of the 770-some odd AOA programs have applied for ACGME accreditation. In the last 1.5 months 40 programs applied, so as I suspected, as the deadline for some programs approaches we'll see more procrastinators applying. It also probably includes programs who hope to be accredited before the coming residency app cycle. My guess is we'll see surges in apps every spring during the transition.

Although they are quoting the survey, they are also taking it out of the original context when they state "We know our students want to train in GME programs with osteopathic recognition.” When they state 7/10, this doesn't mean 7 out of those 10 are strictly going to apply to only residencies with osteopathic recognition (only about 48% of the respondents strictly said yes to this). What it really means if all residency programs had an osteopathic focus, 7 out of 10 would like to have it rather than not. By making more residences with osteopathic focus, this would not shift the 52% percentage that don't think having osteopathic training is a necessity. The only reason to make OMGE spots is to cater to the increasing student die hards that do want them and create a safety net for their students if things go south (with the school expansions going on).

http://www.aacom.org/docs/default-source/single-gme-accreditation/or-survey-may-2015.pdf?sfvrsn=8 (page 6)

From survey: "While several students who report that osteopathic recognition is “Very Important”, also indicate that they are likely to apply only to programs with osteopathic recognition, students who feel that osteopathic recognition is “Important” acknowledge other important considerations, such as location. However, they also specify that “all things being equal”, they prefer programs with osteopathic recognition."

This is what news companies do also, where they take information and tweak it to mean something else or they miss the real meaning totally.

 

[NurWollen]

If 48% of applicants are only going to be applying to programs with osteopathic recognition, there are going to be a lot of unmatched med students.... incurring everyone not applying to FM, IM, or Med-Peds.

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[hallowmann]

Although they are quoting the survey, they are also taking it out of the original context when they state "We know our students want to train in GME programs with osteopathic recognition.” When they state 7/10, this doesn't mean 7 out of those 10 are strictly going to apply to only residencies with osteopathic recognition (only about 48% of the respondents strictly said yes to this). What it really means if all residency programs had an osteopathic focus, 7 out of 10 would like to have it rather than not. By making more residences with osteopathic focus, this would not shift the 52% percentage that don't think having osteopathic training is a necessity. The only reason to make OMGE spots is to cater to the increasing student die hards that do want them and create a safety net for their students if things go south (with the school expansions going on).

http://www.aacom.org/docs/default-source/single-gme-accreditation/or-survey-may-2015.pdf?sfvrsn=8 (page 6)

From survey: "While several students who report that osteopathic recognition is “Very Important”, also indicate that they are likely to apply only to programs with osteopathic recognition, students who feel that osteopathic recognition is “Important” acknowledge other important considerations, such as location. However, they also specify that “all things being equal”, they prefer programs with osteopathic recognition."

This is what news companies do also, where they take information and tweak it to mean something else or they miss the real meaning totally.

"Want to train" is not the same as "Only want to train". Who's talking about necessity? Its not a necessity for us to get the residency we want, but does that mean it shouldn't be a goal?

I guess I don't really see what your point is. If 70% of adults told you it would be nice to have a side of vegetables with their meal and a vegetable company told you that, would you accuse a vegetable company of making misleading claims because some of that 70% would still eat a meal that didn't have vegetables?

 

[NurWollen]

"Want to train" is not the same as "Only want to train". Who's talking about necessity? Its not a necessity for us to get the residency we want, but does that mean it shouldn't be a goal?

I guess I don't really see what your point is. If 70% of adults told you it would be nice to have a side of vegetables with their meal and a vegetable company told you that, would you accuse a vegetable company of making misleading claims because some of that 70% would still eat a meal that didn't have vegetables?

If all you want is a steak, but the steak at the best restaurant you can get to comes with a side of broccoli, then sure, you're interested in a meal that includes vegetables.

If the best residency for me has osteopathic recognition, then great. If not, well, that's fine too.

I don't think the AOA is misleading people, not at all. I don't think their intentions are malicious. I just think they might be a tad too focused on asking and answering the wrong question.

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[Event_Horizon]

 

[IslandStyle808]

"Want to train" is not the same as "Only want to train". Who's talking about necessity? Its not a necessity for us to get the residency we want, but does that mean it shouldn't be a goal?

