Osteopathic Graduate Medical Education

In the past 3 years, since the September 2003 launch of the new Trainee Information, Verification, and Registration Audit (TIVRA) system—and in line with the American Osteopathic Association's (AOA) original projections—there has been a steadily increasing level of compliance from osteopathic internship and residency programs reporting required data to the AOA's division of postdoctoral training. The most recent and dramatic increase in these compliance levels appears to be the direct result of several osteopathic postdoctoral training institutions (OPTIs) introducing assistive software—either proprietary or self-designed—to their consortia, enabling more rapid and accurate processing of the data required by the TIVRA system.

Annual data on osteopathic graduate medical education (OGME) is also reported based on the AOA's Intern/Resident Registration Program (ie, the “Match”). When compared with the data reported for the class of 2003 in THE JOURNAL's Osteopathic Medical Education 2004 issue,¹ there has been a 5% increase in the number of graduates from colleges of osteopathic medicine (COMs) in the class of 2004. Concurrently, there has been an increase of 2.5% for approved internships available to these graduates during this time.

So-called match rates through the AOA's Intern/Resident Registration Program have remained relatively steady at 48%, with 93% of participating COM graduates being matched to their first choice training program. For match participants, the majority (65%) seek and obtain traditional rotating internships, followed by internships in family practice (10%), internal medicine (10%), and emergency medicine (6%).

Trainee Information, Verification, and Registration Audit

The AOA division of postdoctoral training launched the TIVRA system in September 2003 to replace the previous paper-based protocol for osteopathic internship and residency programs, all of which were required by the AOA to (1) submit signed intern and resident contracts to the AOA; (2) verify the status of all osteopathic medical interns, residents, and fellows who have completed training in the previous academic year; and (3) update AOA records with any program changes. Without this vital information from osteopathic internship and residency programs, the AOA is unable to finalize the certification process for osteopathic trainees. One additional advantage of the new system over the old paper-based system is that TIVRA allows the AOA to track the educational progression of osteopathic trainees from the moment they enter an internship or residency program.

Strong, accurate, and verifiable OGME data is critical to the osteopathic medical community, which relies on the regular and accurate reporting of this information. The AOA's division of postdoctoral training provides statistics—based directly on TIVRA data—that are used by the Association for the following purposes:

• to define the osteopathic medical profession in terms of potential workforce strength,

• to document trends in the various medical specialties,

• to record internship and residency program “fill rates,”

• to allow the Association to anticipate future shortages of OGME programs, and

• to report on OGME positions funded through the Center for Medicare and Medicaid Services (CMS).

Finally, because it is not in the purview of the AOA to track allopathic training data for COM graduates, the OGME data available to the division of postdoctoral training allows the Association to make more accurate assumptions about the number of physicians who have opted to receive their residency training through programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

In fact, low compliance rates with TIVRA reporting methods have had a direct impact on the “hassle factor” for osteopathic physicians. For example, some specialties (eg, family practice) allow their residents to take certifying examinations 6 months prior to graduation. However, when the internship and residency programs have not verified training completion for physicians, board certification certificates cannot be released. In addition, with regard to AOA advocacy efforts, data accuracy is needed when the AOA lobbies Capital Hill for issues concerning OGME (M.J. Hardy, JD, oral communication, January 2006).

Accurate reporting of TIVRA data from the osteopathic internship and residency programs ensures the AOA's ability to represent the vitality and growth of the profession accurately. In the past, incomplete reporting on the part of osteopathic internship and residency programs may have underrepresented the strength of OGME in the United States, leading the programs themselves—as well as their constituents (eg, specialty colleges and COMs)—to make inaccurate conclusions based on the data presented by the AOA.

For these reasons, the AOA determined that it was essential to establish a target date for osteopathic internship and residency programs to achieve a level of 100% compliance with TIVRA reporting methods. On the inception of TIVRA, the goal for compliance was set at 2007—and every year subsequent. As of publication, the division of postdoctoral training is pleased to announce that this goal seems well within reach.

At the end of 2003, the AOA had 746 approved internship and residency programs, for a combined total of 7567 approved internship and residency positions. Out of those 746 internship and residency programs, however, the AOA noted a compliance rate of 45% for TIVRA reports.

The AOA had 782 approved internship and residency programs in 2004, representing a total of 7817 approved positions. For that year, the AOA noted a compliance rate of 59% for the required TIVRA reports.

In 2005, the AOA had 843 approved internship and residency programs, for a total of 8370 positions. For the 843 programs approved, the division of postdoctoral training recorded a TIVRA compliance rate of 93%.

The division of postdoctoral training believes that the 34% increase in compliance rates seen in 2005 was due mainly to the diligence of two OPTIs: the OPTI partners of the Centers for Osteopathic Research and Education in Athens, Ohio, and the Statewide Campus System/Michigan State University College of Osteopathic Medicine (MSUCOM) OPTI in East Lansing. Both consortia were able to make use of systems for data importation that reduced the amount of manual entry required by consortia partners to provide comprehensive records to the AOA through TIVRA. As noted, one OPTI purchased proprietary software with data fields that match the data collected by TIVRA, while the other chose to design and create their own software to serve the same purpose.

