The Single Accreditation System: Risks to the Osteopathic Profession.

In August 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) signed a memorandum of understanding with the Accreditation Council for Graduate Medical Education (ACGME) to create the Single Accreditation System (SAS) for graduate medical education (GME) in the United States. The AOA made the decision that it would close its GME accreditation system in response to dramatic growth in colleges of osteopathic medicine, a shortfall in osteopathic GME positions with increasing dependence on the ACGME system, ACGME policy decisions that adversely impacted osteopathic students, and declining osteopathic student interest in primary care. Osteopathic teaching institutions bore responsibility for meeting ACGME accreditation standards between 2015 and 2020, including determining institutional sponsorship, which program applications to submit, program size, educational leadership, and whether to pursue Osteopathic Recognition. Approximately 692 of 954 (72.5%) eligible osteopathic GME programs in 2014-2015 obtained ACGME accreditation by June 1, 2020. There were sharp reductions in surgical and subspecialty programs and a significant drop of DOs in educational leadership positions. A low percentage of ACGME-accredited programs applied for Osteopathic Recognition. In closing its GME accreditation system and joining the ACGME, the AOA gave up control of its direct relationship with osteopathic residents, fellows, and teaching institutions to gain critical GME opportunities. In this article, the author considers whether this gain will offset the risks taken by the AOA, including decreased DO leadership opportunities and role models, lower than expected interest in Osteopathic Recognition, and possible decreased DO interest in osteopathic organizations and osteopathic specialty board certification. Time and the choices of current and future DO trainees in ACGME programs will determine the future of the osteopathic profession-and whether these risks were worth taking.

Response of Chiropractic Organizations to the COVID-19 Pandemic: A Descriptive Report.

Objective: The purpose of this report is to describe actions by chiropractic entities during the early stages of the coronavirus disease 2019 (COVID-19) pandemic. Methods: Large entities that support chiropractic education or practice were invited to participate in this report. Leaders of various entities were emailed an invitation. A designee who was assigned by the leader provided a brief synopsis of actions the entity had taken in response to the COVID-19 pandemic. Only entities that responded are included in this report. Results: Five entities agreed to participate: The Council on Chiropractic Education, Association of Chiropractic Colleges, Federation of Chiropractic Licensing Boards, National Board of Chiropractic Examiners, and the National Chiropractic Mutual Insurance Company. Common themes included (1) recognizing the crisis and taking action, (2) establishing a safe working environment for staff so that services could continue, (3) delivering communications to stakeholders (chiropractic students, practitioners, licensing boards, and others) to guide decisions and direct actions, and (4) continuing to monitor the situation and respond as new information becomes available. Conclusion: These entities serve a large portion of the chiropractic profession. They have been quick to respond in a responsible, compassionate, and supportive manner to assist chiropractic licensing boards, practitioners, and students during the COVID-19 pandemic. These findings are encouraging as the chiropractic profession looks to the future as it navigates changes in education and the health care environment in the months and years ahead.

CATALYST: Piloting a Longitudinal Assessment and Learning Program for Board Recertification and Continuous Professional Development.

Context: As a proposed alternative to the traditional recertification examination, CATALYST is a longitudinal formative assessment platform created on cognitive learning principles. CATALYST was designed by the National Board of Osteopathic Medical Examiners to encourage more complex and durable practice-relevant learning and demonstration of ongoing competencies. Objective: To investigate the value of the CATALYST platform using board diplomates' subjective feedback and comparison of performance on CATALYST questions with performance on board examinations. Methods: Diplomates from 3 osteopathic specialty boards (the American Osteopathic Board of Internal Medicine, the American Osteopathic Board of Pediatrics, and the American Osteopathic Board of Obstetricians and Gynecologists) participated in this pilot study. Over the course of 16 weeks, participants were provided 2 questions per week via the CATALYST platform. An evaluation survey was emailed at the end of the study period to collect participants' feedback. Survey results and correlations of CATALYST performance with past or upcoming board examination scores were analyzed. Results: A total of 196 diplomates completed the surveys, with 95% reporting that participation in the platform would help them stay current in their specialties and 91% reporting that participation would help them provide better care to their patients. For the AOBIM, a significant correlation was found between the number of CATALYST questions answered correctly and performance on the board examination (r=0.51, P<.001). The correlations found for the AOBP and AOBOG were not significant (r=0.197, P=.296, and r=0.370, P=.075, respectively). Conclusion: The CATALYST platform could offer valuable contributions to the board recertification process and to patient safety. Further investigations are being conducted on a new user-friendly platform.

Challenges in surgical oncology training in Brazil: From history to a board-certified specialization.

