National Credentialing Forum 2008 An Overview of Osteopathic

National Credentialing Forum 2008 An Overview of Osteopathic Board Certification Created by Armando F. Ramirez, CAE Secretary, AOA Bureau of Osteopathic Specialists Director, Division of Certification, AOA American Osteopathic Association

What Is Osteopathic Medicine? Osteopathic medicine is a distinctive form of medical care founded on the philosophy that all body systems are interrelated and dependent upon one another for good health. Osteopathic physicians (D. O. ’s) use all of the tools available through modern medicine including prescription medicine and surgery. They also incorporate osteopathic manipulative treatment (OMT) into their regimen of patient care when appropriate. OMT is a set of manual medicine techniques that may be used to relieve pain, restore range of motion, and enhance the body's capacity to heal.

The Osteopathic Profession as of May 2007 – An Overview Ø As of May 2007 there are 61, 000 Doctors of Osteopathic Medicine (D. O. ’s) practicing in the US. Ø There are 25 Colleges of Osteopathic Medicine with an enrollment of nearly 14, 600 students Three of the colleges have branch campuses. Ø The number of osteopathic graduates is on the rise. In ’ 06 -07, the graduating class was approximately 3100.

Pathways to Certification for Osteopathic Physicians Two pathways to board certification exist for D. O. ’s At completion of osteopathic medical school, DO’s can: Enter AOA approved Osteopathic residency Program Leads to Certification from AOA Certifying Boards through the AOA Bureau of Osteopathic Specialists Enter ACGME-approved residency Program 1. Leads to Certification from ABMS Certifying Board or 2. AOA Certifying Boards

What is the Bureau of Osteopathic Specialists? The AOA Bureau of Osteopathic Specialists (BOS), established in 1939, is the official certifying body of the American Osteopathic Association and oversees and implements all certification policies

Mission Statement The AOA Bureau of Osteopathic Specialists (BOS) is the certifying body for the approved specialty boards of the American Osteopathic Association and is dedicated to establishing and maintaining high standards for certification of Osteopathic Physicians. The AOA Bureau of Osteopathic Specialists seeks to ensure that the Osteopathic Physicians it certifies demonstrate expertise and competence in their respective areas of specialization. The AOA Bureau of Osteopathic Specialists is deeply committed to delivery of quality healthcare to all patients by working with all its approved specialty boards in the enhancement and continuous improvement of its certification process.

Structure – Committees of the BOS: • The Full Bureau – consists of representatives from each of the AOA-approved Member Boards • The Executive Committee • The Standards Review Committee • The Recertification Committee • The Committee on Basic Documents and Certificates • The Jurisdiction Committee • The Appeals Committee

Member Boards - 18 Osteopathic Certifying Boards American Osteopathic Board of: -Anesthesiology (AOBA)(1956) Otolaryngology -Dermatology (AOBD)(1945) -Ophthalmology & (AOBOO) (1940) -Emergency Medicine (AOBEM)(1980) (AOBOS)(1978) -Orthopedic Surgery -Family Practice (AOBFP)(1972) -Pediatrics (AOBPD)(1940) -Internal Medicine (AOBIM)(1942) -Pathology (AOBPA)(1945) -Nuclear Medicine (AOBNM)(1974) (AOBPM)(1980) -Preventive Medicine -Neuromusculoskeletal Med (AOBNMM) (1977) -Neurology & Psychiatry (AOBNP)(1941) -Obstetrics & Gynecology (AOBOG)(1942) -Physical Medicine & Rehab (AOBPMR)(1954) -Proctology (AOBPr) (1941) -Radiology (AOBR) (1939) -Surgery (AOBS) (1940)

Osteopathic Certification in General • • • AOA board certification is recognized and accepted by: hospitals, third party payers and federal and state government agencies. The AOA’s board certification program is recognized by several congressional advisory panels and federal agencies, including: The Council on Graduate Medical Education, The Physician Payment Review Commission, and The Surgeon General of the United States Department of Defense and the Department of Veterans’ Affairs. AOA-approved osteopathic certification is also recognized for participation in Medicaid as reaffirmed by enactment of Public Law 104248 “Medicaid Certification Act of 1995. ”

Certifications Issued Since the inception of the osteopathic Board Certification program in 1939, approximately: • 27, 000 Primary board certifications issued • 2800 Subspecialty certifications issued