I guess I don't really see what your point is. If 70% of adults told you it would be nice to have a side of vegetables with their meal and a vegetable company told you that, would you accuse a vegetable company of making misleading claims because some of that 70% would still eat a meal that didn't have vegetables?

I apologize I should have explained what I have getting at better. The article ties 3 statements together

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

Last year, an AACOM survey found that 7 in 10 third-year osteopathic medical students are interested in residency programs with osteopathic recognition.

The 7 out of 10 would want to train in a program with osteopathic recognition. The article doesn't take into context how much they want to train in one. It is stated later on in the survey they state 48% would only apply to strictly osteopathic recognized programs, 30% state it is of limited importance, and 21% that don't care at all. Their are only 48% that want to apply to osteopathic only programs. So the first sentence and second sentence bolded above would fit this percentage. This is the number they should be quoting. They should not be taking the other 30%, because they have other values that are greater than osteopathic recognition, such as program location or how good the quality program. In other words, if all of Mayo clinic's residency programs were to have osteopathic recognition (and that was the best program they matched into) then those 30% would be okay with rather than not. Building OGME would not apply to these people because they will pick the best program for them whether it has osteopathic recognition or not.

The statistic they should have put down is 48% are interested in strictly osteopathic recognized GME and tied this statement to the “The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME.” I don't know if it was an honest mistake or if they are looking for the best statistics to connect the ideas, but in the end they didn't connect the statements correctly.

 

[IslandStyle808]

If all you want is a steak, but the steak at the best restaurant you can get to comes with a side of broccoli, then sure, you're interested in a meal that includes vegetables.

If the best residency for me has osteopathic recognition, then great. If not, well, that's fine too.

I don't think the AOA is misleading people, not at all. I don't think their intentions are malicious. I just think they might be a tad too focused on asking and answering the wrong question.

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You have a way with words sir. It took you less sentences with a better analogy to get the point across than what it took me above.

 

[Drrrrrr. Celty]

I apologize I should have explained what I have getting at better. The article ties 3 statements together

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

Last year, an AACOM survey found that 7 in 10 third-year osteopathic medical students are interested in residency programs with osteopathic recognition.

The 7 out of 10 would want to train in a program with osteopathic recognition. The article doesn't take into context how much they want to train in one. It is stated later on in the survey they state 48% would only apply to strictly osteopathic recognized programs, 30% state it is of limited importance, and 21% that don't care at all. Their are only 48% that want to apply to osteopathic only programs. So the first sentence and second sentence bolded above would fit this percentage. This is the number they should be quoting. They should not be taking the other 30%, because they have other values that are greater than osteopathic recognition, such as program location or how good the quality program. In other words, if all of Mayo clinic's residency programs were to have osteopathic recognition (and that was the best program they matched into) then those 30% would be okay with rather than not. Building OGME would not apply to these people because they will pick the best program for them whether it has osteopathic recognition or not.

The statistic they should have put down is 48% are interested in strictly osteopathic recognized GME and tied this statement to the “The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME.” I don't know if it was an honest mistake or if they are looking for the best statistics to connect the ideas, but in the end they didn't connect the statements correctly.

I'm curious what they're quantifying as interest.

Honestly most of these surveys tend to be along the lines of, would you apply to an AOA program? Obviously I would.
Thus I have an interest.

 

[hallowmann]

If all you want is a steak, but the steak at the best restaurant you can get to comes with a side of broccoli, then sure, you're interested in a meal that includes vegetables.

If the best residency for me has osteopathic recognition, then great. If not, well, that's fine too.

I don't think the AOA is misleading people, not at all. I don't think their intentions are malicious. I just think they might be a tad too focused on asking and answering the wrong question.

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That's a different discussion. As you said they aren't wrong in what they're saying, they're just focused on something that is low on your list of the things to focus on.

Now if you're saying you'd prefer the place with the best steak to have a side of vegetables, but if it didn't that wouldn't prevent you from eating there, that means you want vegetables, just not as much as you want the best steak. I'd still be calling you an adult who wants vegetables.

