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Osteopathic Internship - going away?

Discussion in 'Medical Students - DO' started by Doc 2b, Mar 7, 2007.

  1. Doc 2b

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    Hey guy's here is a .doc I adapted from a PPT we got from our SGA today about the new internship rules. Sounds like the AOA is finally catching up to the 21st century. Anyway enjoy, and mods may want to Sticky this.

    Doc 2b
     

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  2. Taus

    Taus .
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    until those famous 5 states drop their requirement, the AOA can change the name/classification of the internship all they want and it really doesn't solve anything
     
  3. OP
    OP
    Doc 2b

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    Yes, your right. Kind of.

    In order for the licensing board to enforce those rules they are going to have to have enough rotating intern spots to support their decision. With the AOA's new position comes the slashing of traditional spots for, hopefully, using this funding for more specialty positions. That remains to be seen. It will be a slow evolution, but they are already pulling the reigns on the intern spots, cutting several this year.
     
  4. Toohotinvegas33

    Toohotinvegas33 Currently Glasgow 3
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    I've read something similar aswell, in a quarterly ACOEP newsletter, It read that they are going to incorporate the pgy1 into the residencies.
     
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  5. Quakkilla

    Quakkilla Senior Member
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    They finally are using the model of the ACGME, now maybe they can keep a few more sheep in the fold. This at least is progress, now we just need more quality specialty residency positions.:thumbup:
     
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  6. JohnDO

    JohnDO MS III
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    The internship is not going away completely. This seems to benefit Option 1 residencies only.

    "Students will apply and "Match" directly into the residency and the 1st postdoctoral year will be considered the first year of residency training."

    OPTION 1 residencies are:
    * Anesthesiology
    * Emergency Medicine
    * Emergency Medicine/ Internal Medicine
    * Family Practice
    * Family Practice/Emergency Medicine
    * General Surgery
    * Internal Medicine
    * Internal Medicine/ Pediatrics
    * Neurological Surgery
    * Obstetrics and Gynecology
    * Orthopedic Surgery
    * Otolaryngology Facial Plastic Surgery
    * Otolaryngology
    * Pediatrics
    * Urological Surgery

    Option 2 residencies basically get the shaft. As I understand it, they're mandating that option 2 residencies require a preliminary year before you are qualified to apply for the residency. Your preliminary year will not count towards your residency.

    "Programs will not grant residency credit but indicate completion of designated preliminary year curricular rotations, as prerequisites for entry into the 1st year of residency in the 2nd postdoctoral year of training."

    These residencies are:
    * Diagnostic Radiology
    * Neurology
    * Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine
    * Ophthalmology
    * Pathology
    * Psychiatry
    * Radiation Oncology
     
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  7. HCE

    HCE
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    so, as I understand John DO's description above, someone going in to Pathology, a field in which there is little or no patient contact, will be required to spend an additional year of intense patient contact....anyone care to take a stab at the rationale for this?

    Does anyone have information on whether there will still be the ability to get a waiver of the Traditional Year under this new scheme? :idea:
     
  8. Dr JPH

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    Sounds good to me. Radiologists too. Maybe if they had "more intense patient contact" then I wouldnt read "clinical correlation needed" in every damn report. Maybe if they knew more medicine they would understand what its like to get a report back that is as vague as the patients presenting symptoms. Maybe if they knew what it was like to manage patients on the floor, they would do the CT scan with IV contrast the FIRST time like I asked. And maybe if they worked more closely with real people they wouldnt take 12 days to return a tissue diagnosis that I KNEW was cancer just by looking at it.

    Is an additional year of "intense patient contact" going to hurt? No. It will only make you a better doctor, regardless of your chosen specialty.
     
