1. 1 Osteopathic Approval of your ACGME-Accredited FP Residency: Why and How Helen H. Baker, Ph.D, MBA West Virginia School of Osteopathic Medicine, Lewisburg, WV Eric Radcliffe, MD United Hospital Center, Clarksburg, WV STFM Annual Meeting Session S-44 Friday, April 28 4-5:30 pm As of 4/27/06

2. 2 Objectives At the end of this session, the participant will be able to: At the end of this session, the participant will be able to: –List reasons for considering AOA (American Osteopathic Association) program approval –Identify AOA requirements which differ –List steps to AOA approval process –Identify sources of assistance

3. 3 Session Outline List questions from audience Background Reasons ACGME-accredited programs might seek AOA approval Similarities and differences, AOA/ACGME Steps for AOA approval Experience of one MD program director Question/Answer

4. 4 List questions from audience What are your goals for being here??

5. http://www.osteopathic.org/index.cfm?PageID=ost_main 5 Background Osteopathic Medicine Developed 130 years ago by physician A.T. Still Emphasis on inter-relationship of body’s systems Use of osteopathic manipulative treatment (OMT) Philosophy of treating the “whole person” (similar to Family Medicine!) 47% of DOs identify themselves as being FP

6. 6 Eight Percent of All USA Physicians are DOs

7. http://www.osteopathic.org/pdf/ost_factsheet.pdf 7 Location of DOs (50% are in 7 states)

8. http://www.aacom.org/data/cib/16-geographic.asp 8 Osteopathic Colleges

9. 9 Other STFM sessions this meeting re/Osteopathic Medicine (has occurred) STFM “Group on Osteopathic Family Medicine” - met Thurs. breakfast (has occurred) Friday, April 28, 2006 10:30am S-29 Integrating Allopathic and Osteopathic Family Medicine Residency Training Jacqueline Weaver-Agostoni, DO; Stephen Ritz, DO; Stephen Wilson, MD, MPH Saturday, April 29, 2006 1:45pm W13 A Hands-on Introduction to Osteopathic Manipulative Treatment and Acupuncture in a Case of Tension Headache Gautam Desai, DO; Mary Guerrera, MD

10. 10 Reasons for Residency Directors to Consider Seeking AOA Approval Demographics : fill your program with excellent residents –MD student interest in FP has declined –DO numbers growing –Keen DO interest in FP

11. http://www.aafp.org/match/graph02.html 11 Demographics

12. http://www.aacom.org/data/annualreport/AROME2004.pdf pg.20 12 Increasing Number of students in Osteopathic Medical Schools

13. Obradovic et al JAOA Feb 2006 pg 60 13 Demographics, continued… More DO graduates than there are AOA- approved PGY-1 internship positions

14. *http://www.aacom.org/data/studentreport/website/index.html p. 44 14 DO Interest in FP AACOM survey, 2003-2004, national percent choosing FP as a specialty*: –Graduating Seniors: 22.3% –Freshmen: 15.6% WVSOM’s experience: –31% of WVSOM’s Class of 2002 entered FP residencies (source: WVSOM alumni database) –AACOM survey, 2003-2004: 27% of WVSOM Graduating Seniors and 36% of WVSOM entering Freshmen plan to enter FP (source: AACOM report to school)

15. JAMA Education Issues, Table - Aug 16 2005 p 1099 15 More than 1,000 DO Residents in ACGME-Accredited FP Residencies (an unknown number are in dually-accredited positions)

16. 16 Demographics: More than 12% all residents in ACGME- accredited FP programs are DOs

17. 17 Reasons for Residency Directors to Consider Seeking AOA Approval “Osteopathic philosophy” aligns well with “Family Practice” philosophy –Patient-centered care –Wholistic care –Many MDs embrace non-traditional approaches, and DOs add a treatment modality –Can create OMT patient base

18. 18 Reasons for Residency Directors to Consider Seeking AOA Approval Adds diversity Service to potential residents –Some DO grads will wish to train in states with no AOA-approved Internship/FP residency programs –DOs need AOA approved internship for practice in WV, MI, PA, OK, and FL. (Some states have a mechanism for waiver – my state of WV does not!) –DOs need AOA Certification to take leadership role in academics (such as being your osteopathic residency director!)

