1 Associate Dean of Clinical AffairsBurrell College of Osteopathic Medicine at New Mexico State University Planning for Residency Training Oliver W. Hayes, DO, MPH Associate Dean of Clinical Affairs
2 Disclosures Experience AOA Residency Program Director (PD)Emergency Physician AOA Residency Program Director (PD) ACGME Residency Program Director (PD) AOA Director of Medical Education (DME) ACGME Designated Institutional Official (DIO) No Financial Conflicts to Disclose
3 Topics What is residency training and Graduate Medical Education (GME)? Single Accreditation System What is this Single Accreditation System? Opportunities and Challenges for BCOM Students Next steps at Burrell College of Osteopathic Medicine in your career planning
4 Your Career in MedicineChoosing a medical discipline in which you will spend your professional career is a significant decision. Depends on your interests, values, personality, and skills. Depends details of various disciplines such as lifestyle, length of training, competitiveness data, types of cases. Compare your qualifications, pinpoint your preferences for residency training, then compare programs. Position yourself to be more competitive to land a desired residency.
5 What Is Residency Training?Required training to practice as a physician in US. Begins after graduation from medical school (DO, MD, or foreign). Minimum of 3 years and up to 6 years. Residents paid a salary and benefits. Currently DO graduates may attend an osteopathic residency or an allopathic residency. Begins after graduation from an accredited medical school (DO, MD, or foreign).
6 x-ray beam Independent practice of medicine
7 Types -Careers, Physicians, & TrainingVariety of career choices. Most physicians treat patients full time. Teach, conduct research, manage hospitals Physicians often considered in two main groups: Primary care physicians Specialists (or subspecialists) who concentrate on particular types of illnesses or organ systems Training Sites: Academic Medical Centers or Community Teaching Hospitals
8 VA Medical Center Wayne State University School of Medicine
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10 Community-based Medical EducationAs opposed to Academic Medical Center Creating residency programs in community settings is becoming more popular. Health care institution must marry service and educational missions. Organizational structures include partnerships with FQHCs, community teaching hospitals, university (NMSU) and medical school (BCOM).
11 Community-based Medical EducationEvidence - residency characteristics influence future specialization and geographic location.1-3 Residents trained in community settings likely to choose primary care in underserved areas.4,5 Bolster physician workforce, training in community settings is needed. Moving some GME training from academic medical centers to community-based sites.6-10
12 Southern New Mexico Family Medicine ResidencyCommunity-based Residency Program in Las Cruces, NM At Memorial Medical Center Active Family Medicine Clinic with dedicated Faculty Training Full Service Family Physicians Pediatric Hospitalist Service Pharmacy Residency Program
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14 Patients are Essential in Medical EducationCentral mission of any teaching hospital is patient care, but also an education mission. Generally, patients find their role in medical education rewarding. Many caregivers are in different points on a road to becoming a doctor.
15 Medical School HighlightsYear 1 – Normal structure and function Year 2 – Abnormal structure and function Years 3 and 4 – The clinical years Generalist core Specialty core – specialty and subspecialty segments and electives. During these four years each of you will make decisions about residency training
16 Graduate Medical EducationGraduating from medical school, students earn their DO degrees as well as the title “doctor.” Education is far from complete. Most graduates are off to residencies— usually at hospitals— pursuing training in their chosen specialties. During residency, master comprehensive responsibilities of a physician, special skills, and knowledge required to practice medicine.
17 GME and Residencies – MostResidency programs are selective and competitive, requiring an application, recommendation letters, and interviews. Unlike medical school, offer salaries and benefits. Resident physician’s time is spent treating patients, teaching less- experienced colleagues, and attending conferences. Residents assume greater responsibilities through their residency. First year of residency sometimes called an internship. A senior resident is in third, fourth, or fifth year, depending on specialty. Chief resident is a doctor who has completed his/her residency program. Like medical school, residency programs are selective and competitive, requiring an application, recommendation letters, and interviews.