  9. Toohotinvegas33

    Toohotinvegas33 Currently Glasgow 3
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    cough:BURNED:cough....excuse me
     
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  10. HCE

    HCE
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    JP, nice speech, but it makes no more sense than requiring surgeons to do an extra year in psychiatry to improve their bedside manner...wouldn't hurt.
    I have nothing to do with pathology, but I can appreciate their role in the treatment of disease...now that I know there are super-surgeons who can look at a patient and diagnose with no need for a pathologist, I'll have to re-think my outlook...
     
  11. BMW19

    BMW19 Senior Member
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    Yes but this does not change the fact that the extra year is still there from what I gather. So if I do EM and do an ostoepathic program, the program is still going to be four years in length just instead of a "traditional rot. internship" it is called first year of residency. Don't get me wrong I am in favor of EM programs being 4 years in length but just changing the terminology and a little bit of the focus is not changing the length of the programs which I believe is most DO students major concern $$$$$

    BMW-
     
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  12. Toohotinvegas33

    Toohotinvegas33 Currently Glasgow 3
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    This isnt exactly true because DO FM and IM programs where 2 years after the internship same with surgery being 4 years after internship. So really the only program that kinda has an "extra" year is EM. Then again many allo em programs are also 4 years.
     
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  13. dermpathdoc

    dermpathdoc DO Path
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    The rational has always been, that a physician who has taken a transitional internship is grounded in medicine as a whole and better able to communicate with physicians.
     
  14. Dr. Dukes

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    Personally, I think the whole rotating internship is a stupid idea. Any DO who does an allo residency has to jump through hoops to get a waiver on this stupid rule. If DOs want to be considered equal to MDs (not saying they aren't) the best way to do this is to expose MDs to DOs, and the way to do that is get DOs in MD residencies. This won't happen if DOs (who do you think wrote the stupid internship rule in the first place) keep forcing other DOs to do DO residencies.
    The AOA should sack up and make a unilateral change, and tell the 5 states to change their policies.
     
  15. Bull's eye

    Bull's eye The Gunslinger
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    Maybe I'm wrong here, but it sounds to me like EM will be 3 years instead of 4 and the residencies in option 2 will be just like their Allopathic counterparts. (i.e. PGY 1 prelim year then do 4 years of rads/path ect.) remember radiology residency is 4 years not 5. However it looks like psych is getting the shaft. The others I think are on par time wise with Allo.
     
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  16. HCE

    HCE
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    okay, that makes some sense. I'm not sure I agree that you necessarily get the result you're after by requiring a transitional year, but that rationale makes sense.

    To my other point, does the ability to seek a waiver (especially in "those five states") of the traditional year go away with this new 3 Option scheme?
     
  17. beastmaster

    beastmaster Senior Member
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    According to what's written, option 1 residencies effectively become "linked." If true, it's a positive step forward since many in the group currently are not, specifically the surgical subspecialties.

    So calm down folks, this wasn't a referendum on the internship itself.
     
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  18. Dr JPH

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    Are you really that ignorant?

    Have you ever seen a colon CA? How about Gallbladder CA vs acute cholecystitis?

    ****, Im a medical student and even I can see a visual difference.

    I hope your specimen differentiation skills are better than your attitude.
     
  19. HCE

    HCE
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    Are you really that ignorant?

    Have you ever seen a colon CA? How about Gallbladder CA vs acute cholecystitis?

    ****, Im a medical student and even I can see a visual difference.

    I hope your specimen differentiation skills are better than your attitude.

    Go back and look at my original two questions and your responses...first you lash out at Pathologists, and now I'm ignorant....and I have an attitude problem? :laugh:
     
  20. BamaAlum

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    Yes, you can identify some cancers grossly. Adenocarcinoma of the colon is common and easily recognized grossly. However, depth of invasion, lymph node involvement and immunohistochemical markers which ultimately determine stage and treatment need a pathologist's eye. That being said, 12 day turnaround is ridiculous, unless it was some rare lesion that had to be sent out. Even then, 12 days is too long.

