Medial Education Summit OHF Medical Education Summit Report to AACOM June 22, 2006 D. Keith Watson,...

Medial Education Summit

OHF Medical Education Summit

Report to AACOM

June 22, 2006

D. Keith Watson, D.O.


OHF Medical Education Steering Committee

• Silvia Ferretti, DO• Karen Nichols, DO• Michael Opipari, DO• Stephen Shannon, DO• Anthony Silvagni, DO• Kenneth Veit, DO• Larry Wickless, DO• Gary Willyerd, DO• Keith Watson, DO Chair

OHF Medical Education

Summit

Red= AACOM Board of DeansBlue= AOA Board of Trustees


Why was a summit needed for osteopathic medical education?

• To bring key leadership people together around our common concerns

• To have dialogue -- “Seek first to understand” viewpoints and needs

• To remove barriers and promote common direction and policy around the osteopathic education ‘continuum’

• To develop consensus about how to proceed to meet the workforce, recruitment, funding and quality issues facing us.

• To develop action plans for more effective policies and procedures in service to the educational efforts of the profession.

Medical Education Summit


Why was a summit needed for osteopathic medical education?

• Projected physician shortage in 2020-- workforce– Changing patterns of delivery for primary care -- workforce– Medical Education Debt Load-impacts specialty choice -

workforce & funding– Expanded class sizes changes recruitment patterns--

workforce recruitment and quality

• COCA graduates’ choice of available GME--recruitment and quality

• Medical education delivery costs to schools and hospitals is rising rapidly--and not fully covered by available funding patterns– funding

• Limited US GME positions– funding

• Training expansion will tax resources at all levels --quality Medical Education

Summit


Specific Charges to the OHF Medical Education Summit

• Build a comprehensive strategic model of responsible growth in osteopathic medical education.

• Conduct a thorough analysis and evaluation of benefits, detriments and outcomes for the profession with respect to continuing a separate osteopathic match vs. adoption of a single joint match.

• Consider and evaluate emerging states requests for variance from standards.



General Goals for the Summit

1) Study and clarify education POLICY issues sent to the Summit for discussion and identify/discuss associated PROCESS issues that are linked to these policies.

2) Develop consensus POLICY position statements about the referred Summit issues that had been prioritized by the Steering Committee.

3) Define strategies, outcome measures, next action steps and timelines for implementation of each consensus POLICY position statement.

4) Define areas where further data is needed to design collaborative strategies and decisions; create data workgroups to conduct evidence based studies that can be used in future studies and Medical Education Summits to create action steps.


Osteopathic Medical Education(Spheres of Influence)

SpecialtyColleges’

RESC

AACOM(COMS)

AOA EducationDivisions

Residency StandardsAnd Program Approvals

UME Admission, Curriculum And“Pipeline Issues”

OPTI AdministrationAnd Oversight

Bureau of Education

COPTPTRC

COPTI

COCA

Invited Participants

• Educational roles• Accreditor roles• Curricular roles• Approval roles• Learner roles• Public interest roles

• Young physicians (and those in training)

• Chairpersons for specialty college (GME) educational committees

• Deans• Educational Council and

Committee members-AOA• AOA BOT Executive

Committee--Dept Reps• Hospital CEOs and affiliates• Interested Public Members

SpecialtyColleges’

RESC

AACOM(COMS)

AOA EducationDivisions


Over 80 Issues Submitted from……

• Resolutions and referral from AOA House of Delegates• The AOA Board of Trustees• The Board of Deans…AACOM• AOA Osteopathic Medical Educators Council (OMEC)• AACOM Society of Osteopathic Medical Educators

(SOME)• American Osteopathic Directors of Medical Education• Recommendations from the AOA/AACOM Osteopathic

Medical Education Study (Teitelbaum, et al)



How the Summit was “Put together”….• Format decisions:

• Macy style “a” -- Pre Summit Pro/Con white paper commissions…..(time constraints)….

• Macy style “b”-- Participant pre-reading with breakout small group discussions and recommendation for large group vote

• Article/data set assembly• Exemplary collection in ONE place…..

