1. The Nuts and Bolts of Osteopathic Recognition (OR) 2016 STFM Annual Spring Conference Minneapolis, Minnesota Harald Lausen, DO, MA

2. Disclosures I have NO financial conflicts to disclose I am NOT a member of the ACGME Osteopathic Principles Committee

3. Disclaimer Any content of my presentation “The Nuts and Bolts of Osteopathic Recognition” represents my personal opinion and perspective. The content does NOT reflect or represent any organization or association with which I am affiliated.

4. Objectives Following this presentation, attendees should be able to: Understand the requirements and resources for ACGME Osteopathic Recognition (OR) Evaluate and discuss the benefits of and challenges to applying for OR Discuss how the new OR option may impact residency education

5. Common Questions – Why would a program apply for osteopathic recognition? – Should the entire program falling under osteopathic recognition or should the program create a track? – How are osteopathic principles integrated within the six ACGME core competencies? – What are the required elements of an osteopathic learning environment? – What type of learning resources will support osteopathic medical education? – What is the impact of an osteopathic-focused track on a program’s CCC? – What are the director and faculty qualifications / requirements for an osteopathic recognition program? – What are the issues and options for osteopathic and allopathic board certification? – Who is eligible to enter an osteopathic recognition program?

6. Use of Hyperlinks - Instructions All ACGME resources are hyperlinked Place cursor over hyperlink Right click on hyperlink Left click on “Open Hyperlink” option Link should open

8. Single GME Accreditation System (SAS) Executive Summary September 2014 ACGME, AOA, and AACOM Four Dimensions – Transition to SAS – Program Focus – DO Graduate Eligibility in ACGME Programs – Osteopathic Principles in ACGME – Transition to SAS – Governance Focus

9. Benefits of SAS Consistent evaluation and accountability Eliminate duplication in GME accreditation Efficiency and cost-savings (Dual / Parallel) Ensure resident and fellowship eligibility

10. SAS - Resources ACGME Single GME Accreditation Page SAS Frequently Asked Questions Executive Summary of the MOU

11. Osteopathic Recognition (OR) Osteopathic Recognition is conferred upon any ACGME-accredited graduate medical education program providing requisite training in the Osteopathic Principles and Practice (OPP). Programs may be deemed to have Osteopathic Recognition after appropriate application, evaluation, and review of the standards.

12. OR - Resources ACGME Osteopathic Principles Committee Osteopathic Recognition Requirements Osteopathic Recognition FAQs Osteopathic Recognition Milestones Osteopathic Learning Environment Osteopathic Recognition Application Osteopathic Recognition Application Instructions ACGME Osteopathic Recognition Report

13. OR – Current Statistics ACGME Osteopathic Recognition Report As of April 25, 2016 – 42 programs in various stages 30 FM programs 9 IM programs 1 IM/Peds program 1 TY program 1 Sports Med Fellowship

14. Why Apply for OR? Improve Recruitment (Generalists) Increase US Graduates vs IMG (Visa Issues) Expand Clinical Services (OPP/OMT) Expand Procedural Training (OMT) Enhance “Patient-Holism” (OPP) Additional Program Distinction No additional ACGME Fees or Site Visit

15. Applying for Osteopathic Recognition (OR) Osteopathic Recognition Application Osteopathic Recognition Application Instructions Existing ACGME Residency Program – May apply for and receive initial recognition Residency Program in Pre-Accreditation – May apply; No application review until residency program receives initial accreditation Residency Program in Initial Accreditation – May apply for and receive initial recognition

16. OR – Application Sections Review Application and Instructions! Entire Program or Track OPP / OMT Clinical Teaching OPP Integration into Competencies OPP Curriculum Integration and Resources Faculty Resident Eligibility

17. OR – Tracks and Resident Complement Programs receiving Osteopathic Recognition may designate the entire program as osteopathic-focused or designate a portion of the program as an osteopathic-focused track. Programs must have a minimum of one resident per year in the osteopathic-focused track, averaged over a period of three years. No approval required to change the complement of osteopathic-focused residents

18. OR – Continuum of Education Programs seeking Osteopathic Recognition should participate in a community of learning that promotes the continuum of osteopathic medical education. This community should include a college of osteopathic medicine, osteopathic medical students, residents in an osteopathic-focused track, and teaching physicians from a variety of settings committed to maintaining these requirements for Osteopathic Recognition. Such a community can be provided through affiliation with an osteopathic post-doctoral training institution (OPTI)

19. OR – Clinical Learning Environment Osteopathic Learning Environment Focused Rotations and/or Integrated Rotations and/or Osteopathic Rounds and/or Clinic Rotations and/or Osteopathic Patient Care Conference

20. OR – Clinical Learning Environment Focused Rotation with a physician who uses OMT/OPP in majority of patient encounters. Integrated Rotation with an assigned practice that includes planned exposure to OMT/OPP. Osteopathic Rounds in a regularly scheduled fashion with a qualified consulting physician. Clinic Rotations with an assigned clinic that includes planned exposure to OMT/OPP. Osteopathic Patient Care Conference on a regularly scheduled basis where integration of OPP/OMT is discussed as part of the patient care plan.