    As a DO pathology resident I think it is insane that I would be forced to do a rotating internship if I wanted to practice in one of the 5 states (fortunately I don not). It would add very little to my performance as a pathologist and possibly deter me from spending another year doing a fellowship which would actually be worthwhile. This is why whenever I get mail from the AOA it goes in the trash.
     
  21. ej6527

    ej6527 New Member
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    hello,
    this is a nice thread on the waste of time osteopathic internship. I think all the AOA has to do is look at the number of slots that go unfilled each year, it is like %40 !!!!!!
    The osteopathic internship is a JOKE!!!!!!. The 5 states that require it need to get caught up with the other 45 and realize its time to remove that rule and be equal to allopaths. It shouldnt be a requirement, but rather an option. It affects where everyone wants to apply for residency if they know they want to practice in those 5 states.
     
  22. I can't make out heads or tails of this jingo in the word document! Can someone translate?
     
  23. olliemctuffy

    olliemctuffy Member
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    The internship's gotta go. If the dinosaurs at the AOA would finally do something to benefit the students, like eliminating the rotating internship, those states wouldn't be able to require something that doesn't exist!:D
     
  24. JohnDO

    JohnDO MS III
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    From the AOA,

    "OPTION 1 (OGME-1 Resident), programs will grant residency credit for the 1st postdoctoral year of training. Students will apply and "Match" directly into the residency and the 1st postdoctoral year will be considered the first year of residency training."

    In other words, your PGY-1 year will count as both your internship and your first year of residency. So if I chose Internal Medicine, for instance, I'll only do 3 years post-graduate training. The first year will count towards my osteopathic internship as well as my PGY-1 year of my medicine program. This, of course, only applies to AOA-approved residency programs. Contrast to,

    "OPTION 2 (OGME-1 Preliminary), this option will require a preliminary 1st year of training. Programs will not grant residency credit but indicate completion of designated preliminary year curricular rotations, as prerequisites for entry into the 1st year of residency in the 2nd postdoctoral year of training."
     
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  25. BklynWill

    BklynWill EM Attending
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    ... doesn't necessarily mean that 3+1 programs won't just turn into 4-year programs.
     
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  26. Doc Savage 2200

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    that's my ? Everything that I have heard is that the 3 year programs, like EM will just now become 4! Does anyone know the real deal yet?
     
  27. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!
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    I'm going to talk about Option #2 b/c that's the only one I care about and the only one relevant to what I want to do (Ophthalmology).

    The "new rule" is changing NOTHING as it relates to these specialities. Residents going into any of the Option #2 specialties have ALWAYS been required to do a PGY-1 Preliminary year. On the ACGME side, most ophtho residents chose to do a Transitional year (called the TRI in AOA terminology), some did a Preliminary Medicine year, and a few brave souls do a Preliminary Surgery year.

    Moral of the story: This new Option #2 thing does NOT require any added training than what was required in the past.

    Now carry on people about EM or Pathology or whatever...
     
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  28. Stimulate

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    I don't wanna take the wind out of your sails but just an FYI...there are NO anatomic and clinical pathology residencies that are AOA-accredited. If being a pathologist is your goal you will need to apply in the ACGME/MD world. I had a classmate who did this, matched into her first choice, and obtained an automatic waiver in those 5 states because of the absence of even a single AOA-accredited program. There is an AOA forensic pathology residency in florida but it is vacant.

    Also, don't over-estimate the difficulty with which the AOA is granting credit for ACGME internships. The recent JAOA (yes I actually read it) issue quotes a less than 1% rejection rate for those seeking this approval. If you use some common sense, know the rules, work with your program director BEFORE you start internship, you can usually get AOA approval.
     
  29. surrender903

    Physician Verified Account 10+ Year Member

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    this is resolution 42, no?

    it seems more important in my humble opinion is that you talk to individual PD's and see if their program will qualify you for a AOA approved internship, if not then apply for hardship under res 42 (or whatever its called).

    stimulate is right. they have less than 1% rejection rate.

    what i find silly is that they have an AOA forensic path fellowship, but 0 path residencies? ...
     