I would actually argue that this IS a priority for them. They've already established an agreement to improve their accreditation standards (by being under the ACGME). At this point their focus should be on expanding OGME affiliated with COMs for their students (so DOs continue to have a safety net like MDs do - their home institution) and in fulfilling the only thing they're really responsible for (osteopathic focus stuff). Not to say there aren't other priorities like improving COM ClinEd, but that doesn't mean this isn't a priority too.

I apologize I should have explained what I have getting at better. The article ties 3 statements together

“The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME,” he says. “We know our students want to train in GME programs with osteopathic recognition.”

Last year, an AACOM survey found that 7 in 10 third-year osteopathic medical students are interested in residency programs with osteopathic recognition.

The 7 out of 10 would want to train in a program with osteopathic recognition. The article doesn't take into context how much they want to train in one. It is stated later on in the survey they state 48% would only apply to strictly osteopathic recognized programs, 30% state it is of limited importance, and 21% that don't care at all. Their are only 48% that want to apply to osteopathic only programs. So the first sentence and second sentence bolded above would fit this percentage. This is the number they should be quoting. They should not be taking the other 30%, because they have other values that are greater than osteopathic recognition, such as program location or how good the quality program. In other words, if all of Mayo clinic's residency programs were to have osteopathic recognition (and that was the best program they matched into) then those 30% would be okay with rather than not. Building OGME would not apply to these people because they will pick the best program for them whether it has osteopathic recognition or not.

The statistic they should have put down is 48% are interested in strictly osteopathic recognized GME and tied this statement to the “The more programs seek and achieve osteopathic recognition, the more opportunity we have to grow OGME.” I don't know if it was an honest mistake or if they are looking for the best statistics to connect the ideas, but in the end they didn't connect the statements correctly.

I'm still not seeing the conclusion you're making. 48% ONLY want to train in a program with osteopathic focus. 22% (or something) to some lesser degree (not really quantifiable in such a survey) would prefer to train in a program with osteopathic focus, but it wouldn't be enough in and of itself to prevent them from applying to programs without osteopathic focus. To me, that still sounds like 70% of "our students want to train in programs with osteopathic focus".

To put this in a different context, I may prefer to some lower degree (lower than say location) a program that offers 4 peds rotations, but I'm still going to apply to the programs that offer only 3 peds rotations in the location I want. Obviously all other things equal, I'd prefer the one with 4, so I would still be categorized as wanting a program with 4 peds rotations even if I'm willing to apply/go to programs with only 3 in the location I want.

The quote about the more opportunity we have to grow OGME is completely unrelated to student interest. Rather it is a means to provide the students with the options they want. More programs with osteopathic focus = more OGME. Its a direct relationship. The only reason they're bringing up students is as a reason for pushing for more programs with osteopathic focus.

I'm curious what they're quantifying as interest.

Honestly most of these surveys tend to be along the lines of, would you apply to an AOA program? Obviously I would.
Thus I have an interest.

You can read it in the AACOM article what the questions were, and you can even read some direct quotes from the survey.

One of the things that is a bit representative among other students at my school, most of whom don't seem all that interested in incorporating OMT, is the implication that a program with osteopathic focus would be more welcoming to DOs. This is something I've heard a lot from classmates, both in terms of finding places to apply and in terms of just simply preferring places where they won't be the only DO.

Obviously for those who want to learn OMT, they'd prefer to go somewhere with osteopathic focus, but that's not really a sizeable percentage. Perhaps combined with the people who just want the option to learn/use OMT, but haven't made a decision one way or another of using it in practice, that percentage is a bit larger.

 

[Dr Tony T. Chopper]

The only reason to make OMGE spots is to cater to the increasing student die hards that do want them and create a safety net for their students if things go south (with the school expansions going on).

On one hand, the newly minted acgme programs will be open to MD applicants, on the other hand, you are saying that those with osteopathic recognition will be a safe havens for DO applicants. are you saying that ogme deters MD applicants? I'm sure its still all hopeful speculation but this one doesn't make sense to me.

 

[Drrrrrr. Celty]

I don't know if I can say the same about my school. Most people

On one hand, the newly minted acgme programs will be open to MD applicants, on the other hand, you are saying that those with osteopathic recognition will be a safe havens for DO applicants. are you saying that ogme deters MD applicants? I'm sure its still all hopeful speculation but this one doesn't make sense to me.