• http://www.aacom.org/events/edsummit/ • Logon = ohfsummit PW= consensus

• Time decisions:• WF, R, F• Quality discussions

http://www.aacom.org/events/edsummit/


Processes and Formats(Decided by Steering Committee)

• Brief presentations to frame the issue• Breakouts (mixed participants) to develop

recommendations for Sunday AM session• Sunday AM session:

– Y/N poll on recommendation (75% required)– Likert scale 1-4 for less than 75%

• Brief discussion and simple changes to language

– Repoll using Y/N for final attempt at 75% consensus• Send non-consensus items to ‘parking lot’ for later

discussion/resolution


Overview of the Summit Plan

>80 Issues collated,Priority Ranked by SC,

25 then Grouped by topic(Doc 3.1)

SC vigorously discussed and produced Goals

for each topic(Doc 5.5)

SC wrote questionsfor Summit groups to use

to create CONSENSUS or ACTION PLANS

for each Goal(Master Question List 8.4)

Summit Session to recommendConsensus elements (WF)

Action Plans (R and F)Study elements (Q)

Sunday AM GeneralSession decided

Consensus Elements& Action Plans by 75% majority

Summit Outcome: Consensus &

Recommendationsfor Action --What, Who,When, etc.

UME GME US Workforce 2020

“Quality”Education and Outcomes

RP

?

?

Funding andGME Recruitment

Workforce Supply and Mix

UME Recruitment and Funding

OVERVIEW

Medical Schools and Production Numbers

UME Recruitment and Funding

DO

NPP

IMG

MD

Re

cru

itm

en

t P

oo

l

What’s the right target?

2015

The GME Issue US Workforce 2020

?What do we do with the graduates of these schools?

Funding andGME Recruitment

Workforce Supply and Mix

DO

NPP

IMG

MD

LCME ACGME

OGME

IMG ACGME

DO ACGME

10

care

?

?

?

2015


Workforce

The Osteopathic Dilemma:

What will be the need for physicians in 2020?What mix of primary care and specialties?How much of that numerical need can we (DOs) realistically address?

What changes/factors will impact these decisions?Ratio of LCME increases to COCA increases Additional IMGs coming to US

TrainingPractice

Increase in NPP with different practice patterns/needs/locations



Recruitment

What happens to the applicant pool for the COCA schools?How do we deal with recruitment and match issues for Osteopathic GME programs?

Understanding our Learner Group

•Who are they…..and what did you do with MY generation?”


Funding

How do we deal with debt load for medical education?

How do we get additional funding for GME and be sure OGME can grow to match COCA graduate production?


DO class sizes and PGY I GME funding projections……..

Projections: Funded 1st year GME

0

5000

10000

15000

20000

25000

30000

2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13

Funded 1st year GME positions

AACOM research


Quality Medical Education

What do we (you) mean when using this term?

Is there common agreement about how to use the term in medical education?



Quality Focus Groups

• Accreditors - those attendees who inspect, make accreditation decisions etc……

• Educators - Deans, Faculty, Program Directors

• Learners - students, interns and residents

• Public - AOA public members, AOA/AACOM Staff, speakers and guests at the program


Outcome Assessment in Medical Education

UME and GMEMedical Training

Clinical Competence

Medical Practice

HealthOutcome

Other determinants of practice

Other determinantsof Outcome

R. Tamblyn


Outcome Plan: Quality in Medical Education Study

• Focus groups identified informed perspectives and collected survey ‘language’ -- key words

• Post summit -- survey research tool in development• statistically validate it with a pilot to determine reliability of the

tool…..

• Conduct a full survey which has statistical validity and reliability….



Outcomes

• Many parallels with the OME Study Recommendations

• Several call for additional study (like the OME Study recommendations)

http://www.aacom.org/events/edsummit/

Logon = ohfsummit Password = consensusOutcomes


Sunday Consensus and Action Plans

Workforce– 15 Consensus statements - 14 approved

– Examples:

The osteopathic profession should responsibly grow the profession’s percentage of the physician workforce as part of the solution to the predicted workforce shortage in 2020

The profession should identify, create, and provide enough PGYI positions (through policy initiatives, legislative and regulatory pursuits, OPTI and other mechanisms) to match the size of its collective approved graduating classes.

AOA /AACOM should collaborate with AAMC/AAHC/ACGME, etc. to study ideal specialty mix issues in order to inform and direct legislative and policy decisions


Sunday Consensus and Action PlansWorkforce

• Example --not reaching 75% consensus– COCA accreditation standards for approval of class size

increases (existing schools) and approval of new schools class sizes should be strictly enforced and reflect the following:

• A broad and vigorous recruitment plan to provide qualified applicants and ensure successful matriculants

• Sufficient physical facilities and resources to conduct quality contemporary educational activities

• Sufficient paid and/or protected faculty time to conduct UME activities

• Linked and/or OPTI sponsored PGYI OGME Postdoctoral positions available to accommodate the graduating class sizes

• COM dedicated (restricted) required third year core rotations.

– Poll = 73% Y on second vote with red text deleted…….


Sunday Consensus and Action PlansRecruitment

• 28 Consensus Statements, 25 approved– Examples:

AOA Board and AACOM should study dual/parallel tracks and what opportunities exist to maximize outcomes.