Areas of Certification Primary areas of certification include: Anesthesiology Dermatology Emergency Medicine Family Practice Internal Medicine Neurology & Psychiatry Nuclear Medicine Obstetrics & Gynecology Orthopedic Surgery Neuromusculoskeletal Medicine Ophthalmology Otolaryngology Pathology Pediatrics Physical Medicine &Rehabilitation Preventive Medicine Diagnostic Radiology Surgery (General, Vascular…) (A full listing of Specialty and Subspecialty Areas can be found on AOA web site)

Subspecialties Over 40 Subspecialty certifications are available in areas such as : Critical Care Cardiology Nephrology Hand Surgery Maternal Fetal Medicine Otolaryngic Allergy Endocrinology Pain Management

Requirements for Initial Certification ü Successful completion of an AOA-approved osteopathic or ACGME residency ü A valid state license to practice medicine ü Successfully pass board certification ü exam (s) ü Fulfillment of all additional board-specific requirements ü Active Membership in the AOA

Assessment instruments The exams given by AOA Certifying Boards vary by specialty and by certifying but can include • Written exams • Oral Exams • Clinical Exam

Commitment to High Standards: BOS Standards Review Process. Psychometric Validation of Assessment Instruments To ensure osteopathic board certification processes meet the high standards required of the medical profession, the BOS instituted a periodic Standards Review Process of all its Members Boards to ensure that the Guidelines for AOA Certification Examination Standards are met

Commitment to High Standards – Standards Review Process (continued) Guidelines for AOA Certification Examinations • • • Describe the criteria for psychometric standards for AOA examinations (assess validity and reliability) Include job analysis and identifying general and specific learning outcomes Identify methods to ensure the security of the examination process

Commitment to High Standards – Standards Review Process (continued) The Standards Review process is an internal peer-review board accreditation process through which osteopathic boards are evaluated to ensure psychometric and administrative test standards are followed Periodic five-year review of adherence to Exam Standards = Quality Improvement in the Certification Process Boards not meeting the standards are deemed not in compliance and must take action to correct deficiencies

Commitment to High Standards – Standards Review Process (continued) Through the implementation of this process, the BOS can “provide the public with a dependable mechanism for identifying practitioners who have met particular standards. ”* *Standards for Educational and Psychological Testing, American Psychological Association, 1985

AOA Recertification Process The AOA and the BOS believe that initial certification is only the beginning in the assessment of physician competence In 1995, the BOS implemented a policy of recertification which is mandatory for all initial time-dated certifications. The American Osteopathic Board of Internal Medicine (AOBIM) began the recertification process as early as 1993 prior to recertification being required by the BOS. Currently all 18 osteopathic certifying boards have a time-dated certification policy.

Current AOA Recertification Requirements • Successfully pass a recertification exam(s) at intervals no greater than 10 years • AOA-certified physicians must also complete 120 credit hours of Continuing Medical Education for every three-year cycle • A minimum of 50 credit hours in the specialty is required by the BOS, though some specialties do have higher requirements • Membership in the American Osteopathic Association • The current model of recertification is evolving into a continuous rather than periodic process.

Evolution of Osteopathic Certification The AOA, its Bureau of Osteopathic Specialists and Members Certifying Boards believe in the quality movement and the move to enhance the assessment of physician competence with the end goal of improving the quality of patient care in the United States. To that end, it has embarked on several initiatives that are transforming the traditional recertification process.

Evolution of Osteopathic Certification- Initiatives 1. Commitment to implement an Osteopathic Continuous Certification Process that addresses and enhances the assessment of physician competence. In November 2007 the BOS approved a resolution to establish an implementation timeline for all osteopathic boards to have a continuous certification process by 2012. The resolution will be presented for approval to the AOA Board of Trustees in February 2007.

Evolution of Osteopathic Certification: One Osteopathic Model of Continuous Certification already operational On January 1, 2004, the American Osteopathic Board of Emergency Medicine (AOBEM) implemented the Continuous Certification in Emergency Medicine (CCEM) as an alternative model to traditional recertification and assesses certified physicians on a continuous rather than periodic basis.

Components of Continuous Certification in Emergency Medicine (CCEM): • Professional status (state licensure) • Completion of the Continuous Osteopathic Learning Assessments (COLA) -Eight module assessments to be completed over 10 years • Formal Re-certification examination– taken 2 years prior to expiration of certificate • Practice Status (Diplomates must provide evidence of active practice at the time of application for Step III)

Evolution of Osteopathic Certification: Continuous Competency Assessment Models for Osteopathic Boards • Osteopathic Boards are presently evaluating the AOBEM and other continuous competency assessment models.