I think it's reasonable to assume that OGME will continue to be somewhat of a protected space for DOs to match. Will it open up to MD applicants who show skill and personality? Yes.

But honestly, it's very necessary for continued expansion of OGME into fields that DOs might struggle to get into.

 

[IslandStyle808]

I'm still not seeing the conclusion you're making. 48% ONLY want to train in a program with osteopathic focus. 22% (or something) to some lesser degree (not really quantifiable in such a survey) would prefer to train in a program with osteopathic focus, but it wouldn't be enough in and of itself to prevent them from applying to programs without osteopathic focus. To me, that still sounds like 70% of "our students want to train in programs with osteopathic focus".

To put this in a different context, I may prefer to some lower degree (lower than say location) a program that offers 4 peds rotations, but I'm still going to apply to the programs that offer only 3 peds rotations in the location I want. Obviously all other things equal, I'd prefer the one with 4, so I would still be categorized as wanting a program with 4 peds rotations even if I'm willing to apply/go to programs with only 3 in the location I want.

The quote about the more opportunity we have to grow OGME is completely unrelated to student interest. Rather it is a means to provide the students with the options they want. More programs with osteopathic focus = more OGME. Its a direct relationship. The only reason they're bringing up students is as a reason for pushing for more programs with osteopathic focus.

Well, it is one of those agree to disagree type statements. From what I have gather, osteopathic leaders want students who readily utilize osteopathic principles and techniques (whether cranial or OMT etc.). In that 30%, we don't know to what degree they want the training. If it is very high in the spectrum and they are using what they have learning actively, then having more residencies with osteopathic recognition does apply to them. However, if it is low on the spectrum and techniques such as OMT are a "once in a while" treatment, then having more residencies with osteopathic focus doesn't pertain to them much. It would be like a psychiatrist practicing how to do a tracheotomy during residency. It would be great to know, but if one is reluctant to use in an emergency then there is no real point in learning it. Osteopathic leaders are putting the effort to expand osteopathic recognition because they believe students to be in the former category rather than the latter. It is still important to note this difference in the article.

On a side note, both you and Drrrr. Celty have a point about why student want to have residencies with osteopathic recognition. Osteopathic leaders want to create them to continue on the tradition of osteopathic practice. However, of that 48% how much of them are choosing osteopathic only residencies because it is a safety net into a competitive specialty? Of course, it is highly likely the majority of them really do want to practice these principles and techniques. However, what amount of them don't care that much about them and only specifically see these residencies as a high yield spot to match in. This is another context that is missing.

 

[IslandStyle808]

On one hand, the newly minted acgme programs will be open to MD applicants, on the other hand, you are saying that those with osteopathic recognition will be a safe havens for DO applicants. are you saying that ogme deters MD applicants? I'm sure its still all hopeful speculation but this one doesn't make sense to me.

Well, no I don't think that OMGE deters MD applicants, I believe there are those MDs who want to learn it. Some residency programs will still be safe havens to some degree. If one has a osteopathic school as a sponsor for a residency, one can see this as a sign of protection if students don't match well. The schools may push the residency programs to take their students. Residencies having osteopathic recognition (whether having a COM school sponsor, OPTI, or MD sponsor) will most likely want to have DO students since they will be more familiar with osteopathic principles and techniques (ex. OMT). The residency programs are not so much safety nets in this case, but being a DO will be a large plus to them.

 

[NontradCA]

What does osteopathic focus even mean? Lol

 

[Bucks901]

Have you taken the COMPOOP yet? Genuinely curious--not trying to be condescending.

It is a wretched, wretched exam. Spelling errors. I had a question on my exam that didn't even provide answer choices. I had a question that had an answer choice repeated twice word for word.

On top of that, the questions are absolutely ridiculous. A very large portion of my micro was based on bioterrorism--I literally laughed out loud during the middle of my exam at some of the ridiculous questions.

The timing during the exam is ridiculous. You only get 1 bathroom break for the entire exam where they actually pause the clock for you. You get like 11 less seconds per question than the USMLE gives you.

There's a reason why PDs of AOA programs take audition rotations so seriously--because they personally know how much of a joke the COMPOOP is.