The Brazilian Society of Surgical Oncology was established over 30 years ago. Despite that, surgical oncology was finally recognized as a Board-Certified medical specialty in 2017 and has strengthened its role in the standardization of surgical and multimodal approaches in our country. This article aims to describe the process and the main challenges of the specialists training who are qualified for job opportunities and who meet the expectations of the recently created competence matrix for surgical oncologists in Brazil. Thus, we hope to expose the challenges of teaching surgical oncology, describe its history and experiences in important country services, and outline the minimum requirements for creating a more humanistic surgical oncologist who is updated and fully committed with multidisciplinary treatment for cancer patients. We conclude that the main characteristic that the surgical oncologist must have is the ability to offer holistic treatments to the patient, based on the highest level of evidence, love, and compassion, to direct the treatment and understand all of the afflictions that arise with a cancer diagnosis. Moreover, the surgical oncologist in training and in the field must be continuously updating himself to offer the best options of treatment to patients.

Orthopaedic In-Training Examination Resources and Residency Training for the Foot and Ankle Domain.

BACKGROUND: Residency programs use the annual Orthopaedic In-Training Examination (OITE) prepared by the American Academy of Orthopaedic Surgeons (AAOS) to monitor resident progress and prepare them for the part 1 of the American Board of Orthopaedic Surgeons (ABOS) Certifying Examination. The purpose of this study was to determine resources residents currently use to prepare for the OITE and also to learn about their perception of training they receive in the foot and ankle subspecialty in their program and their interest in foot and ankle fellowship after residency. METHODS: An anonymous survey was sent to both allopathic programs and osteopathic residents to learn what resources residents used to study for the OITE, preparatory question sets, on-call resources, their perception on training received in foot and ankle surgery, and their intent to pursue fellowship training. RESULTS: A total of 130 residents participated in the survey. The majority of residents in allopathic and osteopathic residencies used Orthobullets (OB) to prepare for the OITE and use this resource while on-call. Most residents also used OB question sets to study along with the AAOS self-assessment examinations. In total, 43.2% of osteopathic residents felt they did not get enough exposure to foot and ankle subspecialty while in training, in contrast to 31.2% of allopathic residents. A total of 35% of all orthopaedic surgery residents felt they lacked enough exposure to foot and ankle orthopaedic surgery. Only 7 residents (6%, 6 allopathic, 1 osteopathic) intended to pursue a foot and ankle fellowship following graduation. CONCLUSION: Online resources such as OB continue to be frequently used by residents for preparation for the OITE. Greater than one-third of orthopaedic residents feel they do not get enough exposure to foot and ankle orthopaedic surgery. Improvement in this area could be helped by continued endeavors from the American Orthopaedic Foot and Ankle Society such as the Visiting Professor Program and Resident Scholarship Program. LEVELS OF EVIDENCE: Level V: Single Cross-Sectional Study.

Treatment Results of Transurethral Resection of the Prostate by Non-Japanese Board-Certified Urologists for Benign Prostate Hyperplasia: Analysis by Resection Volume.

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard for surgical treatment of benign prostatic hyperplasia (BPH), but it has complications such as bleeding and transurethral resection syndrome. The treatment results of TURP performed by non-Japanese board-certified urologists were examined, and the results were analyzed according to the resection volume to determine how much resection volume was suitable for non-Japanese board-certified urologists. MATERIALS AND METHODS: A total of 72 cases that underwent TURP for BPH at our hospital were examined. The patients were divided into three groups by resection volume (<20 g, 20-30 g, >30 g). The operators were five non-Japanese board-certified urologists. Various clinical factors were examined among the three groups before and after TURP. RESULTS: The average operation time and resection volume were significantly different among the groups. There were more transfused cases with greater resection volume. The changes from before to after TURP in the International Prostate Symptom Score, total prostate volume, and maximum flow rate were significantly different among the three groups, but the rates of these changes were not. CONCLUSIONS: In this study, TURP performed by non-Japanese board-certified urologists was relatively safe and achieved sufficient efficacy. Cases with resection volume less than 20 g appear the most appropriate for non-Japanese board-certified urologists.

Evidence-Based Redesign of the COMLEX-USA Series.

To ensure that the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) reflects the evolving practice of osteopathic medicine, the National Board of Osteopathic Medical Examiners has developed new content and format specifications for an enhanced, competency-based examination program to be implemented with COMLEX-USA Level 3 in 2018. This article summarizes the evidence-based design processes that served as the foundation for blueprint development and the evidence supporting its validity. An overview is provided of the blueprint's 2 dimensions: Competency Domains and Clinical Presentations. The authors focus on the evidence that supports interpretation of test scores for the primary and intended purpose of COMLEX-USA, which is osteopathic physician licensure. Important secondary uses and the educational and catalytic effect of assessments are also described. This article concludes with the National Board of Osteopathic Medical Examiners' plans to ensure that the COMLEX-USA series remains current and meets the needs of its stakeholders-the patients who seek care from osteopathic physicians.

