SPECIAL ARTICLES Allopathic and Osteopathic Medicine Unify GME Accreditation: A Historic Convergence Abdul-Kareem H. Ahmed, SM; Peter F. Schnatz, DO, NCMP; Eli Y. Adashi, MD, MS BACKGROUND AND OBJECTIVES: In 1968, the American Medical As- this latest development redefines sociation resolved to accept qualified graduates of osteopathic medical the allopathic-osteopathic interface schools into its accredited Graduate Medical Education (GME) programs. in a manner reminiscent of the his- An equally momentous decision was arrived at in 2014 when the Accredi- toric 1968 decision of the American tation Council for Graduate Medical Education (ACGME), the American Os- Medical Association (AMA) to accept teopathic Association (AOA), and the American Association of Colleges of qualified graduates of osteopathic Osteopathic Medicine (AACOM) resolved to institute a single unified GME medical schools into AMA-accredit- accreditation system by July 1, 2020. As envisioned, the unified accredi- ed GME programs.3 tation system will all but assure system-wide consistency of purpose and practice in anticipation of the Next Accreditation System (NAS) of the AC- Osteopathic Medicine GME. Governance integration replete with AOA and AACOM and osteopath- and the ACGME ic representation on the ACGME Board of Directors is now well underway. Central to this transition is the des- What is more, osteopathic representation on current Review Committees (RCs) and in a newly established one with an osteopathic focus has been ignation of the AOA and AACOM instituted. Viewed broadly, the unification of the GME accreditation system as member organizations of the goes a long way toward recognizing the overlapping characteristics in the ACGME and their representation training and practice of allopathic and osteopathic medicine. As such, this on the ACGME Board of Directors. momentous development represents the latest, indeed boldest leap toward Subject to this new governance convergence between the two historic branches of American medicine. In structure, the expanded ACGME this Health Policy Analysis we seek to place the impending unification of will assume the additional respon- the GME accreditation process in its historical context, delineate its near- sibility of accrediting the more than term impact, and discuss the potential long-term implications thereof. 1,000 osteopathic (heretofore AOA- accredited) GME programs.1,4 In so doing, the ACGME will be guided by (Fam Med. 2019;49(5):374-7.) osteopathic representation on cur- rent Review Committees (RCs) as well as by a newly established os- n February 26, 2014, the less than to afford all future allo- teopathic-focused RC.1,4 In each and Accreditation Council for pathic and osteopathic physicians every case, the ACGME will be ap- OGraduate Medical Educa- with a “uniform path of preparation plying its Next Accreditation Sys- tion (ACGME), the American Osteo- for practice” and to establish con- tem (NAS), the full implementation pathic Association (AOA), and the sistency in the “evaluation of and of which went into effect on July 1, American Association of Colleges of accountability for… competency… 2014.5 It follows that the all-impor- Osteopathic Medicine (AACOM) re- across all programs.”1 Arguably the tant NAS imperatives—innovation, solved to institute a single unified most significant modification of GME accreditation system for Graduate since the institution of the Resident Medical Education (GME) by July Duty Hour reform, this agreement From Warren Alpert Medical School, Brown 1, 2020.1 The product of 2-year long rewrites the status quo yet again by University (Mr Ahmed and Dr Adashi); discussions, this “watershed moment standardizing GME accreditation in Departments of Obstetrics and Gynecology and 1,2 Internal Medicine, Thomas Jefferson University for medical education” seeks nothing the United States. Concurrently, (Dr Schnatz). 374 MAY 2017 • VOL. 49, NO. 5 FAMILY MEDICINE SPECIAL ARTICLES tracking of outcomes, measurement that states that “AOA programs that the allopathic enterprise.13-18 Key of milestones, ongoing quality im- do not apply for ACGME accredita- milestones in the hard-fought pro- provement, and the clinical learn- tion cannot accept new trainees af- gression to parity included the rec- ing environment—stand to impact ter July 1 of the year in which the ognition of osteopathy as a distinct more GME programs than origi- resident can complete their training medical education track, the estab- nally envisioned.4-6 Notwithstand- by June 30, 2020.” As such, this mea- lishment of a distinct board of ex- ing the forgoing, great care will be sure assures resident applicants that aminers, and the right to prescribe exercised to preserve and codify the any program they enter will