An Update On Osteopathic Medical Education For The UNECOM Alumni CME .

New COM CampusesOpened in 2016 New York Institute of Technology College of Osteopathic Medicine(NYITCOM), Arkansas Burrell College of Osteopathic Medicine (BCOM), New MexicoOpening in 2017 University of the Incarnate Word School of Osteopathic Medicine(UIWSOM), Texas Arkansas College of Osteopathic Medicine (ARCOM), Arkansas Rocky Vista University College of Osteopathic Medicine (RVU-COM),Ivins, Utah

Osteopathic Medical Schools in thePipeline(COMS listed by COCA as seeking applicant status since 2013) Alliant International University, San Francisco, CA College of Osteopathic Medicine-Jefferson, Jefferson, WI Idaho College of Osteopathic Medicine, Meridian, ID Larkin College of Osteopathic Medicine, Miami, FL Louisiana College of Osteopathic Medicine, CentralLouisiana Minnesota College of Osteopathic Medicine, Gaylord, MN College of Medicine at the University of Northwestern-St.Paul, St. Paul, MN Trine University, Angola, INSource -- lleges-of-osteopathic-medicine.pdf

Applications to Osteopathic Medical Colleges(for 2016-17 academic year) The number of individual applicants to osteopathic medicalschools has again surpassed historical records, but the pace ofapplicant growth is leveling off As of April 19, the closing date for the 2016 application cycle,total 2016 applicants are 21,574, an increase of 4.37% from2015. Individual applications to colleges totaled 190,046, a0.02% increase from 2015

Applicants to Osteopathic Medical 70518,17720,67021,574201520160* Does not include UNTHSC/TCOM20132014

AACOMAS Applicants & Matriculants2003-04 through 2015-16AACOMAS Applicants & Matriculants2003-04 through Matriculants3,03402003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16Note: The University of North Texas Health Sciences Center at Fort Worth/Texas College of Osteopathic are not included inthis chart because the data are not part of the AACOMAS database; they receive applications through the Texas Medical and

Mean MCAT Scores by Section (OldMCAT)Mean MCAT Scores by Section - Old MCAT2014 & 2015 Entering Class - Applicants & MatriculantsMCAT Verbal10.009.00MCAT Biological Science9.679.388.63MCAT Physical 0Total: 26.91Total: 27.68Total: 26.38Total: 27.332014 Applicant2014 Matriculant2015 Applicant2015 Matriculant6.005.004.00Note: The decrease in mean scores may the result of fewer pre-2015 MCAT scores being reported due to many applicants reporting newMCAT scores in their application.

Mean Undergraduate GPAMean Undergraduate GPA2014 & 2015 Entering Class - Applicants & MatriculantsGPA Science3.703.603.553.30GPA Overall3.633.563.513.433.50GPA 02.302.102014 Applicant2014 Matriculant2015 Applicant2015 Matriculant

Applicant Survey RespondentsMean Total MCATScores - Old MCATMeanUndergraduateOverall GPA2015 Entering Class Osteopathic & AllopathicApplicantsMatriculants31.433.028.02015 Entering Class Osteopathic & ic

AACOMAS Applicants as a Percentageof AMCAS ApplicantsAACOMAS Applicants as Percentage of AMCAS Applicants2006-07 Through 2015-16Percentage AACOMAS to AMCAS Applicants22,50038.9%Number of AACOMAS 132013-142014-152015-16Percentage AACOMAS to AMCAS ApplicantsAACOMAS Applicants

Factors Influencing Number of ApplicantsFactors that may influence the decline in the rate of increaseof applicants: Demographics – Decline in the rate of increase of college graduates GME shortage news – Prospective applicants, their parents, advisers may beturning away from medicine if there is no assurance of GME Student debt – Prospective applicants may be steering away from graduate andprofessional programs requiring increased debt Economy – Alternative career pathways opening up for college graduates aseconomy improves Increased focus on suicide and depression among physicians – Many maydecide to seek a less stressful profession