Requirements for Certification in Surgery: A Comparison of the American Board of Surgery and the American Osteopathic Board of Surgery.

In early 2014, the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, and the American Association of Colleges of Osteopathic Medicine agreed to a memorandum of understanding describing a single accreditation system for graduate medical education in the United States. Although there are many benefits, such as consistent quality of graduate medical education, alignment of competency standards, alignment with policymakers' expectations, unification of voices on graduate medical education access and funding issues, and visibility of osteopathic medicine, there are also many challenges in creating a uniform system of graduate medical education. The authors review the pathways to initial certification for both the American Board of Surgery and the American Osteopathic Board of Surgery and discuss recertification and maintenance of certification.

The Predictive Validity of the National Board of Osteopathic Medical Examiners' COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations.

PURPOSE: To examine the predictive validity of the National Board of Osteopathic Medical Examiners' Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series with regard to the American Board of Family Medicine's (ABFM's) In-Training Examination (ITE) and Maintenance of Certification for Family Physicians (MC-FP) Examination. METHOD: A repeated-measures design was employed, using test scores across seven levels of training for 1,023 DOs who took the MC-FP for the first time between April 2012 and November 2014 and for whom the ABFM had ITE scores for each of their residency years. Pearson and disattenuated correlations were calculated; Fisher r to z transformation was performed; and sensitivity, specificity, and positive and negative predictive values for the COMLEX-USA Level 2-Cognitive Evaluation (CE) with regard to the MC-FP were computed. RESULTS: The Pearson and disattenuated correlations ranged from 0.55 to 0.69 and from 0.61 to 0.80, respectively. For MC-FP scores, only the correlation increase from the COMLEX-USA Level 2-CE to Level 3 was statistically significant (for Pearson correlations: z = 2.41, P = .008; for disattenuated correlations: z = 3.16, P < .001). The sensitivity, specificity, and positive and negative predictive values of the COMLEX-USA Level 2-CE with the MC-FP were 0.90, 0.39, 0.96, and 0.19, respectively. CONCLUSIONS: Evidence was found that the COMLEX-USA can assist family medicine residency program directors in predicting later resident performance on the ABFM's ITE and MC-FP, which is becoming increasingly important as graduate medical education accreditation moves toward a single aligned model.

Osteopathic Manipulative Treatment Technique Scores on the COMLEX-USA Level 2-PE: An Analysis of the Skills Assessed.

CONTEXT: The National Board of Osteopathic Medical Examiners uses the Osteopathic Manipulative Treatment (OMT) Global Rating Tool to score candidate performance in OMT during standardized patient encounters. To the authors' knowledge, no validity research has been published on the underlying constructs measured by this instrument to date. OBJECTIVE: To evaluate whether the OMT Global Rating Tool measures 1 holistic skill or multiple skill sets. METHODS: Structural equation models were fit to data from first-time test-takers who took the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE) between July 7, 2014, and April 30, 2015. Two theoretical models were evaluated: a model that posited a single underlying skill set, and a model that posited 2 related but distinct skill sets. RESULTS: The 1-factor and 2-factor models were fit to data from 4673 third- and fourth-year osteopathic medical students. Fit statistics indicated that the data were best fit by a model representing 2 factors: pre- and post-OMT technique assessment and OMT technique (r=0.47). CONCLUSION: The OMT Global Rating Tool seems to measure 2 distinct but related skills. Although the results of this study are applicable to broad populations and cannot be used to provide skill-specific subscores, it might be helpful to remediation efforts to target pre- and post-OMT technique assessments and OMT techniques as distinct areas for intervention.

Evolution of AOA specialty board certification.

The launch of Osteopathic Continuous Certification (OCC) signifes the next stage of the osteopathic board certification process. The OCC process replaces the old recertification system for all osteopathic physicians who earned time-limited certificates from American Osteopathic Association (AOA) certifying boards. All 18 AOA certifying boards are now engaged in the continuous certification process. With the advent of any new system, many questions and concerns will arise. The AOA Bureau of Osteopathic Specialists continues to evaluate its new certification system and prepare for modifcations in response to this feedback.

Correlation of the emergency medicine resident in-service examination with the American Osteopathic Board of Emergency Medicine Part I.

INTRODUCTION: Eligible residents during their fourth postgraduate year (PGY-4) of emergency medicine (EM) residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM) Part 1 Board Certifying Examination (AOBEM Part 1). All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE) annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year. METHODS: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME). The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC) curve was generated to depict the relationship. RESULTS: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r=0.61, 95% confidence interval [CI] 0.54 to 0.66). Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65(th) percentile score on the RISE. CONCLUSION: We have shown there is a strong correlation between a resident's percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well prepared they are for the AOBEM Part 1 Board Certifying Examination.