Osteopathic medical education in 2009: sails set for improved healthcare?

Shannon • Editorial O medical education (OME) is constantly changing to meet the evolving needs of the profession and the nation’s healthcare system in which it exists. Although the benefits of some recent modifications have been debated,1-3 the growth of the profession is undeniable, as evidenced in the contributions4-9 to this year’s OME theme issue of JAOA—The Journal o f the American Osteopathic Association. Growth in our profession is driven by increased student enrollment. Not only are there growing numbers of colleges of osteopathic medicine (COMs)— currently totaling 28 campuses10—but many of the existing schools have increased their class sizes.4,11 Admitting the “right” applicants to COMs has always been a key factor in defining our profession. With growth in our colleges4 and changes in the graduate medical education (GME) environment,5 the student selection process helps shape the nature of the osteopathic medical profession, now and in the future. Between 1995 and 2006, I had the extraordinary privilege of serving as dean of the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Me. During those years, I was responsible for the academic program of the college, including the admissions process for potential osteopathic medical students. As at other COMs, UNECOM has an admissions staff and committee charged with selecting students who have the academic abilities to endure the challenging curriculum, the character to succeed as a physician, and the particular personal qualities and background that are essential for a good osteopathic physician (DO). We sought individuals who had demonstrated such character traits as leadership, self-knowledge, and ethics, as well as those that would be caring and compassionate. We looked for individuals likely to graduate with a patientcentered, holistic, preventive, and hands-on approach to their clinical respons i bilities. We also wanted individuals who would be most likely to choose a primary care specialty and to practice in New England.12 Of course, all these traits did not always coexist in the same individual. There were many academic achievers, as determined by Medical College Admission Test (MCAT) scores and grade point averages (GPAs). These applicants had completed rigorous undergraduate (and often graduate) work and would likely succeed against the rigors of biochemistry, gross anatomy and neuroanatomy, microbiology, pathology, physiology, and the other biomedical sciences. As shown in several studies,13-15 these individuals are likely to do well in the clinical sciences, achieve high scores at the end of their second-year board examinations, and— though sometimes less assuredly—survive their core and elective clinical requirements to graduate 4 years later. There were also individuals who had strong backgrounds in caring environments (eg, volunteer work), leadership skills, and experience in clinical or manual therapy treatment. Most importantly, they often demonstrated a driving passion to become a DO, either conveyed during their interviews with the admissions committee or simply through applying only to COMs. They had a clear vision of their future, with solid goals and well thought-out paths. However, these applicants sometimes lacked the demonstrated ability to overcome the academic and standardized examination hurdles necessary to succeed in medical school. At UNECOM, as at all COMs, the work of the admissions committee was to select applicants who had the right combination of academic abilities, values, experiences, and character to produce a graduate that fit all the goals of the college’s mission. For UNECOM, this goal was to produce quality osteopathic primary care physicians for New England.12 Academic traits are simple to measure by MCAT scores and GPA: a top ranking more or less assures academic success and high licensing examination scores.13-15 The pressure to drive admissions decisions by these numbers was (and continues to be) strong because they are used to quantify the quality and competitiveness of a COM’s students and educational program. Although not always explicitly stated, these standardized measures are important gauges of success for myriad evaluators, including prospective students, faculty, board members, and administrators as well as external groups including legislative bodies for statesponsored schools, accrediting agencies,16,17 and US News & World Report.18 Other aspects of the selection process were more difficult and subjective: reviewing the testimony of advisors, mentors, or physicians; assessing the applicant’s activities, achievements, and personal statements; and evaluating all EDITORIAL