Graduate medical education (GME) remains a very timely and important topic for the American Osteopathic Academy of Orthopedics (AOAO), American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME). I wish to share a current overview on the pathway to a single accreditation system (SAS).
First, here are a few facts covering the osteopathic profession as a whole. There are 15 months remaining in the 60-month transition to a SAS. Initially there were 1,244 AOA accredited programs on July 1, 2015. Of these:
- 819 (66%) have ACGME accreditation
- 71 (6%) are in continued pre-accreditation
- 38 (3%) are in pre-accreditation
- 61 (5%) are considering applying
- 171 (14%) are closed
- 84 (7%) are closing
The effect of closed programs on training positions is small. The closed programs represent only 4% of the filled positions in July 2015. The majority of closed programs had no residents training in them.
As regards orthopedic surgery, initially 44 programs were AOA accredited and now:
- 22 are now ACGME accredited
- 18 are in continued pre-accreditation
- 4 are closed or will be closing
In regards to the closed programs, one had no residents and one made the decision to close prior to 2015. The residents in that program all were successfully reassigned. One program will teach out all the current residents by July 1, 2020 and the other closing program still needs to submit its plan to teach out or transfer the residents. The AOA accredits one hand fellowship and that program will be applying to ACGME for accreditation.
In the most recent (and final) AOA match, 109 orthopedic positions were filled by DOs. The data for the 2019 MD match will not be available until May. At that time we will know the number of DOs that matched into ACGME programs and the number of MDs that matched into previously AOA accredited residencies.
If a program fails to achieve ACGME accreditation by July 1, 2020, what will happen to the residents in the program? The AOA and ACGME are both committed to seeing that all residents complete their training and have reached an agreement whereby the AOA will be able to accredit such programs until the last resident graduates. The Program Training and Review Committee (PTRC) of the AOA is addressing this issue. The AOAO Evaluating Committee will be revising our standards for residency training to consider the needs of those trainees in a “teach out” position.
The next meeting of the ACGME Orthopaedic Review Committee takes place April 12 and 13, 2019. Although the agenda is not public, several of our programs will be considered for accreditation. Programs not yet accredited will have three more opportunities after this April meeting.
As the transition to a SAS progresses, many of our program directors are seeking guidance from the ACGME by attending the recent ACGME Annual Educational Conference. In addition, several program directors have attended the Council of Orthopaedic Residency Directors (CORD) meeting held in conjunction with AAOS. In recent years we have encouraged our program directors to become active in CORD as a replacement for the Educator’s Course the AOAO offered in the past. Some of our program directors have assumed leadership roles in CORD and are beginning to have an impact on that organization.
Look for further updates to the SAS in future issues.