Evolution of Osteopathic Certification: Initiatives (continued) 2. Assessing Core Competencies Beginning with the third cycle of the Standards Review Process in 2009, each of the Osteopathic Boards will be evaluated on how the seven core competencies, already being taught by osteopathic residency programs, are being incorporated into the certification process

Assessing Core Competencies (continued) The Seven Core competencies being implemented by osteopathic residency program under mandate of the AOA Council on Postdoctoral Training include the following: Ø Osteopathic Philosophy and Osteopathic Manipulative Medicine Ø Medical Knowledge Ø Patient Care Ø Professionalism Ø Interpersonal and Communication Skills Ø Practice-based Learning Ø Improvement and Systems Based Practice

Evolution of Osteopathic Certification: Initiatives (continued) 3. Evaluation of the use of innovative assessment tools to assess physician performance in daily practice The AOA Clinical Assessment Program (CAP) The Clinical Assessment Program (CAP) for Physicians is a web-based performance measurement program developed by the American Osteopathic Association that analyzes data abstracted directly from patient medical records. Originally designed to measure clinical practice in residency training programs, CAP was extended to the physician’s office in December 2005. Three measure sets, including Diabetes, Coronary Artery Disease and Women’s Health Screening, were developed using evidence-based guidelines that represent state-of-the-art professional standards of care. These guidelines track patient outcomes in order to improve the quality of care and are comparable to other ambulatory care measure sets.

The AOA Clinical Assessment Program (CAP) The National Standards used for this AOA effort include: • • • The NCQA Health Employer Data and Information Set (HEDIS) measures Center for Medicare and Medicaid Services (CMS) Doctors Office Quality Initiative (DOQ) • Joint Commission core measures.

CAP and Continuous Board Certification Process Several of the osteopathic boards see the potential CAP could have in the assessment of physician competence and are studying the feasibility of incorporating it into the continuous certification process as it is being developed.

Board Certification: still a relevant force in healthcare For decades, board certification of physicians has been viewed by both the public and other interested parties as a mark of competence and excellence for those holding that designation. The AOA, its Bureau of Osteopathic Specialists and Member Certifying Boards believe that in the quality movement taking place in today’s healthcare environment, board certification remains, now more than ever, a viable, adaptable and critical tool in the assessment of physician competence.

Information Resources Predoctoral Osteopathic Medical Education American Association of Colleges of Osteopathic Medicine (AACOM) www. aacom. org AOA Commission on Osteopathic College Accreditation (COCA) www. do-online. org Predoctoral Education Osteopathic Postdoctoral Training AOA Council on Osteopathic Postdoctoral Training (COPT) www. do-online. org Osteopathic Board Certification AOA Bureau of Osteopathic Specialists (BOS) www. do-online. org Board Certification Osteopathic Credentials Verification Service www. do-profiles. org For Prospective Patients Seeking Verification of Osteopathic Board Certification 1 -800 -621 -1773, Extension 8266

Q&A The American Osteopathic Association and its Bureau of Osteopathic Specialists thank you for your interest. Contact information American Osteopathic Association Bureau of Osteopathic Specialists www. do-online. org 1 -800 -621 -1773, extension 8266 aramirez@osteopathic. org