The COPT and TIVRA system should ensure complete and accurate match information on the AOA website, OPPORTUNITIES. To maintain accuracy of the GME programs the AOA Dept of Education should assure timely and appropriate updated information. COPT must stiffen oversight and penalties for program noncompliance of data to this site.



• 3 Examples of those NOT reaching 75%:– The leaders of this Summit will create a task force to re-examine and

define Osteopathic philosophy, due to the evolution of the osteopathic profession.

• Poll #2 --- after discussion = 32% Y

– The AOA BOS and ABMS should move toward parallel programs from dual programs by discussing recognition of AOA certification for eligibility of subspecialty training in allopathic programs as soon as possible

• Poll #2 =--after discussion = 29% Y

– The AOA should facilitate the development of policies and procedures for postgraduate program graduates (I,R,F) regardless of their training (ACGME, AOA) to allow all DO’s to have full rights and privileges of their degree

• Board certification and recertification• Licensure• Positions such as DME, Dean, etc.

• Poll #2 --after discussion = 67%


Sunday Consensus and Action Plans

• Recruitment examples continued:

The COPT and the system should ensure complete and accurate match information on the AOA Website; OPPORTUNITIES. COPT must stiffen oversight and penalties for program noncompliance of data submitted to this site

AOA will improve the accuracy of OPPORTUNITIES website by sending letters to specialty colleges requesting that the website be updated and checked for accuracy by June 30, 2006.



• Recruitment Examples continued: AOA, AACOM and specialty colleges will create a

task force with students and residents to: gain insight from current OMS on osteopathic messages they are receiving that guide decision making on selecting GME programs

GME standards should be enhanced and enforced. The COPT shall be charged to review as necessary and promulgate enhanced GME standards. This should be done in conjunction with the specialty colleges ...



• Recruitment Examples Continued:

• AOA and specialty colleges evaluate standards carefully to allow innovative pilot programs in new and existing hospitals in “small states”

• COPT and Specialty Societies review standards to enhance quality and value to their specialty education


Sunday Consensus and Action PlansFunding

• Funding• 22 Consensus Statements - all passed

•Example:

•AOA, AACOM, and State Societies should lobby the Federal Government for the following:

• to raise the ceiling on student loan interest deduction

• Maintain and or increase Federal outlays for loan repayment and scholarship programs

• Extend the number of years for deferment of Federal subsidized loans

• Improve relationships with Bureau of Indian Affairs and Nations, VA and other alternate funding sources


What next? Next Steps• Complete review and articulation of OHF Med Ed

Summit I recommendations with accompanying rationale from group notes……(underway with AACOM and AOA staff integration)

• 50+ remaining original items to be prioritized– Refer to Med Ed Summit II

• Four recommendation areas (at least) that need further clarification– Refer to Med Ed Summit II Steering Committee

• Develop study formats and Pro/Con analysis

• Quality study is in development stages.


Events post Summit

• Report to AOA BOT Feb 21, 2006 (KW)• Report to AODME April 8th, 2006 (KW)• Joint meeting AACOM and AOA Staff (AACOM

Offices April 18th) Reviewed all recommendations and developed action plans

for most• Letters requesting actions to AOA and AACOM Presidents on

specific items appropriate to respective group– Referral to appropriate bodies inside AACOM and AOA requested

• Timelines and report back requests articulated (within months)

• Plans for Med Ed II underway Karen Nichols, D.O. to Chair the Summit II

• Report to AACOM June 22, 2006 (KW)


Successes• Steering Committee grappled with tough

decisions/questions and worked through them• AACOM/AOA staff collaborated at several levels• The educational leadership came together,

deliberated about DIFFICULT questions facing our profession……

• Public articulation of 60+ points where there is general agreement--allows us to move NOW on those--• Identified items which need different context and

study..


Observations

The Summit set the stage for ‘evidence based decisions’ about policy Allows us to move forward with policy action plans where there was not clear

consensus before

Like any good investigation, the process uncovered additional questions (but now with more refinement).

The definition process will become more difficult at each level of discovery……. Directive is now to proceed with evidence based studies, papers etc.

Tendency to generalize or use the information improperly is overwhelming (as in any evidence based work). It is easy to succumb to ‘faulty logic’ It is easy to infer meaning where there is none….. How we use the information is a testament to our integrity as a

profession…….

We need an organizational vehicle to conduct educationally based research for our profession.


Wheel of Learning for Organizations(Processes and Outcomes)

Reflecting

Connecting

Deciding

Doing


Questions?

Medial Education Summit OHF Medical Education Summit Report to AACOM June 22, 2006 D. Keith Watson,...

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