To the Editor:
In their June 2009 Academic Medicine article, Wood and Hahn1 reported “perceptions that the quality of osteopathic education, and therefore the graduates of DO medical schools, are of a lower quality than is the case with MD schools.” They then sought to dispel these perceptions by analyzing certain aspects of accreditation across the two professions.
There are fundamental problems with this approach. Simply assessing the similarities and differences between the accreditation standards for the educational programs that grant MD and DO degrees does not begin to provide an answer to this complex question, as we will presently explain.
Furthermore, the authors' comparison of the accreditation standards overlooks a number of significant issues. For example, among its accreditation standards for MD educational programs, the Liaison Committee on Medical Education (LCME) requires the presence of research activities at the institutional level; opportunities for medical students' engagement in those activities; curricular content related to the basic principles of clinical and translational research, including how such research is conducted, evaluated, explained to patients, and applied to patient care; systems of career advising for students; and attention to the “hidden curriculum” in the learning environment. None of these areas is addressed in the Commission on Osteopathic College Accreditation (COCA) standards. Moreover, COCA's approach to diversity issues in medical education differs significantly from that of the LCME. COCA's diversity standards are framed in the terminology of antidiscrimination statements, in contrast to LCME standards that require the development of proactive activities at schools (e.g., pipeline programs) to enhance diversity among faculty, staff, and students and contain an expectation that schools will recognize their collective responsibility for contributing to the diversity of the profession as a whole.
Another significant omission in the article's analysis is the failure to mention LCME standards related to ensuring the quality and consistency of the clinical training setting. LCME standards require that medical students have a component of their education and training in the presence of resident physicians; COCA standards are silent in this area. LCME standards require that programs identify the types of patients, clinical conditions, and both the setting and level of students' involvement that the faculty deem necessary for students to meet educational program learning objectives to ensure appropriate depth of training and consistency of clinical experiences across different sites of training. This LCME standard requires that schools carefully monitor and document such exposure for each and every student.
Finally, there are other, more subtle differences among the standards of the two accrediting organizations, and the authors tend to overstate some minor distinctions. Although most of the differences that they do identify consistently suggest that the LCME's approach to ensuring educational quality is more effective (e.g., medical students' participation as voting members of the accrediting bodies, the presence of standards that address the academic environment, and standards on teaching, evaluation, and curriculum management), they then conclude that the differences are insufficient to effectively answer their question about the quality of DO graduates.
Comparing accreditation standards for educational programs is only a small part of the analysis that would be required to answer the underlying question posed by the authors regarding the relative quality of graduates of MD- and DO-granting educational programs. Such an analysis would, of necessity, include both an operational definition of quality andan in-depth assessment of the characteristics of entering students and of graduates' performance in their residency training, assessments for licensure, and medical practices.
Dan Hunt, MD, MBA
LCME secretary, 2010–2011, Association of American Medical Colleges, Washington, DC; email@example.com.
Barbara Barzansky, PhD, MHPE
LCME secretary, 2009–2010, American Medical Association, Chicago, Illinois.
Robert Sabalis, PhD
LCME assistant secretary, Association of American Medical Colleges, Washington, DC.
1 Wood DL, Hahn MB. Accreditation standards of osteopathic and allopathic medical schools: Could they affect educational quality? Acad Med. 2009;84:724–728.