OSTEOPATHIC MEDICAL EDUCATION Larry Wickless, DO 1, D Burkhart 1, JL Obradovic 1, AF Ramirez 1 ABSTRACT Osteopathic medicine’s principles and practices, which emphasize the relationship between body systems, are integrated throughout the full spectrum provided by the osteopathic medical education continuum. Students begin osteopathic medical education with a four-year curriculum. The first two years of the osteopathic medical curriculum focus on basic sciences. The third and fourth years emphasize clinical work, with much of the teaching in community hospitals and major medical centers. Following graduation, the new osteopathic physician completes an approved 12 -month internship. The internship year exposes the physician to core disciplines to include internal medicine, emergency medicine and family practice. Once the physician completes the internship year, the physician then chooses an osteopathic residency program in a specialty area of choice, i. e. emergency medicine, family practice, general surgery, internal medicine, obstetrics and gynecology, pediatrics, etc. , which require two to five years of additional training depending on the discipline. In addition, an osteopathic physician can further subspecialize through osteopathic fellowship training that requires another one to three years of additional training after residency. WHAT IS OSTEOPATHIC MEDICINE? Osteopathic medicine (formerly known as osteopathy) is "a complete system of medical care with a philosophy that combines the needs of the patient with current practice of medicine, surgery and obstetrics. The emphasis is on the interrelationship between structure and function, and has an appreciation of the body’s ability to heal itself. " [2] Outside the United States, "osteopathic medicine" is often used interchangeably with "osteopathy". Doctors of Osteopathic Medicine, or D. O. s, apply the philosophy of treating the whole person (a holistic approach) to the prevention, diagnosis and treatment of illness, disease and injury using conventional medical practice such as drugs and surgery, along with manual therapy (Osteopathic Manipulative Medicine or OMM). * *http: //en. wikipedia. org/wiki/Osteopathic_medicine OSTEOPATHIC MEDICINE IN THE UNITED STATES – SOME FACTS: Number of U. S. Osteopathic Physicians: 61, 000 (As of May 2007) Number of U. S. Osteopathic Medical Schools: 25 Number of Students in Osteopathic Medical Schools: 14, 600 (As of May 2007) The knowledge and experiences acquired through the osteopathic medical continuum are assessed through a board certification process that requires successful completion of educational components and a rigorous and psychometrically valid exam and emphasizes life-long learning through required continuing medical education and recertification. The AOA Bureau of Osteopathic Specialists, through eighteen certifying boards, is the primary certifying body for osteopathic physicians and provides the certification mechanism. 1 American Osteopathic Association PREDOCTORAL EDUCATION PREPARING FOR ADMISSION To be considered for admission to any of the nation's osteopathic medical schools, applicants typically have a bachelor's degree, with undergraduate studies that include one year each of English, biological sciences, physics, general chemistry and organic chemistry. Other requirements may include genetics, mathematics, and psychology. Most prospective D. O. students major in sciences with an emphasis in biology or chemistry; however, applicants may major in any discipline as long as they meet the minimum course and grade requirements. Applicants must also take the Medical College Admissions Test (MCAT). Osteopathic medicine is a people-oriented profession that demands dedicated and empathetic individuals. Prospective osteopathic medical students must exhibit a genuine concern for people. Applicants may wish to spend some time with a D. O. or do volunteer work in a healthcare setting before considering a career in this field. Osteopathic medical colleges require a personal interview to assess an applicant's desire to become an osteopathic physician. THE OSTEOPATHIC CURRICULUM The first two years of the osteopathic medical curriculum focus on basic sciences. The third and fourth years emphasize clinical work, with much of the teaching in community hospitals, major medical centers and doctors' offices. During the clinical years, students study general medicine and are involved in research. They rotate through urban, suburban and rural settings, gaining exposure to all areas of medicine. Osteopathic principles and practices, which emphasize the relationship between body systems, are integrated into the four-year curriculum. Students learn osteopathic manipulative treatment for prevention, diagnosis and treatment of disease. AN OSTEOPATHIC PHYSICIAN’S JOURNEY THROUGH THE MEDICAL EDUCATION CONTINUUM POSTDOCTORAL EDUCATION POSTDOCTORAL TRAINING & LICENSURE Following graduation, D. O. s complete an approved 12 -month internship. Interns rotate through hospital departments including internal medicine, family practice and surgery. Many may then choose to complete a residency program in a specialty area, requiring two to six years of additional training. D. O. s are licensed for the full practice of medicine and surgery in all 50 states. Each state determines the tests and procedures for licensing its physicians. In some states, the same tests are given to D. O. s and M. D. s; other states administer separate licensing exams. CORE COMPETENCIES EMPHASIZED IN POSTDOCTORAL TRAINING At the graduate medical education level, all osteopathic internship and residency programs must now incorporate seven core competencies developed by the AOA Core Competency Task Force and approved by the AOA Board of Trustees. This is an effort to shift graduate medical education from "experience-based" education to "competency-based" education The osteopathic core competencies are osteopathic philosophy and osteopathic manipulative medicine, medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and system-based practice Number of AOA-approved residency training positions: 5, 787 (2005 -2006) Number of approved osteopathic residency programs: (2006 -2007) BOARD CERTIFICATION CONTINUING MEDICAL EDUCATION & LIFE-LONG LEARNING BOARD CERTIFICATION: AN ESSENTIAL CREDENTIAL FOR PHYSICIANS Although board certification of physicians is a voluntary process in the United States, the majority of hospitals, insurance companies and health care management organizations make it a requirement to have hospital staff privileges and obtained reimbursement for services rendered. To that end, osteopathic physicians begin the board certification process immediately after completing their residency training or just prior to the completion of their residency training to ensure their ability to practice is not impaired. Board certification protects the public by ensuring that the examinees have completed a program of study or practice in their specialty and have passed a rigorous exam process that has been psychometrically evaluated for validity and reliability. OSTEOPATHIC CERTIFICATION EVOLVING The American Osteopathic Association, through its official certifying body, the Bureau of Osteopathic Specialists and its eighteen Member Certifying Boards offers 85 certifications in specialty, subspecialty and areas of added qualifications ranging from Family Practice to Internal Medicine to Surgery and Cardiology. Osteopathic certification is presently evolving into a continuous certification process rather than a process in which recertification occurs every several years. Continuing Medical Education is a lifetime commitment to learning by osteopathic physicians who recognize that the study of medicine does not end with completion of medical school or residency training. The American Osteopathic Association requires its members to earn a specified number of continuing medical education credits every three years in order to maintain membership and board certification. Through this requirement osteopathic physicians not only maintain their medical knowledge and skills current but also remain at the cutting edge of their respective specialties by learning about the latest advances in the medical field.