18 GME and Residencies – FewerRather than enter a residency program, some graduates do a transitional year designed as experience in medicine or surgery. Precursor to residencies like dermatology, ophthalmology, or neurology. Physicians seeking more specialized training pursue fellowships after residency. Doctor who intends to specialize in cancer care would complete an internal medicine residency followed by oncology fellowship. Physicians in these programs are called “fellows”.
19 After residency and/or fellowshipAfter GME, physicians obtain board certification. In US, 24 specialty boards establish criteria that physicians must meet to be certified in a given field. Certification requires completed training and examination. Physicians who pass become diplomates of specialty boards. Medical licensure is a separate process and procedures governed by each state.
20 Sample Residency LengthsFamily medicine – 3 years Emergency medicine – 3 years Internal Medicine – 3 years IM subspecialties – 3 years Pediatrics – 3 years Ped subspecialties – 3 years OB/GYN – 4 years Pathology – 4 years Anesthesiology – 4 years Dermatology – 4 years Neurology – 4 years Ophthalmology – 4 years Psychiatry – 4 years Radiology – 4 years Orthopedic surgery – 5 years Otolaryngology – 5 years Surgery – 5 years Surg subspecialties – 3 years
21 Single GME Accreditation SystemFebruary 26, 2014 Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM) committed to single accreditation system. The single accreditation system allows graduates of allopathic and osteopathic medical schools to complete their residency and/or fellowship education in ACGME-accredited programs. By July 1, 2020 all GME programs will be accredited by ACGME.
22 What does this mean? Bringing together accreditation of residencies and fellowships This is not about joining undergraduate medial education accreditation or merging board certification. That means that osteopathic and allopathic medical schools will retain their distinctions. Similarly, processes for board certification, continuing medical education programs, and licensure remain unchanged.
23 Very Important DifferenceNMRP Residency Match AOA Residency Match (NMS) Program Accreditation Individual Certification and much more ACGME Program & Institutional Accreditation ABMS Individual Certification
24 ACGME Established in 1981 Parent Organizations which formed ACGMEAmerican Association of Medical Colleges (AAMC) American Board of Medical Specialties (ABMS) American Hospital Association (AHA) American Medical Association (AMA) Council of Medical Specialty Societies (CMSS) “Parent Orgs” became “Member Orgs” and nominate Board Members 2015 AOA and AACOM became “Member Orgs”
25 ACGME Mission and Values“We improve health care and population health by assessing and advancing the quality of resident physicians' education through accreditation.” Values Honesty and integrity Excellence and innovation Accountability and transparency Fairness and equity Stewardship and service Engagement of stakeholders
26 ACGME Accreditation Structure
27 ACGME Functions Accredits 9,527 GME Programs120,108 interns, residents, and fellows 693 sponsoring institutions 136 specialty and subspecialty areas 29 Review Committees 1 Recognition Committee Approximately 6,000 items or decisions yearly
28 Our Plan for You Understand “How to Navigate the ACGME System”Keep abreast of the Process for ACGME Accreditation of Currently AOA-approved programs Help you understand what is known currently and what is yet to be determined. Provide Regular Updates The Match Value of COMLEX-USA and USMLE Making sure that our students and future graduates thrive in the Single Accreditation System Students & Trainees: Single GME Accreditation System Info An overarching goal in the single GME accreditation system is to maximize access to GME opportunities and options for all osteopathic medical students and graduates.It will allow osteopathic medical students to apply for programs in specialties of their choice. It will increase recognition of osteopathic medicine and bring our unique health care to a wider audience. The AOA and ACGME are acutely aware that moving to a single GME accreditation program creates uncertainty for DO and MD students and residents who will be training during the transition. Both organizations agree that protecting students and residents is paramount. The AOA is committed to helping all students and trainees navigate the evolving system. Please feel free to contact the for assistance. In addition, AACOM has published a comprehensive list of Student FAQs that provide additional information. Latest Updates A student webinar "Navigating the Single GME Accreditation System" will take place at 7:30 p.m. EDT on Wednesday, June 29, Education leaders will inform osteopathic medical students about the transition to the single graduate medical education accreditation system. Register today. Nine ACGME specialty programs have indicated that they will accept AOA PGY1 year for entry into those programs. Language issued by the Review Committees states that, during the