Since its inception in 2003, the TIVRA system has undergone annual revisions aimed at improving usability and the overall quality of the data collected. Past improvements have included:

• a help guide,

• a toll-free telephone help line,

• an e-mail address for end-user support,

• data validation features,

• a Copy function to reduce manual input,

• a TIVRA report, and

• additional import functions for some users.

Future versions of TIVRA are currently under development to assist the end-user's ability to import the most current OGME data.

Although the division of postdoctoral training introduces updates and improvements to TIVRA each year to assist end users, it is the hope of the AOA that more OPTIs will seek to serve their partners in the role of facilitators in 2006, leading to a similar increase in their OPTI compliance levels in the TIVRA program.

Match Data and OGME Program Data

When reviewing the data presented in this annually published JAOA article, readers are asked to note that the statistics related to the AOA's Intern/Resident Registration Program (ie, the “Match”) (Table 1 through Table 4) are generated at the conclusion of each match cycle (ie, February), months before the beginning of each academic year.

In addition, statistics related to approved internship and residency programs and the osteopathic trainees filling those programs (Table 5 and Table 6) are generated at the end of each academic year (ie, May).

In other words, the time differential between the reported match statistics and the statistics reported on OGME programs and osteopathic trainees is more than a year. Because of this time differential, the data reported in these two groups of tables do not lend themselves to direct comparison.

The Match: Academic Training Year 2004–2005

The COMs awarded degrees to 2769 students in 2004 (Table 1), reflecting a 5% increase over the data reported for 2003.¹ Conversely, the number of approved internship positions open to COM graduates decreased nearly 2%, from 2659 positions in 20031 to 2616 positions in 2004.

The AOA's Intern/Resident Registration Program provides osteopathic medical students with an opportunity to secure osteopathic internship positions before graduation. Data on students in the past two graduating classes who participated in the AOA's Intern/Resident Registration Program is presented in Table 2. A total of 48% of participating graduates were matched to internships through this program in the 2004–2005 academic year. Although a large number of COMs had more than 50% of their participating graduates matched to internships through this program (Figure 1), MSUCOM once again had the highest percentage of participating graduates matched, with 89% of its graduates securing internship positions through the Match during the 2004–2005 academic year.^1–4 Participation in the AOA's Intern/Resident Registration Program is generally lower for COMs located in states with fewer osteopathic postdoctoral training opportunities. Of participating students, approximately 93% were matched to the internship positions they listed as their first choice (Table 3).

Table 2

American Osteopathic Association Intern/Resident Registration Program Intern Match by Graduating Class: Matched Participants by Colleges of Osteopathic Medicine

	Class of 2003			Class of 2004
College *	Graduates, No.	Matched, No. (%)	Graduates, No.	Matched, No. (%)
DMU/COM	203	76 (37)	195	71 (36)
KCOM/ATSU	171	83 (49)	145	68 (47)
KCUMB-COM	209	81 (39)	212	94 (44)
LECOM	136	102 (75)	168	110 (65)
MSUCOM	138	121 (88)	134	122 (91)
MWU/AZCOM	123	34 (28)	130	40 (31)
MWU/CCOM	151	51 (34)	165	58 (35)
NSU-COM	182	107 (59)	174	95 (55)
NYCOM/NYIT	265	111 (42)	307	124 (40)
OSU-COM	83	53 (64)	87	55 (63)
OU-COM	109	63 (58)	110	59 (54)
PCOM	233	174 (75)	248	182 (73)
PCSOM	55	28 (51)	61	18 (30)
TCOM	111	25 (23)	120	34 (28)
TUCOM-CA	85	27 (32)	107	36 (34)
UMDNJ-SOM	72	54 (75)	83	49 (59)
UNECOM	109	39 (36)	112	35 (31)
Western U/COMP	161	45 (28)	184	57 (31)
WVSOM	74	47 (64)	77	58 (75)
Total	2670 †	1321 (49)	2819 ‡	1365 (48)

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Table 3

American Osteopathic Association Registration Program Intern Match Class of 2004

Participants Matched to First Choice Osteopathic Medical Internship Positions by Colleges of Osteopathic Medicine

College *	Graduates, No.	Total Matched, No. (%)	Matched With First Choice, No. (%)
DMU/COM	193	58 (30)	54 (93)
KCOM/ATSU	142	51 (36)	50 (98)
KCUMB-COM	211	80 (38)	73 (91)
LECOM	165	94 (57)	83 (88)
MSUCOM	133	119 (89)	114 (96)
MWU/AZCOM	129	28 (22)	28 (100)
MWU/CCOM	165	56 (34)	53 (95)
NSU-COM	171	84 (49)	79 (94)
NYCOM/NYIT	296	116 (39)	107 (92)
OSU-COM	86	47 (55)	43 (91)
OU-COM	108	57 (53)	54 (95)
PCOM	246	163 (66)	153 (94)
PCSOM	58	18 (31)	16 (89)
TCOM	119	29 (24)	29 (100)
TUCOM-CA	107	30 (28)	28 (93)
UMDNJ-SOM	80	49 (61)	43 (88)
UNECOM	110	33 (30)	31 (94)
Western U/COMP	175	45 (26)	40 (89)
WVSOM	75	48 (64)	46 (96)
Total	2769 †	1205 (44)	1124 (93)

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Figure 1.

