SPECIAL REPORT

A Single Graduate Medical Education Accreditation System:

Ensuring Quality Training for Physicians and Improved
Health Care for the Public
Boyd R. Buser, DO

he American Osteopathic Association

and June 30, 2020. During the transition period, DOs

(AOA), the Accreditation Council for Grad-

who complete AOA programs that have preaccredi-

uate Medical Education (ACGME), and the

tation status will meet the ACGMEs initial year and

American Association of Colleges of Osteopathic

fellowship eligibility requirements. In addition, DOs

Medicine (AACOM) entered into an agreement in

will no longer have to repeat training years or choose

February to transform the accreditation system for

their GME training site on the basis of eligibility for

vice president and dean of

graduate medical education (GME) programs in

future specialty training options.

the University of Pikeville-

the United States. The agreement was the product

Kentucky College of

of 2 years of intensive discussions by a joint task

the single accreditation system, the ACGME will

force created in response to proposed changes in

create 2 new review committees. The Neuromuscu-

the ACGME Common Program Requirements as a

loskeletal Review Committee will have accreditation

component of the planned implementation of their

authority over osteopathic neuromusculoskeletal

Next Accreditation System. These changes would

medicine/osteopathic manipulative medicine

have restricted access for osteopathic physicians (ie,

residency programs. Its 6 members will include 5

DOs) moving from AOA postdoctoral programs to

AOA representatives and 1 ACGME representative.

ACGME training in residencies and subspecialty

A 15-member (13 AOA, 2 ACGME) Osteopathic

fellowships. The first meeting of the task force was

Principles Review Committee will evaluate the os-

held in March 2012, and after an initial assessment

teopathic principles dimension of programs seeking

of the current and future GME environment, the or-

osteopathic recognition across all specialties. Ac-

ganizations agreed that the potential benefits of a

creditation standards of the ACGME for osteopathic

single GME accreditation system warranted pursuit

principles and practice will be added to specialty

of this goal.

standards and will be applicable to all programs

Under the agreement, all postdoctoral training

seeking osteopathic recognition. Residents from

programs currently accredited by the AOA will tran-

ACGME programs with osteopathic recognition will

sition to ACGME accreditation. A single system

be eligible for advanced training.

preserves access to ACGME postdoctoral training

programs for DOs and takes bold strides to demon-

for faculty credentials will be modified to ensure

strate the consistent quality of GME training in the

that AOA-certified DOs are acceptable as ACGME

United States across the medical professions. Re-

faculty. Some programs may require appointment of

moving barriers between the professions widens the

a program codirector certified by the American

influence of osteopathic medicine in postdoctoral

Board of Medical Specialties, while programs cur-

training. It demonstrates the quality of osteopathic

rently accredited by the ACGME that seek osteo-

postdoctoral training outside of osteopathic post-

pathic recognition may likewise require a program

doctoral training institutions into new realms.

codirector certified by the AOA. Programs that cur-

In just over a year, osteopathic GME programs

rently have dual accreditation will no longer have to

will begin applying for accreditation by the

undergo 2 sets of inspections or pay 2 sets of ac-

ACGME. Upon application, programs will enter

creditation fees.

preaccreditation status. The transition from dual ac-

crediting bodies to a single accreditation system will

organizations of the ACGME, ensuring the osteo-

take place over a 5-year period between July 1, 2015,

pathic medical professions voice within existing

Dr Buser is a member of the

Board of Trustees of the
American Osteopathic
Association (AOA) and is a
member of the AOA-ACGME
(Accreditation Council for
Graduate Medical Education)
Joint Task Force. He is the

Osteopathic Medicine.
Address correspondence to
the AOA, 142 E Ontario St,
Chicago, IL 60611-2864.
E-mail: acgme
@osteopathic.org

The Journal of the American Osteopathic Association

April 2014 | Vol 113 | No. 4

To preserve distinctive osteopathic GME within

The agreement confirms that ACGME standards

The AOA and AACOM will become member

231

SPECIAL REPORT

governance structures. The AOA and AACOM will

dards developed by the Osteopathic Principles

each nominate individuals to 4 seats on the ACGME

Review Committee previously described. Osteo-

Board of Directors, and those seats will be phased in

pathic and allopathic (ie, MD) graduates will have

to create staggered terms. Terms will begin after

access to all training positions. However, additional

ACGME bylaws are amended, until which point the

prerequisite education and training may be required

AOA and AACOM will send observers to ACGME

for MDs who wish to enter ACGME residencies

board meetings. During the period leading up to the

with osteopathic recognition. The new system will

bylaws change, osteopathic observers will also at-

allow DO and MD graduates to demonstrate

tend Residency Review Committee meetings.

achievement of common quality milestones and

The AOA will continue to accredit GME pro-

competencies while preserving the unique dimen-

grams until July 1, 2020. It is important to note that

sions of osteopathic medicine and recognizing its

the single accreditation system will pertain only to

contribution to health care in the United States.

the accreditation of GME programs. Other compo-

nents of the medical education continuumsuch as

funding strengthens physician advocacy in Wash-

undergraduate medical education and continuing

ington, DC, and at the state and local levels. As ef-

medical educationwill continue to be accredited

forts are made to cut GME funding, the single

through their existing mechanisms.

accreditation process makes a clear statement of the

The AOA and the American Board of Medical

collaborative work being done by the AOA,

Specialties will continue to operate their own board

AACOM, and the ACGME to remove inefficien-

certification examinations, and AOA certification

cies, improve GME quality, and demonstrate ac-

will be the appropriate path by which physicians

countability for the public trust.

will demonstrate their competence in the unique

dimensions of osteopathic medical practice. The

tation of osteopathic and allopathic GME programs

Comprehensive Osteopathic Medical Licensing

but preserves and protects the structures within each

Examination-USA (COMLEX-USA) will continue

profession. Together, a single GME accreditation

to be the required examination series and the

system will prepare future generations of physicians

pathway to licensure for osteopathic physicians.

with the highest quality GME and the broadest op-

The COMLEX-USA series is the only licensing

portunities to serve the public.

examination that assesses osteopathic principles

and practice and is required by the AOA Commis-

system for GME, visit http://www.osteopathic.org

sion on Osteopathic College Accreditation.

/acgme. This Web page will be updated as addi-

tional information becomes available. (doi:10.7556

Under the single accreditation system, all GME

programs will have the option to request osteopathic

recognition. To achieve such recognition, the program will be required to meet the osteopathic stan-

232

Having a unified voice on GME access and

In short, the agreement streamlines the accredi-

For more information on the single accreditation

/jaoa.2014.063)
2014 American Osteopathic Association

The Journal of the American Osteopathic Association

April 2014 | Vol 114 | No. 4