21. OR – Clinical Competency Committee July 2016 effective for residency programs in pre-accreditation Once the residency program has received OR, it must include Milestone assessment in Osteopathic Principles and Practice as applicable to the specialty.

22. OR - Milestones Osteopathic Recognition Milestones Aggregate score is 1 indicator of program educational effectiveness Osteopathic-focused programs must include integration of Osteopathic Principles and Practice into the six ACGME core competency areas.

23. Milestones - OPP Osteopathic Principles and Practice define the conceptual understanding and practical application of the distinct behavioral, philosophical, and procedural aspects of clinical practice related to the four tenets of osteopathic medicine: – the body is a unit; the person is a unit of body, mind, and spirit; – the body is capable of self-regulation, self-healing, and health maintenance; – structure and function are reciprocally interrelated; and, – rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function

24. OR - Milestone Domains Patient Care 1 – Osteopathic Principles for Patient Care Patient Care 2 – Examination, Diagnosis, and Treatment Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Systems-Based Practice Professionalism

25. OR - Curriculum Instruction and evaluation in the integration of OPP Use of OPP throughout the educational program Environment that supports scholarly activity to advance OPP Commitment from educators and leaders to create and maintain the required learning environment for all residents Sufficient number of faculty members (MD or DO) who, through prior training and certifications, are able to supervise the performance of OMT in the clinical setting for patient care Access to a variety of learning resources to support osteopathic medical education, including reference material pertaining to OMT and OPP integration into patient care Participation by faculty members and residents in scholarly activity specific to OPP

26. OR - Curriculum Access to a variety of learning resources to support osteopathic medical education, including reference material pertaining to OMT and OPP integration into patient care, including: – access to a number of examination tables suitable for osteopathic manipulative treatment and education in order to achieve the goals and objectives for this part of the curriculum – facilities for osteopathic clinical and didactic activities Learning activities to advance the procedural skill acquisition of OMT for both residents and faculty members Resident teaching of OPP, such as resident-delivered integrated OPP didactic lectures, hands-on OMT workshops, and/or resident-led journal clubs Communicate to the interprofessional collaborative team the philosophy of OPP

27. OR – Curriculum Resources Live or video presentations of OPP / OMT References that enhance the understanding of OPP Role modeling of OMT in the patient care setting Online training modules to enhance learners’ understanding of OPP and the application of OMT in the clinical setting

28. OR - Director Program Director, Co-Program Director, or Osteopathic-focused Track Director Board certification through the American Osteopathic Association (AOA) specialty certifying boards in the program specialty, or qualifications judged acceptable to the Recognition Committee Engage in osteopathic-focused professional development applicable to his/her responsibilities as an educational leader Trained in the evaluation and assessment of all ACGME competencies, including OPP competencies Participate in a faculty development program that includes OPP May be shared between programs

29. OR - Faculty The program director/co-program director/track director must have documented training in hands-on courses in osteopathic manipulative medicine or have certification requiring hands-on training, such as a doctorate in osteopathic medicine with board certification through the American Osteopathic Association (AOA). The Committee expects all specialty and subspecialty programs with Osteopathic Recognition to have at least two faculty members able to develop and deliver curriculum intended to promote OPP and use of OMT consistent with the osteopathic competencies. – A program may use external resources to support this effort, such as resources provided through a relationship with an educational consortium (e.g., an OPTI) or a college of osteopathic medicine.

30. OR – Faculty One or more program faculty member(s) must work closely with the program director to assist in the development of the OPP competency education and evaluation system, and to teach and advise residents. This faculty member must: – be board certified through an AOA specialty certifying board or possess qualifications judged acceptable by the RC – be trained in the evaluation and assessment of the ACGME and osteopathic competencies – participate in a faculty development program including OPP – evaluate residents, including direct observation of osteopathic-focused program or track residents with patients – participate in organized clinical discussions, rounds, journal clubs, or conferences with specific integration of OPP or OMT

31. OR – Resident Eligibility COCA or LCME Graduate International Graduate – hold a currently-valid certificate from the Educational Commission for Foreign Medical Graduates (ECFMG) prior to appointment or – hold a full and unrestricted license to practice medicine in a United States licensing jurisdiction in his/her current ACGME- accredited specialty/subspecialty program or – have graduated from a medical school outside the United States and have completed a Fifth Pathway program provided by an LCME-accredited medical school

32. OR - Resident Eligibility Prior to matriculation, residents must have sufficient background and/or instruction in osteopathic philosophy and techniques in manipulative medicine sufficient to prepare them to engage in the curriculum of the program, to include: – osteopathic philosophy, history, terminology, and code of ethics – anatomy and physiology related to osteopathic medicine – indications, contraindications, and safety issues associated with the use of osteopathic manipulative treatment – palpatory diagnosis, osteopathic structural examination, and osteopathic manipulative treatment