19. 19 Reason: FP Tradition/ Curricular Emphasis in Osteopathic Medical Education National average, number of weeks in Family/Community Medicine at osteopathic medical schools is 11.6 weeks WVSOM requires 20 weeks FP –FM 1 (first clinical rotation), 8 wks, w/ rural DO –FM 2, 4 weeks, FP of student’s choice –FM 3, 8 weeks –3 mo. in rural WV (can be FP or other)

20. *2005 WV Higher Education Policy Commission "Report Card" 20 Reasons for Considering Dual Approval DOs may be more likely to practice in rural areas (may meet your mission!) –19.9% of WVSOM’s graduates from the classes of 1995 – 2000 are in practice in non-urban areas of WV, compared to 9.2% from Marshall U. and 6.5% from WVU* Usually only way to get the access to osteopathic “Hospital Day” recruitment fairs Possible advantages of the “OPTI” consortium (explained on next slide)

21. 21 Use resources from an “OPTI” Osteopathic internship/residency training is provided only within an “Osteopathic Postdoctoral Training Institution”, or “OPTI” Consortium of at least one osteopathic medical school and one AOA-accredited hospital (but may be multiple) Generally regional, sometimes national Intended to improve academic environment, and have College assist with OGME OPTI can assist you with program development

22. 22 OPTI Locations Full list of OPTIS – with names and phone numbers – is on line at: http://www.do-online.osteotech.org/index.cfm?PageID=sir_postdocoptiloc

23. 23 Similarities and Differences: ACGME and AOA requirements About 90-95% of requirements will be the same Osteopathic profession calls PGY-1 “internship” and approves intern program separately from residency: often confusing to MDs –Lines are blurring a bit for osteo. FP

24. 24 PGY-1 “Internship” Additional requirements, Internship: –Must have a DO faculty member who completed an AOA-approved internship to be in charge of the Internship – “Director of Medical Education” (“DME”) or “Director of Osteopathic Medical Education” –DME runs internship and has oversight for all residency programs (see detail in Standards) –One DO can be both DME and FP residency director (some AOA specialties require a different residency director - controversial)

25. http://www.do-online.osteotech.org/pdf/sir_postdoctrainproced.pdf 25 Qualifications of DME (Internship Director) Graduate of an AOA-approved college Successful completion of an AOA-approved internship Member of AOA and Association of Osteopathic Directors and Medical Educators (AODME) AOA Board certified: New DMEs who are ABMS certified must establish AOA board eligibility by time of document submission, and be certified within 3 yrs. Three years practice experience, and 3 years experience as teaching faculty member Other requirements at http://www.do- online.osteotech.org/pdf/sir_postdoctrainproced.pdf http://www.do- online.osteotech.org/pdf/sir_postdoctrainproced.pdf

26. 26 Similarities and Differences Internship Internship may be “traditional internship” or “Special Emphasis” (here, FP) Internship may be “traditional internship” or “Special Emphasis” (here, FP) For programs seeking dual approval “FP emphasis” is preferred, but “traditional” track may be acceptable Special emphasis has 6 weeks OB, 6 weeks Peds

27. 27 Traditional Rotating Internship: Rotations FM: one month in hospital or ambulatory site, or one-half-day per week continuity of care, min. 46 weeks General IM: 2 months One month each: Gen. Surgery, Emergency Med., Peds, OB/G Not more than 3 mo. electives; not more than one month non-clinical Detail in Standards, Detail in Standards, http://www.do- online.osteotech.org/pdf/sir_postdoctrainproced.pdf http://www.do- online.osteotech.org/pdf/sir_postdoctrainproced.pdf --Trainees should complete Internship requirements within first 18 months

28. 28 Internship Rotations: Family Medicine Emphasis FM: one month in hospital or ambulatory site, or one- half-day per week continuity of care, min. 46 weeks General IM: 2 months plus 1 mo. critical care One month each: Gen. Surgery, Emergency Med. 1 ½ mo. Peds, OB/G Not more than 3 mo. electives; not more than one month non-clinical (maybe less for FP emphasis) Detail found in curriculum section of FP standards, http://www.do- online.osteotech.org/pdf/sir_postdocfpomtstds.pdf http://www.do- online.osteotech.org/pdf/sir_postdocfpomtstds.pdf http://www.do- online.osteotech.org/pdf/sir_postdocfpomtstds.pdf