Member Boards of the American Osteopathic Association Anesthesiology Sallie C. Vazzano, Corresponding Secretary 6500 NW Tower Drive, Suite 13 Kansas City, MO 64151 (816) 584 -2622 Dermatology Rick Mansfield Administrator 1501 East Illinois Kirksville, MO 63501 -3203 (800) 449 -2623 Emergency Medicine Josette Fleming, Administrator 142 E. Ontario Street, 8 th Floor Chicago, IL 60611 (312) 335 -1065 www. aobem. org Family Physicians Carol Thoma, MBA, Executive Director 330 E. Algonquin Rd. , Ste. 6 Arlington Heights, IL 60005 (847) 640 -8477 www. aobfp. org Internal Medicine Gary L. Slick, D. O. , Executive Director 1111 W 17 th Street Tulsa, OK 74107 -1898 (918) 561 -1267 www. acoi. org/Cert. Gen. html Neurology & Psychiatry Neuromusculoskeletal Medicine Nuclear Medicine Obstetrics & Gynecology Mr. Stephen J. Noone, CAE, Executive Director 3500 De. Pauw Blvd. , Ste. 1080 Indianapolis, IN 46268 (317) 879 -1881 www. academyofosteopathy. org/certification. cfm? p age=neuromusculoskeletal Ophthalmology and Otolaryngology Sandra Hudepohl , Administrative Secretary 4764 Fishburg Road, Suite F Huber Heights, OH 45424 (800) 575 -2145 or (937) 235 -9794 Fax: (937) 235 -9795 Email: aoboo 61040@aol. com AOBNM Staff 142 East Ontario Street Chicago, Illinois 60611 (800) 621 -1773 ext. 8227 aobnm@osteopathic. org Orthopedic Surgery Barb Sharp, Executive Director 1117 Stone Street, Suite 4 Port Huron, MI 48060 (877) 982 - 6267 www. aobos. org/ Sandy Elcock, C. M. S. C. Administrative Assistant 2730 S. Val Vista Drive, #146 Gilbert, AZ 85296 Phone: (480) 650 -3206 E-mail: aobnp@att. net Barbara Scott Administrator (708) 755 -2490 E-mail: AOBOG@aol. com www. aobog. org Pathology AOBPa Staff 142 East Ontario Street Chicago Illinois 60611 (800) 621 -1773 ext 8227 aobpa@osteopathic. org www. aoboo. org/ Pediatrics Physical Medicine and Rehabilitation AOBP Staff 142 East Ontario Street Chicago, Illinois 60611 (800) 621 -1773 ext. 8267 aobp@osteopathic. org AOBPMR Staff 142 East Ontario Street Chicago, Illinois 60611 (800) 621 -1773 ext. 8226 AOBPMR@osteopathic. org www. aobp. org Preventive Medicine www. aobpmr. org/ Proctology Radiology David Harrison, D. O. , Secretary 3520 Guion Road, Suite 307 Indianapolis, IN 46222 (317) 923 -1033 AOBPM Staff 142 East Ontario Street Chicago, Illinois 60611 (800) 621 -1773 ext. 8229 aobpm@osteopathic. org Surgery Pamela A. Smith, Executive Director 119 E. 2 nd St. Milan, MO 63556 (660) 265 -4011 Karen Morgan , Corresponding Secretary 4764 Fishburg Road, Suite F Huber Heights, OH 45424 (800) 782 -5355 www. aocr. org/certification/index. asp www. aobs. org/ Boards without standalone websites have requirements posted on the AOA website at www. do-online. org under Certification