Percent Change in Bachelors Degrees5.00%4.50%4.00% 0.86%0.85%1.00%0.50%0.00%Projected

AACOM Growth Report (2014)

AACOM Growth Report (2014)

Growth in OMEOsteopathic medical college applicants, enrollment, & graduates over the last decade:First Year Enrollment(includes repeaters)DO College ApplicantsTotal EnrollmentTotal Graduates 2015-16: 20,447 2015-16: 7,219 2015-16: 25,876 2015-16: projected 5,420 2005-06: 8,258 2005-06: 3,908 2005-06: 13,406 2004-05: 2,756

Combined MD/DO 1st Year EnrollmentProjected to Increase 49%M.D.D.O.Combined200216,4882,96819,4562019Growth % Source: 2014 AAMC Survey of Medical School Enrollment Plans

2014-2015 Graduating SeniorSurvey—Reported DebtSource: AACOM Data and ta-and-trends/2014-15-GSSSR.pdf?sfvrsn 16

AACOM 201415 GraduatingSeniorSurvey—DebtandScholarship

Recruiting and Maintaining U.S. Clinical TrainingSites: Joint Report of the 2013 Multi-DisciplineClerkship/Clinical Training Site SurveyA joint report from the American Association of Colleges of Nursing(AACN), the American Association of Colleges of Osteopathic Medicine(AACOM), the Association of American Medical Colleges (AAMC), and thePhysician Assistant Education Association (PAEA), summarizes the resultsof a March 2013 survey sent to the dean or director of every eligible schoolor program in the four disciplines.61

Survey response rate Overall response rate to survey – 85% By discipline DO – 91% MD – 83% NP – 85% PA – 84%62

Concern about adequacy of clinical training sites63“Moderately” or “Very Concerned”DOMDNPPANumber of clinical sites81%80%96%95%Supply of qualified primary care preceptors65%84%94%91%Supply of qualified specialty preceptors70%62%84%73%Demographic diversity of patients32%23%48%40%Diversity of medical conditions29%21%38%36%

Respondents reporting increased difficulty finding sites, by specialtyFor DO programs, by specialty 10% reporting difficulty64% reporting %Psychiatry42%OMM35%Emergency medicine19%Internal medicine16%Radiology10%

Increased difficulty developing new and preserving existing coresites65“Somewhat” and “Much more difficult”DOMDNPPANew sites81%71%86%76%Existing sites68%69%78%78%

Clerkships reported in community based settings, by discipline66

Incentives reported by DO and MD programs67

Payment reported by DO and MD programs68

69

Paying for clerkship slots% of schools reporting pressure fromexisting clinical training sites regardingpayment (s) for student rotations60%51%50%40%49%51%39%2015 PreliminaryResults of NewPaymentQuestions 24% pay forstudents torotate atacademic sites. 26% pay forstudents torotate atcommunitybased sites.32%30%20%10%0%2009 2012 2013 2014 2015**Preliminary results from 2015 Medical SchoolEnrollment SurveySource: AAMC Survey of Medical SchoolEnrollment Plans

99.4% of 2015 DO Graduates Placed inGME6000DO Graduate Match Outcomes 2015as of May 1, 201553095260[VALUE] (99.4%)500040003000[VALUE] (48%)[VALUE] (46%)20001000490[VALUE] (5%)[VALUE] (.5%)[VALUE] (.6%)

2016 GME Placement ReportNMS (AOA), NRMP & SOAP (ACGME), and Military Match(Data as of May 1, 2016 - Final Data in Fall 2016) 99.61% of DO graduates seeking GME successfully placed into GME (5,356 newphysicians) 2,633 (48.97%) placed into AOA accredited GME positions 2,465 (45.84%) placed into ACGME accredited GME positions 233 (4.33%) placed into military match 25 (0.47%) placed into other GME positions (San Francisco match, etc.) 0.39% did not match or place into GME