I didn't believe the hype behind the COMPOOP until I actually took it. I was one of the lucky ones who somehow ended up with a good score...but I could have easily ended up with a much worse score.

It is truly an awful thing and I'm glad that PDs do not take it seriously.

I had the exact same experience. Can we sticky this in the COMLEX forum?

 

[hallowmann]

On one hand, the newly minted acgme programs will be open to MD applicants, on the other hand, you are saying that those with osteopathic recognition will be a safe havens for DO applicants. are you saying that ogme deters MD applicants? I'm sure its still all hopeful speculation but this one doesn't make sense to me.

OGME are affiliated with COMs and OPTIs. Many of those are the ACGME sponsoring organizations for those programs. OPTIs in general exist to function in the way that home institutions function at MD universities. They are affiliated residencies that can also serve as clinical rotation sites.

The only way they will be "safe havens" is in the same way MD home institutions are for their students. They are residencies that know their students, and can use the school as a feeder into their program. Its a good way to have a backup for the bottom 5% of the classes. It's one of the reasons why OGME development is actually important, completely separate from the students who actually are interested in programs with osteopathic focus.

The idea that the 3rd years that thought osteopathic focus was important to them were only those that wanted to learn OMT isn't realistic. Most DOs don't use OMT all that much. As I mentioned many people at my school would prefer programs with osteopathic focus more for what it says about the program - e.g. DO-friendly, won't look down on the DO for being a DO, etc.

 

[ortnakas]

The idea that the 3rd years that thought osteopathic focus was important to them were only those that wanted to learn OMT isn't realistic. Most DOs don't use OMT all that much. As I mentioned many people at my school would prefer programs with osteopathic focus more for what it says about the program - e.g. DO-friendly, won't look down on the DO for being a DO, etc.

I'm hoping to end up applying ACGME, but I'm definitely planning on paying a lot of attention to the "osteopathic focus" schools for precisely this reason. I'm not bottom 5% of my class but I'm also far from a rock star, so it makes sense for me and students like me to aim high but concentrate on DO-friendly programs. (For what it's worth I don't hate all of OMM, but don't see it being a huge part of my practice in the future either.)

 

[hallowmann]

I'm hoping to end up applying ACGME, but I'm definitely planning on paying a lot of attention to the "osteopathic focus" schools for precisely this reason. I'm not bottom 5% of my class but I'm also far from a rock star, so it makes sense for me and students like me to aim high but concentrate on DO-friendly programs. (For what it's worth I don't hate all of OMM, but don't see it being a huge part of my practice in the future either.)

I'm essentially doing the same. I'm applying to more dual programs more because of regional preference than anything else. If I feel more OMT training is necessary (seeing as how I actually see myself using it to some degree), I'll do a year of it as a fellowship or CME workshops if I end up just at an ACGME program.

 

[Old_Mil]

You will make your life much easier if you take the USMLE, get boarded through your specialty's allopathic board, and leave the chiropractic theory behind once and for all.

 

[GUH]

You will make your life much easier if you take the USMLE, get boarded through your specialty's allopathic board, and leave the chiropractic theory behind once and for all.

"I'm going to make a statement and tell you to do something different from your well-reasoned plan without explaining why"

 

[Drrrrrr. Celty]

You will make your life much easier if you take the USMLE, get boarded through your specialty's allopathic board, and leave the chiropractic theory behind once and for all.

Kinda curious whether this Dr. Barrett or not...

 

[racerwad]

"I'm going to make a statement and tell you to do something different from your well-reasoned plan without explaining why"

Are you asking him to explain why this is a good idea? It sound be fairly obvious, but it is an important detail that many of my osteopathic classmates did not consider when making their decisions.

Just so we're on the same page, virtually every specialty has either osteo or allopathic specialty boards (American Board of Emergency Medicine vs American Board of Osteopathic Emergency Medicine, for example). You are boarded by one of the those groups based upon your training - ACGME or AOA. Therefore, the remainder of your certifications (your actual boards, not the COMLEX or USMLE) will be administered by them and you can't switch. If you go to an AOA residency, you will forever have to deal with OMM in your continuing education. This, in addition to the quality of AOA vs ACGME residencies, was more than enough for me for forego AOA-training.