transition to a single accreditation system, programs may wish to consider applicants from AOA-approved programs that are not yet pre-accredited or accredited by the ACGME. Core programs will not jeopardize their accreditation status if they accept such applicants. Read the exact language from the ACGME RCs on this topic. Jan. 11: The ACGME announced that many fellowships will now accept the COMLEX-USA examination on equal footing with the USMLE. This change is specifically related to the "exceptionally qualified candidate" provision included in the ACGME's new Common Program Requirements. If an individual applies to a fellowship program based on this provision and has successfully completed Levels 1, 2 and 3 of COMLEX-USA, he/she will not be required to take the USMLE. The ACGME will be issuing guidelines to assist fellowship program directors in determining whether individual applicants are eligible for appointment. Eligibility criteria for every ACGME-accredited subspecialty can be reviewed on the ACGME’s website. Protecting Students & Trainees New standards help ensure residents will complete their training in an accredited training program. AOA-accredited programs that have not entered into the ACGME accreditation process cannot accept a resident if the resident’s expected training completion date is after the AOA ceases its accreditation functions on June 30, 2020). For example, a 3-year program not applying for ACGME accreditation could not accept new residents after July 1, 2017, because the resident’s graduation date would be after the end of the transition period, when that program’s AOA accreditation would cease. The AOA also has taken steps to protect residents in AOA programs that may have trouble achieving ACGME accreditation. Programs that have continued pre-accreditation status for 2 full years and have trainees that cannot complete their training by June 30, 2020, must work with their OPTI and sponsoring institution to develop and submit a plan for the potential transfer all trainees to an ACGME-accredited program. DO graduates of AOA programs that have pre-accredited status will be treated as graduates of ACGME-accredited programs when applying to advanced ACGME residencies and fellowships. DOs seeking fellowship spots during the transition will be eligible for ACGME fellowships provided that their AOA program has been awarded pre-accreditation status and the applicant meets the other existing requirements of the individual fellowships. The recently revised common program requirements, which would have prevented DOs with AOA training from entering advanced standing ACGME residencies and fellowships, will be moot under the new system for residents training in AOA programs with ACGME pre-accreditation status. Residents are encouraged to consult with their program directors, mentors and osteopathic specialty colleges regarding which fellowship programs may be most receptive to their applications. Update on the Match The AOA Match is occurring in 2016 and the foreseeable future. It will cease when all AOA-accredited training programs become ACGME-accredited, presumably on or before June 30, Until that time, the AOA Match will continue to match DO graduates into AOA-accredited programs. AOA-accredited programs will not be able to participate in the National Residency Match Program (NRMP) match until they have received Initial Accreditation by the ACGME. Programs with pre-accreditation status are still approved by the AOA, and prospective residents still have to go through the NMS match. Once all programs are considered ACGME-accredited after the transition is complete, it is likely there ultimately will be one Match. The Value of COMLEX Throughout the transition, COMLEX-USA will continue to be the valid examination for DO competency assessment for licensure. It is also required by COCA accreditation standards as a requirement for graduation from all colleges of osteopathic medicine. Thus, osteopathic medical students will continue to be required to pass the COMLEX-USA examination (Levels 1 and 2) in order to graduate from an osteopathic medical school. While COMLEX is first and foremost a licensure examination, residency program directors also use it to assess applicants to their programs. The AOA, AACOM, and the NBOME are escalating efforts to help ACGME residency program directors understand and interpret COMLEX-USA scores. It is important to note that neither the COMLEX-USA nor the USMLE exams are specifically required by ACGME accreditation standards for residency program application or acceptance. We expect that, in the vast majority of cases, COMLEX-USA will be increasingly recognized by ACGME-accredited residency program directors in the single GME accreditation system. Program directors are generally enthusiastic to learn more about COMLEX-USA and osteopathic medicine. However, there are still some ACGME programs that will prefer to see a USMLE score. If a student has aspirations for such programs, then that student will have to make the decision about whether to take the USMLE in addition to the COMLEX.