DO Grads in Primary Care GME -- historical50004500400050.0%Percent DO Graduates Placing in Primary Care GME 2009-201349.0%Total reported graduatesPercent DO graduates in all Primary 458480620092010201120122013Source: AACOM Annuial Survey of Colleges of Osteopathic Medicine.Primary care includes Family Practice and OMM and Family Practice and NMM (AOA), Family Medicine (ACGME), and Internal Medicine, Pediatrics(AOA and ACGME).42.0%

DO Grads in Primary Care GME -- historical50004500Number DO Graduates Placing in Primary Care GME 2009-20134000445835003000480641593588AOA accredited Primary Care GMEACGME accredited Primary Care 10201120122013150080993278820090Source: AACOM Annuial Survey of Colleges of Osteopathic Medicine.Primary care includes Family Practice and OMM and Family Practice and NMM (AOA), Family Medicine (ACGME), and Internal Medicine, Pediatrics (AOA and

An Update on Osteopathic MedicalEducation Background Environment Trends in Osteopathic Medical Education Single Accreditation System - Implementation Update AACOM Activities/Priorities Discussion

Typical Physician TrainingTimeline11 to 18years

Single Accreditation System (SAS) AACOM continues to work collaboratively with the ACGME andthe AOA in the transition to the single GME accreditationsystem, which officially launched July 2015 AACOM participates in various committees as the threeorganizations work through operational and educational effortsrelated to the transition SAS streamlines the residency program application process andbroadens access to residency and fellowship programs DO students can train in ACGME programs and still continueosteopathic training through ACGME programs with osteopathicrecognition

Key Benefits of the new system Ensures that the evaluation and accountability for thecompetency of residents is consistent across all GMEprograms, helping to ensure quality and efficiency Ensures that all physicians have access to the primary and subspecialty training they need to serve patients Allows the osteopathic and allopathic communities to speak witha unified voice for GME to better serve the public Recognizes the unique principles and practices of DOs asintegral to the U.S. health care system Continues to include osteopathic-focused training programs;AOA trained and certified physicians can serve as GME faculty

Transition Timeline February 2014, MOU signed by ACGME, AOA, AACOM tocreate a single accreditation system for graduate medicaleducation (GME) April 1, 2015 institutions begin to apply July 1, 2015 programs begin to apply Only programs w/n institutions with ACGMEaccreditation or those who achieve pre-accreditationcan apply Transition period: July 1, 2015-June 30, 2020 AOA stops accrediting programs June 30, 2020

AOA/AACOMIntegration intoGovernance andOperations ofnew ACGMEACGMEBoard CommitteeAdding DOsto RCsRC forONMMRecognitionCommitteefor OMDesignation

Highlights All DOs and MDs will be eligible for training positions andfellowships MDs must demonstrate readiness to enter osteopathic training Program size will not prevent AOA programs from achievingACGME accreditation Through the transition, GME accreditation will change, but otherelements of the osteopathic medical education continuum will bepreserved, COMLEX, predoctoral education, CME, AOA BoardCertification

KEY DEVELOPMENTS All relevant ACGME Review Committee (24 RCs)will accept AOA board certified programdirectors, as long as they meet all otherrequirements for program directors for the reviewcommittee Neurological surgery decided in 2016 to accept AOA boardcertification for program directors Several ACGME Review Committees are workingto integrate AOA board certification languagewithin ACGME program requirements, at least 15have already submitted language for ACGMEboard approval, all are expected to do so shortly

KEY DEVELOPMENTS COMLEX-USA announcement by ACGME to itsprogram directors: acceptance for graduatesfrom pre-accredited programs, seekingfellowships as exceptionally qualified candidates Acceptance of AOA internship year forspecialties that require a preliminary year

Newly Approved AOA Standards New standards help ensure residents will completetheir training in an accredited training. These standards set deadlines for programs to eitherapply for ACGME accreditation, or stop acceptingtrainees if the trainees cannot complete the programby June 30, 2020. If a program does not apply to theACGME by the deadline, it will not be able to accepttrainees the following February.