  30. BamaAlum

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    Dude, you're not taking any wind out of my sails. I am already in a ACGME approved AP/CP residency. I have almost completed my first year. I have absolutely no desire to practice in those five states so the issue for me is moot. I was stating that there is no way I would want to do an internship, that's all.
     
  31. Stimulate

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    I think it is funny that the AOA actually makes a rule about programs that do not even exist. Why do they include pathology on the list when there aren't any programs? It just makes no sense.
     
  32. Stimulate

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    This is certainly a viable approach, however, there may be some allopathic program directors who are not interested in going out of their way to keep up-to-date on the resolution 42 rule. The bulk of the effort is usually up to the intern. The PDs will probably know if it has been done successfully before and if you ask early enough they may be able to make some minor accomodations in your schedule to help you qualify.

    I get a lot of people who ask for advice regarding resolution 42 and I always tell them to know the rules and work on it before they even start internship. Better to try to get some help before the intern rotation schedule is permanent so as to avoid getting off on the wrong foot with the PD.

    I have no intention of applying for licensure in those 5 clueless states but I actually went through the process (successfully) because I don't like the idea of ANY state being able to deny my licensure for something this ******ed.
     
  33. theraball

    theraball Panned
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    Pardon my ignorance as a pre-MS1, but what exactly is so bad about the traditional rotating internship? I keep hearing this complaint about wasting a year, as though you will be a year older and nothing to show for it. But it seems to me that this internship provides an opportunity to obtain more general training at a higher level than what MS-3 and MS-4 can achieve. How is this a bad thing? Am I the only person around who thinks such an internship might be beneficial?

    Some older MDs think it was a mistake for the AMA to eliminate the allopathic version of the rotating internship. I'm no expert but most of the opinions I read in this and similar threads seem to be based on people's selfish aspirations and some visceral dislike for the AOA rather than objective analyses of what's good for the profession and the various specialties. I wish there was more information out there; maybe someone knows of an article or two that would elucidate the issues?
     
  34. Taus

    Taus .
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    When you're a few hundred grand it debt and are at least 30 years old you may want to be able to start actually working and/or providing for your family ASAP.

    If you don't mind putting another year (or 2+) in and you want to aquire a specific set of skills you can do a fellowship after your residency.
     
  35. DOctorJay

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    how does this internship talk affect a field like PM&R which like anesthesiology you match into as a PGY2 but typically have to complete a PGY1 year elsewhere.

    I've been planning on doing a DO accredited PGY1 year anyway just to keep the 5 states open for the future so do I just continue with this plan?
     
  36. theraball

    theraball Panned
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    I'm not disputing the obvious economic advantages of starting work a year earlier as a board-certified physician, or the more intensive training that results from focusing exclusively on your specialty right out of medical school.

    I'm questioning the wisdom in eliminating the rotating internship as an integral part of osteopathic training. The internship makes you a more well rounded physician. Traditionally the osteopathic focus has been, so it is said, to treat the whole person and focus on primary care, this seems like a logical and useful component to our overall education.

    Knowing that there is optional post-residency training available doesn't go very far to mitigate the damage that this change has caused.
     
  37. Terpskins99

    Terpskins99 Fear... The Stig
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    There are exactly 5 (FIVE) states that require the osteopathic intern year. So just how "integral" is it to our osteopathic training? Are you implying that residents training in those locations become better physicians just because of the intern year? I doubt it. One more year of scut-work won't make any difference in my abilities to properly address a patient. For the vast majority of us, the osteopathic intern year is an annoyance. And as Taus mentioned, its a major headache when you have to start paying off loans.
     
  38. OP
    OP
    Doc 2b

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    There actually is a DO Pathology program run by NSU-COM. It may be dually accreditited through University of Miami, I'm not sure.
     
  39. BrainDoc22

    BrainDoc22 Junior Member
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    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.
     

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