29 Career Planning and DevelopmentIdentify career goals Explore specialty from comprehensive online database Choose a disciple Select and apply to residency programs from comprehensive online databases of accredited residency training programs
30 Career Planning and Development4-year process of self-assessment, career exploration, and decision making Planning career, and getting a residency position is an active, extracurricular process. 1st and 2nd year of Medical School at BCOM Understanding yourself/ Exploring your options – Assess interests/explore options 3rd and 4th year of Medical School at BCOM Deciding among options and selecting residency programs to apply Looking ahead to the Match , we have excellent resources, including counselors, career seminars, faculty advisors, student interest groups, and a helpful support staff. Our ultimate goal is to help you start down a successful career path in medicine. Involves a complex, iterative process to arrive at a decision that is right for you. The ideal process is repetitive cycle of these steps: Self-reflection: who you are, what you bring from your life before coming to medical school, and what your professional passions are Amassing a vast array of different experiences during medical school Reflecting on experiences and how this influence your career choice. A few students are already certain about what specialty they want to pursue even before starting medical school. If that’s you, be aware that there is a good chance that you may change your mind! Most students, however, choose a specialty some time during their third year of medical school and firm up their decision early in the fourth year
31 Careers in Medicine 4-step processYear 1 - Understanding yourself and osteopathic medicine: Learn what your interests, values, and skills are. Arrange shadowing experiences Learn about the 4-year process of career decision making Register for "Careers in Medicine" website Year 2 - Exploring Options: Learn about specialties that interest you - stay curious, flexible, and open- minded Learn about different clerkship opportunities Talk with your advisor
32 Careers in Medicine 4-step processYear 3 - Choosing a Specialty: Career Exploration and Preliminary Decision-Making: Use the clerkships to help you define your specialty interest Choose a specialty Year 4 - Getting into Residency: Make the specialty decision and determine which residency program provides the best opportunity Apply to residencies Work on the elements of your ERAS application
33 References Morris CG, Johnson B, Kim S et al. Training Family Physicians in Communities: Health Workforce Solution. Fam Med.2008;40:271– 6. Brooks RG, Walsh M, Mardon RE, et al. Roles of Nature/Nurture in Recruitment and Retention of Primary Care Physicians in Rural Areas: Review of the Literature. Acad Med.2002;77:790–98. Rosenthal TC, McGuigan MH, Anderson G. Rural Residency Tracks in Family Practice: Outcomes. Fam Med.2000;32:174–7. Noble J, Friedman RH, Starfield B, Ash et al. Career Difference between Primary Care and Traditional Trainees in Internal Medicine and Pediatrics. Ann Int Med.1992;116:482–87. Dick JF, Wilper AP, Smith S, et al. Effect of Rural Training During Residency on Selection of Primary Care Careers: A Retrospective Cohort Study From Large Internal Medicine Residency Program. Teach Learn Med. 2011;23:53–7.
34 References Zweifler J. Balancing service and education: linking community health centers and family practice residency programs. Fam Med. 2993;25:306–11. Jones TF. The Cost of Outpatient Training of Residents in a Community Health Center. Fam Med. 1997;29:347–52. Morris CG, Chen FM. Training Residents in Community Health Centers: Facilitators and Barriers. Ann Fam Med. 2009; Morris CG, Johnson B, Kim S, Chen F. Training family physicians in com- munity health centers: a health workforce solution. Fam Med. 2008; 40(4): Phillips RL, Petterson S, Bazemore A. Do residents who train in safety net settings return for practice? Acad Med ;88(12):
35 This photo was taken in Peru near a glacierThis photo was taken in Peru near a glacier. The paved trail ended at this sign and we laughed that in the US, there would be a fence and "Do not Enter" sign.
36 Questions Posterioranterior and LateralThe standard chest examination consists of a PA (posterioranterior) and lateral chest x-ray. The films are read together. The PA exam is viewed as if the patient is standing in front of you with their right side on your left. The patient is facing towards the left on the lateral view. Comparison films can be invaluable - Old Gold! If you have comparison films, the old PA film is displayed adjacent to the new PA film and the old lateral is displayed adjacent to the new lateral. On the left is a simulated patient in position for a standard PA (posterioranterior) chest x-ray. On the right is a normal PA film