I've read this thread with great interest, as I go to one of the older "new" schools (AZCOM, 1st class entered 1996). Thru the thread I think a lot of important issues have been touched on that pertain to osteopathic education as a whole. I don't have many answers, but I do have opinion, based on my experience.
For those who don't know, AZCOM is one of these schools that doesn't have a university owned hospital for rotations. They have affiliations/agreements with several area hospitals for residency based rotations, although they have many, many preceptor based rotations that are the backbone behind the clinical years. They also have a fairly liberal rotation policy, in that you can set up whatever you want if the preceptor thing doesn't appeal to you. The first two years at AZCOM are stellar. You will be on an equal footing with any osteopathic school in the country from an didactic standpoint. (Notice I'm not saying "better than anyone else", just equal to).
As I see it, residency based rotations are the gold standard for medical student education. Not to say tht all residency rotations are great (they aren't) or that preceptor based rotations are bad (I've had some very good experieinces with them). However, I think that the big problem with osteopathy in general (OMM, stigma, etc) and DO education in paticular is that we lack credibility because we fail to standardization our education. With a preceptor, who honestly evaluates the effective teaching by the preceptor? Preceptor based rotations and the schools who use them rely on a crapshoot method education. I think that the number of students who take it upon themselves to persevere despite this system speak more to the quality of the students rather than the system. We succeed in spite of the system, not because of it. And it all leads back to a failure of quality control.
It applies to residencies too. I love primary care physicians, the true foot soldiers of medicine. But the AOA's emphasis on primary care hurts us because we focus too much on outpatient medicine. Our allo colleagues are rightly critical of DO education if it relies solely on the preceptor/outpatient model. If DOs really applied DO "philosophy" to education, we'd embrace the whole gamut of specialties. However, I think it's probably easier and less painful for the powers that be to ignore this aspect of education, because it implies weakness in our schools and graduate training. In other words: we DOs emphasize primary care because it's the easiest and most available avenue we have to establish ourselves. (Let me add a disclaimer: there are many motivated, intelligent people in the AOA who see these problems. And they have spoken out about them, but for whatever reason change is very slow in coming.)
So what's the solution? I wish the AOA would mandate that all DO schools financially support a wide range of residency program IN THE CITIES/VICINITIES in which they reside. (It's sort of laughable that AZCOM students are told that we have "our own Midwestern residency programs.... in Chicago.") This means no more stand alone FP or IM residencies, we need Peds, OB, Surgery, Psych, etc, and subspecialties too as appropriate. If this happens, we not only make available the gold standard rotations for DO students, but we create opportunity for existing DOs who love to teach a more supported/funded setting to do so.
The pathway to practicing as a physician does not end at med school graduation, and school that don't make a good faith effort to provide a complete pathway are on shaky moral ground. The pathway should lead straight thru residency, with the ultimate goal being board certification. If we can promote this, we not only strengthen the students and residents, but we add numbers and vitality to osteopathic board socities. This results in more stability, better research, more organization, better support of the political arms of the AOA on state and national levels. In short, by supporting the complete educational pathway we can earn some of the respect that osteopaths deserve.
So back to new schools: I have no problem with them so long as they provide reasonable measures for complete education. If they are just interested in making $$$ while their students languish with preceptors, I say this is wrong. To both they and their enablers in the AOA, a pox on both their houses.
Lastly it was a great experience for me to leave AZ and rotate within established osteopathic education programs. We can do these things, because they are being done well in Michigan, Ohio, and Pennsylvania right now. Interviewing around the country actually restored some of my faith in osteopathic education. There are great residency programs out there. We need leaders with the vision and foresight to apply these principles over the next generation of DO education. There are no quick fixes by any stretch, but these new schools are a good place to start making changes.
