Osteopathic physician (D.O.) residency programs that do not achieve accreditation under the new Single Accreditation System (SAS) standards by June 30, 2020 will lose access to their share of more than $9,000,000,000 of public tax dollars. This U.S. Centers for Medicare & Medicaid Services (CMS) funding helps sponsoring institutions cover direct and indirect resident physician training expenses. A significant financial burden would then be shifted to marginal costs of the residency program’s sponsoring institution in the absence of CMS funding. The sponsoring institution’s ability or willingness to bare these costs occurs during a time when hospital operating margins are at historic lows (Advisory.com /Daily Briefing /May 18, 2017 | The Daily Briefing / Hospital profit margins declined from 2015 to 2016, Moody's finds). Loss of access to CMS funding may result in potentially cataclysmic reductions in the production and availability of primary care physicians for rural and urban underserved populations. Which osteopathic residency programs will be able to survive the new accreditation requirement changes by the 2020 deadline? What are some of the defining attributes of those programs that already have achieved “initial accreditation” under the new SAS requirements? How can the osteopathic programs in the process of seeking the new accreditation more effectively “pivot” by learning from those programs that have succeeded? What are the potential implications of SAS to both access and quality of health care to millions of Americans? This report is based upon a study that examined and measured how osteopathic physician residency programs in the U.S. are accommodating the substantive structural, financial, political and clinical requirements approximately half way through a five-year adaptation period. In 2014, US Graduate Medical Education (GME) physician program accreditation systems formally agreed to operate under a single accreditation system for all osteopathic (D.O) and allopathic (M.D.) programs in the U.S. Since July 1, 2015, the American Osteopathic Association (AOA) accredited training programs have been eligible to apply for Accreditation Council for Graduate Medical Education (ACGME) accreditation. This agreement to create a Single Accreditation System (SAS) was consummated among the AOA, the American Association of Colleges of Osteopathic Medicine (AACOM) and ACGME with a memorandum of understanding. As this research is published, the ACGME is transitioning to be the single accreditor for all US GME programs by June 30, 2020. At that time, the AOA would fully relinquish all its GME program accreditation responsibilities. The new SAS operates under published ACGME guidelines and governance. Business policy and health care resource allocation question motivated this research. Failure of osteopathic programs to “pivot” to the new standards could result in fewer licensed physicians being produced in the high demand primary care field. Potential workforce shortage areas include urban and especially rural populations (CRS Report 7-5700 R44376 Feb 12, 2016). Large physician shortages already have been projected to care for a rapidly aging US population without considering the impact of the GME accreditation changes currently underway (Association of American Medical Colleges 2017 Key Findings report www.aamc.org/2017projections). The goal of this research is to provide osteopathic GME programs practical insights into characteristics of a sample of osteopathic GME programs that have successfully made the “pivot” into SAS requirements and been accredited by ACGME and those that have not. The study seeks to better understand the experiences, decisions, challenges and expectations directly from osteopathic programs directors as they strive to meet the realities of the new SAS requirements. Do programs that are already accredited differ significantly from those that have not? How do characteristics such as program size, geographic locations, clinical program components, program sponsor structure, number and experience of faculty and administration, cost planning and perceived benefits of the movement to SAS factor into successfully meeting the new requirements before the 2020 closing date? A cross-sectional research survey was designed, tested and deployed to a national sample of currently serving osteopathic GME program directors. The survey elicited data about each program’s “pivot” from AOA GME accreditation practices and guidelines to the new Single Accreditation System (SAS). The survey instrument was designed to obtain information about patterns in osteopathic GME program curricula, administrative support functions, faculty training, compliance requirements and program director characteristics shared by those programs that have been granted “initial accreditation” by the Accreditation Council for Graduate Medical Education (ACGME) who administer SAS. Thirty five (35) osteopathic GME program directors responded to the 26 question survey in June 2017. Descriptive statistics were applied and central tendency measures determined. The majority of survey respondents were Doctors of Osteopathic Medicine (D.O.s) from specialty residency programs sponsoring an average of 16 residents. Respondents were mostly non-profit, urban, multi-facility health system locations with an existing affiliation with a research college or university. About half of the programs had completed some form of fiscal due diligence related to the potential