29. 29 Residency Approval (for PGY-2 and -3) Need AOA-certified DO Director for FP residency (osteopathic) –Individual must be AOA certified in FP, with 3 years of practice experience beyond residency –Must be active member of department, engaged in patient care One faculty member for six Residents, but min. of two faculty, including director: all but DME/Residency Director and continuity-of-care Supervisor can be MDs Supervisor of “continuity of care” experience must be DO, certified, 6 years experience or graduate of ACOFP- approved residency Other requirements listed in Standards, available at http://www.do-online.osteotech.org/pdf/sir_postdocfpomtstds.pdf http://www.do-online.osteotech.org/pdf/sir_postdocfpomtstds.pdf

30. 30 FP Residency Rotations (includes internship) Emergency Medicine – 3 months Internal Medicine – 6 months min. –2 mo. General IM as intern –1 month critical care medicine – rest of emphasis in IM should be sub- specialty

31. 31 Residency Rotations, cont. OB/Gyn: min. 16 weeks over 3 yrs –4 or 6 weeks in PGY-1 –Residency: minimum 4 weeks maternity care min. 8 weeks gynecology

32. 32 Residency Rotations, cont. Peds/Adolescent Medicine: min. 4 ½ mo. –Recommend 6 weeks during Internship include 25% time in Neonatal Nursery include 25% time in Neonatal Nursery at least 50% time to pts between 2 and 16 years of age at least 50% time to pts between 2 and 16 years of age –Rest in ambulatory and inpatient settings, and with neonatal intensive care nursery

33. 33 Residency Rotations, cont. Surgery: 5 months total –At least one month in each of the three years –Emphasis on ambulatory management of surgical problems.

34. 34 AOA “Core Competencies” 1. Osteopathic Philosophy and Osteopathic Manipulative Medicine 2. Medical Knowledge 3. Professionalism 4. Interpersonal and Communication Skills 5. Patient Care 6. Systems-Based Practice 7. Systems-Based Learning and Improvement

35. 35 Similarities and Differences, Residency, continued Continuity of Care Clinic (# days is specified) –Internship: usually ½ day wk –Usually 3 half-days in Yr 2, 4 in Yr 3 Osteopathic Manipulative Treatment (OMT), Osteopathic Manipulative Medicine (OMM) –Usually Lecture/Lab component in Year 1 (get help from your OPTI) –Patient clinic in 2 nd and 3 rd year (can be part of continuity of care) –Supervision by DO faculty

36. 36 Differences, continued Different “Match” (more changes being discussed) Different licensing exam (COMLEX-USA Level 3) AOA requires a scholarly activity *by resident (research paper, state/national presentation, or other) Residents attend osteopathic conferences Osteopathic in-service exam yearly Osteopathic certifying exam (March, PGY-3) AOA and ACOFP “resident” membership May have OPTI meetings (trainees, DME) Residency Director must attend ACOFP residency directors’ workshop yearly.

37. 37 Steps to AOA approval Identify, seek help from your OPTI! Application (“paper program”) Inspection/Site Visit as part of approval process, and also after first DO interns and residents are in program Specialty College (ACOFP, American College of Osteopathic Family Physicians) recommendation AOA PTRC (Program and Trainee Review Committee) have final approval

38. 38 Fees/Costs (may change) AOA Annual Fees –$300 program (Intern, FP Residency) –$120/yr per approved position Probably have OPTI fees Some programs choose to pay resident membership fees to AOA/ACOFP Some programs pay Certification costs

39. 39 Experience of one MD Family Practice Program Director Eric Radcliffe Eric Radcliffe, MD Residency Director United Hospital Medical Center