The colleges of osteopathic medicine listed had more than 50% of their participating graduates matched to internships through the American Osteopathic Association's Intern/Resident Registration Program in the 2004–2005 academic year.

Sixty-five percent of COM students in the class of 2004 chose a traditional rotating internship (Table 4). Collectively, about 26% of the matched students in this graduating class chose internships in emergency medicine (6%), family practice (10%), or internal medicine (10%). These figures are comparable to data previously reported for the class of 2003,¹ in which 63% were matched with a traditional rotating internship and approximately 27% chose emergency medicine (5%), family practice (13%), or internal medicine (9%).

Osteopathic Graduate Medical Education Programs

Approximately 70% of all AOA-approved internship training positions available are located in six states (Table 5): Florida, Michigan, New Jersey, New York, Ohio, and Pennsylvania. When compared with data for the 2003–2004 academic year,¹ though the number of approved internship positions for the 2004–2005 academic year increased in ten states and decreased in eight states (Figure 2), the AOA noted a slight overall increase (2.5%) in the number of approved internship training positions.

According to the AOA Basic Document on Postdoctoral Training⁵ any internship or residency training program that has been inactive for 3 consecutive years shall be considered “lapsed.” It will therefore be closed administratively by the Council on Osteopathic Postdoctoral Training's Program and Trainee Review Committee. For example, one state, Tennessee, began offering osteopathic internship positions again in the 2004–2005 academic year after having no available positions and being lapsed/closed for the 2 previous years.

Figure 2.

American Osteopathic Association's Intern/Resident Registration Program. When compared to data reported for 2003–2004, ¹ the number of approved osteopathic medical internships in the 2004–2005 academic year has increased in ten states but decreased in eight states. The number of internship positions added or lost in each state noted is provided in parentheses.

For the previous 4 academic years, COM graduates have been able to register for internship and residency programs that link osteopathic medical internships to AOA-approved second-year residency programs.^1–4 Once again, with the 2004–2005 Match, every medical specialty that is offered in either specialty-tracked internships or in traditional rotating internships linked with specialties was represented.^1–3 Out of the 913 linked internship and residency positions offered in 2004–2005 (as compared with 866 in 2003–2004¹), 68% were filled. Although anecdotal evidence indicates that COM graduates are receptive to this combined offering because it provides stability and security for subsequent training years, our most recent data indicates a 5% increase in the number of linked positions offered, with a lower percentage filled compared to 2003–2004.¹ In the previous year, 73% of linked positions were filled.¹

In the 2004–2005 academic year, there were 558 AOA-approved residency programs (Table 6), representing a 1.6% increase over the 549 approved programs in the 2003–2004 academic year.¹ In addition, there were 2420 residents in AOA-approved training programs in 2004–2005, representing a 4% increase from the 2327 residents in training during 2003–2004.¹

The AOA has established mechanisms by which osteopathic physicians may obtain approval for training provided through the ACGME (ie, Resolution 42 [A/2000]—Approval of ACGME Training as an AOA-Approved Internship). This approval is key for those osteopathic physicians seeking medical licensure in states requiring an osteopathic internship and for those physicians desiring osteopathic board certification. Between July 2001 and June 2005, a total of 822 osteopathic physicians have petitioned the AOA for approval of their first year of ACGME postgraduate training (ie, a 50% increase in total approvals). Since June 2004,¹ 274 osteopathic physicians have petitioned for approval.

Conclusion

The division of postdoctoral training continues to look forward to working with osteopathic internship and residency programs and their OPTIs in the coming year as they strive toward the goal of 100% compliance for 2007 for data reported to the AOA through the TIVRA system. Achieving this goal together ensures the AOA's ability to accurately represent the vitality and growth of the osteopathic medical profession.

The number of postdoctoral internship opportunities available currently exceeds the number of graduates choosing to avail themselves of those offerings. However, the rate of growth seen in of number of osteopathic medical graduates is increasing faster than the number of approved internship positions, which may lead to increased competition for internship positions within the profession in the coming years. Postdoctoral residency training continues to demonstrate positive growth in geographic regions where osteopathic opportunities have been limited for graduates of our COMs. The AOA is committed to working collaboratively with other stakeholders in OGME to provide high-quality training opportunities to graduates of our COMs.