OGME-1R
Questions regarding the transition from traditional rotating internships to OGME-1P, preliminary years and OGME-1R, resident years, continue to pour into the AOA, ACOS, and other specialty colleges. ACOS chose Option #1 which incorporates the first training year into the existing surgical residency program, giving the program director oversight of the entire training program. Adding that first year of training to the existing program does not decrease the length of the existing program. The following table indicates the Option (1, 2, or 3) which specialty colleges have chosen as of March 2007:
Option-1
Option-2
Option-3
Specialty
Anesthesia
Diagnostic Radiology
Dermatology
Emergency Medicine
Neurology
P M & R
ENT
NMM/ OMM
Occ/Prev Med
Family Practice & OMT
Ophthalmology
Proctology
FP/EM
Pathology
General Surgery
Psychiatry
Internal Medicine
Radiation Oncology
IM/EM
IM/PEDS
Neurological Surgery
Obstetrics/Gynecology
Orthopedic Surgery
Urological Surgery
To the casual observer, there will not appear to be any changes in the way osteopathic surgical resident training is conducted. ACOS surgical residents will still be required to complete an AOA approved internship. That year will now be the OGME-1R year and, instead of being under the purview of the DME , the responsibility of that first year of training will lie with the surgical residency program director. The AOA directed resident programs to apply for the additional needed positions as soon as practical in order to have the approved positions in place by September 2007 to effectively participate in the 2008 Match. Guidance provided to the programs was that the additional positions requested by resident programs came from the existing number of first-year slots at the institution. The AOA indicated that this number should not exceed the number that a program can promote into the second year of the specialty. For general surgery residency programs this number should be ¼ of the total number of currently approved positions.
In an effort to facilitate the process, the RESC determined the number of additional approved positions which a program must have to ensure the continuity of the residency program. If a resident program is currently linked to internship positions at the institution, it will be those first-year positions that should be transferred to the residency program. The RESC determined that a program had only to complete the existing form for Application for Increases in Residency Training Programs, with a cover letter explaining the rationale for the increase. Programs are not required to submit the required documentation with the application to accomplish this transfer of positions. Both the AOA and the ACOS have tried to make this transfer of positions as seamless as possible. Programs requesting positions in excess of the positions fitting these guidelines must submit the application for increases with required documentation and fees through the existing channels to the AOA.
To assist surgical resident program directors in assuming the oversight of the initial training year of the resident, OGME-1R, the ACOS has embraced the existing model general surgery emphasis internship rotation for all ACOS surgical specialties. A model general surgery emphasis internship rotation has been in place since 2001. At its August 2006 meeting the Resident Evaluation and Standards Committee modified that model rotation schedule slightly to ensure that all surgical residents are exposed to a concentration of surgical areas. Those model rotations have gone to the AOA COPT for approval and incorporation into the Basic Standards for Residency Programs in the Surgical Specialties. Urological and neurological surgery programs are also expected to adhere to the rotation guidelines for general surgery OGME-1R. The following are the requested model rotations for general surgery programs:
OGME-1 ROTATION GUIDELINES
GENERAL SURGERY (OGME-1R)
The following rotation is required for first-year residents in general surgery:
1. Rotations for ½ day per week, for 46 weeks, in an out-patient clinic or office.
2. Two months of general internal medicine
3. One month of ICU
4. One month of emergency medicine
5. One month of obstetrics and gynecology
6. One month of pediatrics
7. Four months of general surgery
8. Two months of electives to include any of the following areas:
a. Urology
b. Orthopedics
c. Anesthesia
d. ENT
e. General Surgery
f. Vascular Surgery
g. Neurosurgery
h. Cardiovascular Thoracic Surgery
i. Plastic and Reconstructive Surgery
j. Radiology
Many institutions have these existing rotations in place. Some institutions have extensive curriculums to accompany these rotations; some have learning objectives; and some have only the rotations. Because the Model Curriculum in General Surgery, implemented in July 2006, addresses the training of surgical residents from osteopathic medical school through the completion of their surgical training, only minor changes to the model curriculums will be undertaken. Programs are encouraged to work with their DMEs to ensure that the transfer of the oversight of the first-year surgical resident from the DME to the residency program director is without difficulty.