One last thing to consider is your CME. I think this can vary across specialties, but for EM, if you are AOA-boarded, you can't always get credit for attending things like ACEP, SAEM or listening to any number of FOAM resources. Instead, you have to go to an AOA-approved conference for the equivalent experience. Same goes for smaller local conferences, skills course, etc. I am under the impression that the AOA/ACOEP is getting more lenient on the types of credits they will accept, but why would you put with that? AMA-approved are also more common so it will be more likely that training opportunities will be in your area versus having to travel. And finally, you won't have (or rather, I won't have to) to continue regurgitating any more OMM baloney. I might as well stick to the baloney I will actually use in day-to-day practice.

 

[GUH]

Are you asking him to explain why this is a good idea? It sound be fairly obvious, but it is an important detail that many of my osteopathic classmates did not consider when making their decisions.

Just so we're on the same page, virtually every specialty has either osteo or allopathic specialty boards (American Board of Emergency Medicine vs American Board of Osteopathic Emergency Medicine, for example). You are boarded by one of the those groups based upon your training - ACGME or AOA. Therefore, the remainder of your certifications (your actual boards, not the COMLEX or USMLE) will be administered by them and you can't switch. If you go to an AOA residency, you will forever have to deal with OMM in your continuing education. This, in addition to the quality of AOA vs ACGME residencies, was more than enough for me for forego AOA-training.

One last thing to consider is your CME. I think this can vary across specialties, but for EM, if you are AOA-boarded, you can't always get credit for attending things like ACEP, SAEM or listening to any number of FOAM resources. Instead, you have to go to an AOA-approved conference for the equivalent experience. Same goes for smaller local conferences, skills course, etc. I am under the impression that the AOA/ACOEP is getting more lenient on the types of credits they will accept, but why would you put with that? AMA-approved are also more common so it will be more likely that training opportunities will be in your area versus having to travel. And finally, you won't have (or rather, I won't have to) to continue regurgitating any more OMM baloney. I might as well stick to the baloney I will actually use in day-to-day practice.

Thank you.

 

[racerwad]

Thank you.

I probably should also clarify that all of my understanding comes from my experience/perspective in EM and that it may not be totally generalizable to other specialties. Basically, caveat emptor totally applies when you are planning what specialty and program you're applying to. It is important to consider what some of the future implications will be. I know I am lazy and will likely have trouble staying on top of my continuing education. The thought of having to work harder just to do stuff I personally did not consider important was a big turn off.

 

[TheOther]

Are you asking him to explain why this is a good idea? It sound be fairly obvious, but it is an important detail that many of my osteopathic classmates did not consider when making their decisions.

Just so we're on the same page, virtually every specialty has either osteo or allopathic specialty boards (American Board of Emergency Medicine vs American Board of Osteopathic Emergency Medicine, for example). You are boarded by one of the those groups based upon your training - ACGME or AOA. Therefore, the remainder of your certifications (your actual boards, not the COMLEX or USMLE) will be administered by them and you can't switch. If you go to an AOA residency, you will forever have to deal with OMM in your continuing education. This, in addition to the quality of AOA vs ACGME residencies, was more than enough for me for forego AOA-training.

One last thing to consider is your CME. I think this can vary across specialties, but for EM, if you are AOA-boarded, you can't always get credit for attending things like ACEP, SAEM or listening to any number of FOAM resources. Instead, you have to go to an AOA-approved conference for the equivalent experience. Same goes for smaller local conferences, skills course, etc. I am under the impression that the AOA/ACOEP is getting more lenient on the types of credits they will accept, but why would you put with that? AMA-approved are also more common so it will be more likely that training opportunities will be in your area versus having to travel. And finally, you won't have (or rather, I won't have to) to continue regurgitating any more OMM baloney. I might as well stick to the baloney I will actually use in day-to-day practice.

I had some follow-up questions. To be an ACGME-boarded DO, how far along both USMLE/COMLEX does one need to go? Am I correct in thinking that COMLEX needs to be completed all the way and USMLE only up to Step 2 CK/CS? And am I recalling correctly that I vaguely remember reading that it varies by state?

