The Future of Osteopathic Accredited Orthopedic Fellowships
By Lee Vander Lugt, DO
Executive Director, AOAO
As all of you are aware, the American Osteopathic Association (AOA) Board of Trustees and the American Association of Colleges of Osteopathic Medicine (AACOM) at their July meetings rejected the Memorandum of Understanding (MOU) for a unified accreditation system submitted by the Accreditation Council for Graduate Medical Education (ACGME). Although the American Osteopathic Academy of Orthopedics (AOAO) was supportive of these efforts, we have no choice but to abide by that decision.
Anticipating that the unified accreditation system might not be approved, the AOA has been working diligently on a Performance Based Accreditation System (PBAS) for the evaluation of all osteopathic residency training programs. The AOAO is fully supportive of this endeavor and is part of the reactor group to provide comments as the process moves forward. However, I feel the greater need at this time is the development of post residency opportunities for our trainees. At this point in time, the ACGME Common Program Requirements are scheduled to be implemented on July 1, 2015.
In essence, these requirements would not allow individuals who have completed an osteopathic residency into ACGME post residency fellowship training. Several weeks ago, the ACGME published some revisions to these requirements by creating a “Fellow Eligibility Exception” rule that each specialty residency review committee (RRC) can decide to accept or reject. These changes are open for comment until December 31, 2013.
The AOA has again submitted comments regarding the Common Program Requirements, including talking points arising out of the recent failed negotiations. Although this exception offers a glimmer of hope for DO residents, the bar is still very high. The applicant must satisfactorily complete steps 1, 2, and 3 of the USMLE, demonstrate clinical excellence in comparison to their peers, participate in additional clinical or research training in the area of the fellowship, demonstrate scholarship in the area of the fellowship and demonstrate leadership in a specialty organization.
At its face to face meeting in Dallas on August 17, 2013, the AOAO Evaluating Committee discussed this situation at great length. It is the strong feeling of the committee that the AOAO cannot sit on the sidelines while our residents struggle to obtain the post residency training most (75%) desire. The committee feels we, the AOAO, need to take a proactive role to create post residency training opportunities for our residents.
Working with individuals at the AOA, Dr. Carl Mogil and I have spoken with Tom Gentile and Mark Cummings regarding the predicament in which we find ourselves and the desire to “think outside the box” and explore innovative ways to develop and fund osteopathic orthopedic post residency training opportunities. Both men have extensive experience in osteopathic GME and OPTI experience. This goal is certainly in line with our strategic plan to “take necessary steps to have full ownership of the Evaluating Committee including residency training.” In the current environment I think we could add fellowship training to that statement. Initially, the AOAO Evaluating Committee would suggest exploring fellowships in sports, trauma, adult reconstructive, hand and spine.
Dr. Gary Ulrich, AOAO Past President, has been working to establish an AOAO Foundation. One of the goals of the foundation is funding of fellowship training for osteopathic orthopedic residents. Although the foundation is probably 9-12 months away from having any funds available, it is anticipated that this project will require disbursement of Academy resources in the near future. Information is still being gathered by AOAO leadership and will be discussed during the Board’s meeting this October. We will continue to update our membership as this project unfolds.
For the latest information on the ACGME discussions go to http://www.osteopathic.org/inside-aoa/Pages/ACGME-single-accreditation-system.aspx.