retain drugs.13,14,17 Amended state laws per- “unique principles and practices of its accreditation through the comple- mitting the licensing of osteopathic the osteopathic medical profession” tion of their training.9 practitioners followed suit.19 Addi- by way of a “Recognition Commit- As of August 14, 2015, the tional progress was evident in the tee” tasked with defining an “osteo- ACGME Review Committees of wake of the Flexner Report with pathic recognition” designation to most (21 of 23) applicable special- osteopathic medicine gaining entry be conferred upon qualified GME ties resolved to assure further al- into the United States Military Med- programs.1,4,7 Similar commitments lopathic-osteopathic equity by ical Corps and into AMA-accredit- have been made to maintain osteo- abandoning the prior requirement ed GME programs.3,20,21 However, it pathic signature GME programs, the of an American Board of Medical was not until the recent unification oversight of which will rest with a Specialties (ABMS)-certified co-pro- of GME accreditation that allopathic dedicated Osteopathic Neuromuscu- gram director.9-11 These specialties and osteopathic medicine have con- loskeletal Medicine Review Commit- include allergy and immunology, an- verged in a manner heretofore un- tee (ONMM RC).1,4 esthesiology, dermatology, diagnos- likely.22-26 Going forward, AOA-accredited tic radiology, emergency medicine, In the eyes of many, the distinc- GME programs are to apply for family medicine, general surgery, in- tion between allopathic and os- ACGME accreditation and, if desired, ternal medicine, neurology, obstet- teopathic disciplines has become for the “osteopathic recognition” des- rics and gynecology, ophthalmology, increasingly nuanced.23 Absent the ignation between July 1, 2015, and orthopedic surgery, otolaryngolo- osteopathic emphasis on the pri- June 30, 2020.1,4 Upon entering the gy, osteopathic neuromuscoloskele- macy of the musculoskeletal sys- ACGME accreditation process, AOA- tal medicine, pathology, pediatrics, tem in human health and disease, accredited GME programs are to be physical medicine and rehabilitation, primary care-focused training,27-29 assigned a “pre-accreditation” sta- plastic surgery, preventive medicine, and an emphasis on a holistic ap- tus.4 Starting July 1, 2016, eligibility psychiatry, and thoracic surgery. proach to patient care, the two dis- for all advanced residency positions Identical arrangements will apply ciplines are similar.23,30 Drawing on will require completion of prerequi- to for Transitional Year programs. In an overlapping applicant pool, both site training in a program accredited contrast, the ACGME Review Com- the allopathic and osteopathic medi- by the ACGME, the Royal College of mittees of the specialties of urology cal education enterprises follow the Physicians and Surgeons of Canada and neurosurgery will, for now, con- well-trodden track from undergrad- (RCPSC), or the College of Family tinue to require an “ABMS-certified uate to graduate to postgraduate Physicians of Canada (CFPC). Resi- co-program director.”9,10 Given the training. In 2013, osteopathic medi- dents in or entering existing AOA- absence of osteopathic counterparts cal schools were home to 21.2% of all accredited GME programs with to the specialties of colon and rec- actively enrolled medical students.31 ACGME “pre-accreditation” status tal surgery, medical genetics, nucle- Both require a pre-med orientation during the 5-year transition period ar medicine and radiation oncology, and the Medical College Admission who are seeking training in ACGME- these programs will continue to rely Test (MCAT) as conditions for entry accredited residency and fellowship on an “ABMS-certified co-program into a 4-year undergraduate medical programs, will be subject to the eli- director.”9,10 education program. Both subscribe gibility standards (per specialty) that to similar curricular and accredita- were in effect June 30, 2013 or July Parallel Training Tracks tion standards. Both pursue similar 1, 2016, whichever is less restrictive.8 In 1874, Andrew Taylor Still, MD, licensing and specialty certification Throughout this transitional inter- DO, gave rise to the clinical princi- milestones that are all but uniformly val the AOA will continue to exer- ples that launched the osteopathy recognized by state-licensing boards cise its accreditation authority over movement.12 Special focus has been as well as by public and private pay- osteopathic GME programs.4 How- placed on the import of holistic pre- ers. Both enjoy a comparable scope ever, at the conclusion of this period, vention and on the relationship be- of practice as well as eligibility for on or before June 30, 2020, the AOA tween the musculoskeletal system membership