40. 40 Contact Information Helen H. Baker, Ph.D., MBA Associate Dean for Assessment and Educational Development West Virginia School of Osteopathic Medicine (WVSOM) 400 N. Lee Street, Lewisburg, WV 24901 Voice 304-647-6260; fax 304-645-4859 hbaker@wv.wvsom.edu Eric J Radcliffe MD Clarksburg Family Practice #1 Hospital Plaza, PO Box 2308 Clarksburg, WV 26302 Phone: 304-624-2339 Fax: 304-624-2787 E-Mail: radcliffe@uhcwv.orgradcliffe@uhcwv.org Lorenzo Pence, DO Associate Dean for GME, WVSOM Voice 304-647-6237; fax 304-645-4859

41. 41 Objectives – Accomplished? At the end of this session, the participant will be able to: At the end of this session, the participant will be able to: –List reasons for considering AOA (American Osteopathic Association) program approval –Identify AOA requirements which differ –List steps to AOA approval process –Identify sources of assistance

42. 42 Questions Discussion

43. 43 References 1. American Osteopathic Association, “What is a Doctor of Osteopathic Medicine (DO).” Available at http://www.osteopathic.org/index.cfm?PageID=ado _whatis accessed 4/21/06. http://www.osteopathic.org/index.cfm?PageID=ado _whatis http://www.osteopathic.org/index.cfm?PageID=ado _whatis 2. American Association of Colleges of Osteopathic Medicine – Geographic Map of Colleges of Osteopathic Medicine (for entering class 2006): available at http://www.aacom.org/data/cib/16- geographic.asp, accessed 4/21/06 http://www.aacom.org/data/cib/16- geographic.asphttp://www.aacom.org/data/cib/16- geographic.asp 3. NRMP Graph #1, Family Practice Positions Offered and Filled, http://www.aafp.org/match/graph02.html, accessed 4/21/06. http://www.aafp.org/match/graph02.html

44. 44 4. American Association of Colleges of Osteopathic Medicine – Annual Report. Available at http://www.aacom.org/data/annualreport/AROME2004.p df pg.20, accessed 4/21/06. http://www.aacom.org/data/annualreport/AROME2004.p df pg.20 http://www.aacom.org/data/annualreport/AROME2004.p df pg.20 5. Obradovic, JL; Beaudry, SW; Winslow-Falbo, P. Osteopathic Graduate Medical Education. JAOA, Feb 2006, 106(2), 59-68. 6. American Association of Colleges of Osteopathic Medicine – Debts, Plans and Opinions of Osteopathic Medical Students in 2004. Available at http://www.aacom.org/data/studentreport/website/index.html, p. 44, accessed 4/21/06. http://www.aacom.org/data/studentreport/website/index.html http://www.aacom.org/data/studentreport/website/index.html 7. Baker, HH. Thirty-one percent into family practice: Experience of the West Virginia School of Osteopathic Medicine. Scholastic poster presented at the Society of Teachers of Family Medicine annual meeting, Toronto, CA, May 2004.

45. 45 References, continued …. 8. JAMA Annual Education Issues, Appendix II, Graduate Medical Education: Table 1m Resident physicians on Duty in ACGME-Accredited and Combined Specialty Graduate Medical Education Programs, August 1, 2004. Most recently Sept. 7, 2005, 294(9), p. 1129. Baker, HH, Wachtler, J. Osteopathic Postdoctoral Education. JAOA, Nov. 1990, 90 (11), p 1010-1019. or http://jama.ama- assn.org/cgi/content/full/294/9/1129 accessed 4/21/2006. http://jama.ama- assn.org/cgi/content/full/294/9/1129http://jama.ama- assn.org/cgi/content/full/294/9/1129 9. OPTI Locations (and contact information). Available on-line at 9. OPTI Locations (and contact information). Available on-line at http://www.do- online.osteotech.org/index.cfm?PageID=sir_postdocopt iloc, accessed 4/21/06.http://www.do- online.osteotech.org/index.cfm?PageID=sir_postdocopt iloc

46. 46 Acknowledgements / Thanks This is an update of an earlier presentation (thanks to previous co- presenters): STFM, April 30, 2002 -- Mitchell Kasovac, DO, Andre Blaylock, MD, and Helen H. Baker, Ph.D Thanks for review of earlier drafts of these slides (any mistakes are Helen’s own!) to: Mitch Kasovac, DO, consultant on osteopathic medical education Lorenzo Pence, DO, WVSOM’s Associate Dean for Graduate Medical Education Mike Opipari, DO, Chairperson, COPT