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“There is no desire on our part to do anything other than reinforce the importance of community-based training.”

And in the coming months, “it’s al- most certain that working groups will have to be put together specialty by specialty to do the heavy lifting of com- paring the standards and seeing what makes sense and coming to agreements on them,” Dr. Buser said.

Best of both worlds

But the two disciplines have more in common than not when it comes to training expectations, says Don Peska, DO, dean of the Texas College of Osteo- pathic Medicine (TCOM) at the Universi- ty of North Texas Health Science Center in Fort Worth. For DOs, the agreement represents “a

the Governance and Financing of GME. The emerging accreditation system will enhance the medical profession’s accountability to the public, regard- less of which tradition of medicine they come from, through a set of common competency expectations and uniform standards for GME programs nation- wide, said ACGME Chief Executive Of- ficer Thomas Nasca, MD.

“This will give us the ability to say with a single voice that all programs that are graduating residents are meeting high standards and achieving the new outcomes the public has asked for: use of electronic health records, literacy, the ability to function in multidisciplinary teams,” he said. As the country faces a severe physi-

cian workforce shortage, due in part to a federal cap on Medicare-funded GME residency positions, “we’ll be able to pro- vide accountability for the use of those dollars, and the public could then wisely invest in expanding those numbers to meet the public need,” Dr. Nasca added. The merger also would help pre-

pare physicians to practice in an ever- changing health care environment, as evidenced by the federal health system reform law, said Boyd R. Buser, DO, an AOA Board of Trustees member and chair of the organization’s Bureau of Os- teopathic Graduate Medical Education Development. Those changes show up

44 TEXAS MEDICINE January 2013

at all levels of medicine, from medical schools, to board certification, to licen- sure maintenance. At the same time, both ACGME and

AOA were reevaluating their accredita- tion systems to adapt to more outcomes- based performance, with some ACGME changes threatening to limit osteopathic graduates’ access to allopathic residency programs. “All of these things came together, and it made sense for us to be talking about possible ways to work together to im- prove the system,” said Dr. Buser, dean of the University of Pikeville-Kentucky College of Osteopathic Medicine. “It’s an opportunity to share best practices in training physicians, including perfor- mance standards that emphasize positive results. That ultimately should translate into better, more affordable care for patients.”

Although the agreement represents a historic change, one thing will remain the same, Dr. Buser affirmed. The AOA is “very clear about maintaining those things that are distinct about our [osteo- pathic] education and practice.” Dr. Nasca says the ACGME structure

will require some changes to reflect the differing osteopathic principles, and the council will add a special review com- mittee on neuromusculoskeletal medi- cine to oversee the osteopathic compo- nent of training programs.

very important breakthrough in the rec- ognition that our [osteopathic and allo- pathic] programs are virtually identical,” said Dr. Peska, who also sits on the AA- COM board. With the exception of an osteopathic principles component, the two residency training tracks share the same six core clinical competencies: patient care, med- ical knowledge, practice-based learning and improvement, systems-based prac- tice, professionalism, and interpersonal and communication skills. Duty hours and duration of training requirements also are similar. To be sure, there are differences, “but

there are things that both sides find appealing in the others’ programs,” Dr. Peska said. “When we see the uniform standards emerge in July 2015, we ex- pect to see standards that borrow from the best of both worlds.” For instance, osteopathic programs traditionally use smaller, more commu- nity-based hospitals or ambulatory facili- ties. That could be a way to expand the number of residencies across the country, particularly in primary care, often a fo- cus of osteopathic programs, Dr. Peska says.

Only about 40 percent of allopathic

programs are based in bigger academic or institutional medical settings, but about 60 to 70 percent of trainees enroll there because they are larger programs, Dr. Nasca says. “There is no desire on our part to do anything other than re- inforce the importance of community- based training.”

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