Edit: changed purality

 

[racerwad]

I had some follow-up questions. To be an ACGME-boarded DO, how far along both USMLE/COMLEX does one need to go? Am I correct in thinking that COMLEX needs to be completed all the way and USMLE only up to Step 2 CK/CS? And am I recalling correctly that I vaguely remember reading that it varies by state?

Edit: changed purality

AFAIK, your understanding is correct (because it mirrors my own - HA!). I am not sure about variability between states. Completing COMLEX is what is required to apply for a license as a DO. To be boarded in your specialty means you have completed residency training to be eligible to sit for that respective board's licensing exam.

I took all 3 COMLEXs (and PE) and Step 1 & 2. I haven't heard of anyone needing to take Step 3 or needing to take USMLE CK, but that is something your program could address. I have also never heard of anyone taking Step 3 in lieu of Level 3 for the reason I mentioned above.

In order to be competitive to apply to many ACGME programs, most DOs applying to those programs will have taken Step 1 and 2.

 

[TheOther]

AFAIK, your understanding is correct (because it mirrors my own - HA!). I am not sure about variability between states. Completing COMLEX is what is required to apply for a license as a DO. To be boarded in your specialty means you have completed residency training to be eligible to sit for that respective board's licensing exam.

I took all 3 COMLEXs (and PE) and Step 1 & 2. I haven't heard of anyone needing to take Step 3 or needing to take USMLE CK, but that is something your program could address. I have also never heard of anyone taking Step 3 in lieu of Level 3 for the reason I mentioned above.

In order to be competitive to apply to many ACGME programs, most DOs applying to those programs will have taken Step 1 and 2.

Got it, thank you!

 

[NurWollen]

Has anyone else noticed that the AOA opportunities site has been updated with a spot where the AOA reports whether a program has applied or not? Nothing you can't get by looking at the ACGME database, but hopefully it's a sign that the AOA is holding programs' feet to the fire a bit.

I've noticed most of the programs in my school's OPTI now self-self-report as planning to apply in June 2016, whereas before it said "not available" under that section.

I think we're going to see a lot
of programs applying in the next couple of months. The list of pre-accredited programs is going to get a lot longer, and the merger is going to look less like a disaster.

 

[GUH]

Has anyone else noticed that the AOA opportunities site has been updated with a spot where the AOA reports whether a program has applied or not? Nothing you can't get by looking at the ACGME database, but hopefully it's a sign that the AOA is holding programs' feet to the fire a bit.

I've noticed most of the programs in my school's OPTI now self-self-report as planning to apply in June 2016, whereas before it said "not available" under that section.

I think we're going to see a lot
of programs applying in the next couple of months. The list of pre-accredited programs is going to get a lot longer, and the merger is going to look less like a disaster.

The fact that more programs applied does not determine whether the merger is a disaster or not.

 

[NurWollen]

The fact that more programs applied does not determine whether the merger is a disaster or not.

No, but hopefully most of them will be approved. And that will help determine whether this merger is a disaster.

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[dozitgetchahi]

Unrelated, but although screening and discrimination this has been the status quo for DO students in GME, it still baffles me to no freaking end how the reliance/culture of standardized testing can be so unceremoniously discarded for some nebulous ideations of prestige. Is this real life? Did we not, for all this time, quantify potential to succeed with the SATs and the MCAT (mostly) regardless of academic background? Estranging a highly qualified DO student for a categorically less qualified MD student drives me insane.

One of the tests (COMLEX) is ****. The other (USMLE) isn't. ACGME PDs are also used to using theirs.

At the end of the day, you either play ball the way they want you to or you sit on the bleachers. Whining about it doesn't get you anywhere.

 

[ToKingdomCome]

What is the absolute mimimum USMLE STEP 1 score that a DO should shoot for the be competitive at moderately competitive specialities like gas, EM, etc? 210, 215,220? And if a student were to go into those specialties with just a COMLEX score would that be doable going the acgme route?

 

[kenjixshadow]

What is the absolute mimimum USMLE STEP 1 score that a DO should shoot for the be competitive at moderately competitive specialities like gas, EM, etc? 210, 215,220? And if a student were to go into those specialties with just a COMLEX score would that be doable going the acgme route?

210, 215, 220 are not competitive at all albeit you can still match if you apply broadly. Lots of places will throw your applications out if you have only COMLEX scores.