33. OR – MD Eligibility The Committee expects that MD applicants, or any other applicants who are physicians but not DOs, will demonstrate some level of preparation for entry into an osteopathic- focused position in a program with Osteopathic Recognition. Such preparation may be demonstrated by: – Structured basic osteopathic principles and practice training prior to beginning residency – Prior completion of elective osteopathic principles and practice rotations – Prior completion of osteopathic principles and practice courses at an osteopathic medical school – Other experiences and training to enable the matriculated resident to demonstrate entry-level competency for participation in the program

34. OR – Scholarly Activity Osteopathic-focused faculty members and residents must participate in scholarly activity specific to OPP Osteopathic-focused faculty members must produce at least two scholarly pieces annually, averaged over a five-year period Osteopathic-focused residents must produce at least one piece of scholarly activity prior to graduating from the program

35. OR – Faculty Scholarly Activity Faculty – Topic presentation at a regional, state, or national meeting – Presentation at a grand rounds – Publication of articles, book chapters, abstracts, or case reports in peer-reviewed journals – Publication of peer-reviewed performance improvement or education research – Peer-reviewed funding – Peer-reviewed abstracts presented at a regional, state, or national specialty meeting – Leadership in a regional, state, or national osteopathic- related organization

36. OR – Resident Scholarly Activity Residents – All listed under faculty – Resident-led didactic with integration of OPP – Resident-led workshop with integration of OPP – Resident-led journal club with osteopathic content

37. OR – Program Evaluation Residents and faculty members must have the opportunity to evaluate the osteopathic- focused components of the program confidentially and in writing at least annually. The program must use the results of residents' and faculty members' assessments of the osteopathic-focused components of the program together with other program evaluation results to improve the program.

38. OR – Faculty Evaluation At least annually, the program must evaluate faculty member performance as it relates to the integration of Osteopathic Principles and Practice in the educational program. Evaluation must include at least annual written confidential evaluations of the osteopathic- focused program or track faculty members by the osteopathic-focused program or track residents.

39. OR – Resident Evaluation The program must provide formative and summative assessment of resident performance based on the Osteopathic Principles and Practice Milestones and other forms of evaluation, as applicable to the specialty. Assessment of knowledge of Osteopathic Principles and Practice in the specialty should occur through a specialty-specific osteopathic in-service examination or other equivalent formal exam.

40. OR – Resident Formative Evaluation Formative evaluation must include: – Ongoing assessment of the integration of OPP throughout the competency domains, which should occur during patient care activities; – Assessment of appropriate documentation of osteopathic manipulative medicine as applicable to the specialty program; – Assessment of OPP integration into patient care as applicable to the specialty; and, – Assessment of OPP integration into scholarly activity.

41. OR – Resident Summative Evaluation The program director, co-program directors, or osteopathic-focused track director must provide a summative evaluation for each resident upon completion of the program. Assessment of skill proficiency in osteopathic manipulative medicine should be measured through practical skill assessments. The program must include Milestone assessment in OPP as applicable to the specialty.

42. OR – Board Certification Osteopathic Recognition FAQs The Osteopathic Principles Committee has decided that it will not enforce the 80 percent take rate requirement for AOA Board Exams. The Committee will seek to formally remove this requirement during the next focused revision of the Requirements for Osteopathic Recognition. The Board pass rate will still be enforced and will be based on those eligible graduates of the program that choose to take the applicable AOA Board exam

43. OR – Board Certification SAS Frequently Asked Questions The ACGME’s Board of Directors recognizes that osteopathic graduates may take osteopathic certifying board examinations, and has instructed all Review Committees to propose language regarding board certification requirements to include AOA certifying board pass rates to accommodate this expectation. The ACGME currently monitors pass rates on ABMS board examinations and will do the same for AOA board pass rates.

44. OR – Board Certification SAS Frequently Asked Questions Programs in which some or all graduates take the applicable AOA certifying exam may not achieve the required minimum “take rate" for the applicable ABMS board examination as specified in the specialty-specific Program Requirements. When this occurs the program will not receive a citation and the program’s accreditation status will not be adversely impacted on the basis of non-compliance with this requirement.

45. AOA Board Exams - MD Eligibility MDs are currently not eligible to sit for AOA specialty boards Discussion is ongoing Future eligibility for MDs to take AOA specialty boards is expected

47. Questions? Tiffany Moss, MBA Executive Director, Osteopathic Accreditation 312.755.5490 tmoss@acgme.org

48. Thank You! Harald Lausen, DO, MA Chief Medical Officer, SIU HealthCare Assistant Dean for Clinical Education, SIU School of Medicine Professor of Clinical Family & Community Medicine hlausen@siumed.edu