cost impact of SAS. None of those surveyed reported utilizing outside consultants to assist in the SAS “pivot” process. Most programs plan to keep the same number of residents while others expressed an interest in expanding or contracting. None of the respondents planned to close their program. The dichotomous dependent variable (DV) was whether or not the Osteopathic GME program had “achieved or not yet achieved initial SAS accreditation” at the time of the survey. A cross tabulation analysis of the DV with potential predictive variables (IV) was conducted and Chi-square and various exact significance tests were applied to gage goodness of fit. Results were grouped into categories that aligned with the five research questions and hypotheses. Several characteristics were shared by those programs that achieved SAS. GME sponsor institutions that currently have dually accredited programs by the AOA and ACGME seemed to be at a distinct advantage. Although they represented a smaller number of total survey respondents (20%), all primary care program participants reported SAS achievement. Directors reported an average of six (6) full-time paid faculty members teaching in their programs and twice that number of preceptor volunteers in the total sample. Realization of any operational cost savings or efficiencies as a result of moving to a single accreditation system was a principle concern for the majority (86%) of GME program director respondents, regardless of current accreditation status, although most felt SAS would result in offering medical student graduates access to all accredited US GME residency and fellowships programs.

In the 1990's the Accreditation Council for Graduate Medical Education (ACGME) recognized a need to fully integrate learning outcomes assessment into the accreditation process for resident physician training programs. ACGME leaders had concluded that by increasing emphasis on curricular development and by evaluating student performance through measurement of learning outcomes, the accreditation process would become a more reliable predictor of the residency program's success. In 1994 the ACGME created an initiative that would transform the current accreditation model of minimum threshold requirements towards a student performance based model of improved learning outcomes based on curricular development. responsible for the accreditation of over 8037 physician residency training programs in the United States. One hundred fifty of these programs provide training in the specialty of pathology and its anatomic and clinical sub-disciplines (AMA , 2007). Concurrent with the beginning of the ACGME Outcomes Project (1994) , four major pathology education groups in North America entered into a collaboration to improve the quality of pathology resident training. Their focus encompassed improvements in both clinical and managerial skills . The findings of this joint study culminated in the publishing of the Graylyn Conference Report in 1995 (Smith et al., 2006). One of the major recommendations in the report was that resident training in clinical laboratory administration should be improved. National leaders in pathology education felt that these changes were necessary to accommodate the evolving role of the pathologist as a clinical and administrative leader in a rapidly changing health care delivery setting. Prior to this current investigation, no studies appear to exist that provide an in-depth analysis of the perceptions of the residency directors about the need of expanded training in laboratory administration. This quantitative study has evaluated the amount of time and priority given to managerial training, the inclusion of administration topics in the curriculum and the extent of learning outcomes assessment in administration that residency program directors believe are being linked to successful professional performance in recent graduates . / Educational Administration

Behavioral science faculty (BSF) who work in family medicine residency education find themselves in inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that BSF fill while working in inpatient medicine teaching services within family medicine residencies. The purpose of the present modified sequential explanatory study was to clarify the roles of BSF and how the BSF responsibilities inform training of mental health clinicians. The convenience sample for quantitative analysis included 60 BSF who currently work on an inpatient medicine teaching service and completed a web-based survey on contextual demographics and roles on inpatient medicine teaching service. The convenience sample for qualitative analysis included 24 BSF who participated in a semi-structured interview about the roles and responsibilities on an inpatient medicine teaching service. Results suggest that behavioral science faculty members assume the roles of Educator, Administrator, Patient Care Supporter, Evaluator, Scholar/Researcher, Community Service Liaison, Mentor/Advisor, and Gatekeeper, and perform multiple responsibilities within each role. I will identify the responsibilities within each role that BSF fill in inpatient medicine teaching services using qualitative analysis and explore discrepancies between previous frameworks and this study's outcomes. Implications for this research will help to inform the hiring process for behavioral science faculty, resident education, and comprehensive behavioral science faculty and marriage and family therapy training. / Ph. D.