Newly Approved AOA Standards Charts in Section X. of the Basic Documentsdelineate a date by which programs in a specificspecialty must stop accepting trainees if no ACGMEapplication is submitted For example: family medicine programs must submitan application for ACGME accreditation by January1, 2018. If a program has not submitted anapplication by this time, their program must stopaccepting trainees.

AOA Training Programs as of July 1,2015Total AOA 62*173 AOA programs are dually-accredited programsSource: AOA presentation at AOA Annual Business Meeting 2016

Number of DO Residents in AOAProgramsYearTotal Number of DO Residentsin AOA : Appendix 1: Osteopathic Graduate Medical Education, 2016Authors Bulmaro Martinez and Maura BiszewskiFrom JAOA, April 2016, vol 116, no 4

Status of Applications: Institutions As of 9/14/2016Status of institutional tationContinued preaccreditationSource: ACGME Accreditation Data System Public SiteInitial accreditationTotal applied

Status of Applications: Programs As of 9/14/2016Status of program applications3002422502001501301005656Continued tationSource: ACGME Accreditation Data System Public SiteTotal applied

AOA Call Campaign: Plans for ACGMEClosed, 71,AccreditationN 1,2446%Does NotPlan toApply, 75,6%Applied orWill Apply,1029, 83%Undecided,22, 2%No Contact,39, 3%No Pathway,8, 0%Source: AOA presentation to BOT at OMED 2016

AOACall Campaign: Program Closuressince 7/1/15, N 71New programdoes not want topay AOA fees, 8,11%Program has notContractedtrainees for 3 Years, 43, 61%Internship notneeded for SAS,5, 7%Funding issues,3, 4%Closed byPTRC, 2, 3%Hospital closed,1, 1%Source: AOA presentation to BOT at OMED 2016Closure plannedprior to SAS, 6,9%Does not wish toapply forACGME, 3, 4%

Osteopathic Recognition

In 2014, AACOM established an AdHoc Committee on GME Transitionto provide recommendations to theOPC.The Committee developed a paperon what an osteopathically-focusedprogram should include and whatpre-requisites would be necessaryfor an MD to succeed in anosteopathically-focused programAccess report gme/next-steps-forGME

Osteopathic Recognition Key method to codify osteopathic principles and practiceswithin ACGME program requirements “Osteopathic Recognition (OR) is conferred upon anyACGME-accredited graduate medical education programproviding requisite training in the Osteopathic Principlesand Practice (OPP).” Overseen by the ACGME Osteopathic PrinciplesCommittee (OPC)OR Program Requirements available on ACGME rogramRequirements/Osteopathic Recogniton Requirements.pdf

Why Pursue Osteopathic Recognition? Provides an organized approach to perpetuate osteopathicmedicine’s contributions to patient care. Creates opportunity for all physicians to learn OsteopathicPrinciples and Practices Creates program distinctiveness. Programs with Osteopathic Recognition are acknowledgedon the ACGME website. Osteopathic medical students would rather train in aprogram with Osteopathic Recognition“Patient care delivered within the context of Osteopathic Principles andPractices is aligned to patient-centered, high-value care and the needs ofour nation’s healthcare system.”Source: Presentation by Robert Cain, DO, Chair, OPC at OMELConference 2016

OPC Key Developmental ActivitiesOPC WorkingGroup Formed inOct 2014 Proposed Requirements PostedNovember 2014OPC CommitteeFormed, January2015OPC ProgramRequi

Burrell College of Osteopathic Medicine (BCOM), New Mexico Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM), North Carolina Chicago College of Osteopathic Medicine of Midwestern University (CCOM/MWU), Illinois Des Moines University - College of Osteopathic Medicine (DMU-COM), Iowa