Frequently Asked Questions: Osteopathic Neuromusculoskeletal Medicine Review Committee for Osteopathic Neuromusculoskeletal Medicine ACGME

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1 Frequently Asked Questions: Osteopathic Neuromusculoskeletal Medicine Review Committee for Osteopathic Neuromusculoskeletal Medicine ACGME Question Introduction If an institution has an AOA-approved twoyear neuromusculoskeletal medicine (NMM) program and an AOA-approved Plus One program, do both programs need to separately apply for ACGME accreditation? [Program Requirement: Int.C.] Is the length of the educational program still 24 months if a resident has satisfied the requirements to enter at the ONMM2 level? No, only one program needs to apply for ACGME accreditation. Programs have the ability to train residents in two different formats within the same accredited program. A program can train residents in the traditional 24-month format or choose to accept residents into the ONMM2 level of the program. Residents accepted into the ONMM2 level must have completed a residency program and met other eligibility criteria prior to entry. The length of training for a resident entering the program at the ONMM2 level is 12 months. A program can choose to train residents in only one format or in both formats. No, the educational program may be shortened to 12 months based on prior training in osteopathic neuromusculoskeletal medicine. This prior training must include the completion of an ACGME-accredited or AOA-approved residency program. [Program Requirement: Int.C.] Are leaves of absence included in the required 24 months by which a resident must complete the educational program, if the resident enters at the ONMM2 level? No, a resident could complete the educational program over a period longer than 24 months if he or she was on a program director-approved leave of absence. In such a case, the educational program can only be extended beyond the 24 months by the length of the approved leave of absence. [Program Requirements: Int.C.2.-3.] Institutions 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 1 of 9

2 If a rotation occurs at a site that is not under the governance of the program s Sponsoring Institution and the rotation is with a member of the Sponsoring Institution s employed faculty, is a Program Letter of Agreement (PLA) necessary? [Program Requirement: I.B.1.] A PLA is not necessary for a rotation that occurs at a site that is not under the governance of the program s Sponsoring Institution under the following circumstances: Rotation is an elective Rotation is under the supervision of the program director Rotation is under the supervision of a member of the Sponsoring Institution s employed faculty o In this instance, the program must be able to demonstrate that the faculty member was provided the information outlined in Program Requirements I.B.1.a)-d). Rotation is with a member of the program s faculty that has a contractual agreement with the Sponsoring Institution to teach at the graduate medical education level o In this instance, the program must be able to demonstrate that the faculty member was provided the information outlined in Program Requirements I.B.1.a)-d). Program Personnel and Resources What would be viewed by the Review Committee as an acceptable program director workshop? [Program Requirement: II.A.4.p)] How do residents access the ACGME Case Log System? [Program Requirement: II.A.4.s)] A PLA is necessary for required selective rotations outlined in IV.A.6.f).(1).(c)- IV.A.6.f).(1).(e).(iii) unless they fall into one of the situations listed above. The Review Committee recommends that program directors (or a faculty member designee) attend a workshop or conference that has at least five to eight hours of content specific to osteopathic neuromusculoskeletal medicine and medical education. An example of such a workshop is the American Academy of Osteopathy s annual program director workshop. Program directors and residents will receive login information for the Resident Case Log System, which is a web-based data collection system accessible through the ACGME website. Is there a fee to use the ACGME Resident Case Log System? There is no fee to programs or residents to use the Case Log System. [Program Requirement: II.A.4.s)] 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 2 of 9

3 How do residents know what to log in the ACGME Case Log System? [Program Requirement: II.A.4.s)] Can injection procedures supervised by a physician who is not board certified in neuromusculoskeletal medicine be logged by residents in the Case Log System? [Program Requirements: II.A.4.s)- II.A.4.s).(1)] If a resident completes a 40-hour basic course on osteopathic cranial manipulative medicine prior to entering residency, does he/she need to complete another course during the program? [Program Requirement: II.D.4.] Resident Appointments What do ONMM1 level and ONMM2 level mean? [Program Requirements: III.A.1.a).(1)-(2)] May a program director grant an exception for a resident entering at the ONMM2 level who completed an ACGME-accredited residency program without Osteopathic Recognition? [Program Requirement: III.A.1.a).(2)] Information about the Case Log System, including what must be logged and how to use the system, can be found on the Documents and Resources section of the Osteopathic Neuromusculoskeletal Medicine section of the ACGME website here. Yes, the Review Committee will allow residents to log injection procedures supervised by a physician who is not certified in neuromusculoskeletal medicine by the American Osteopathic Board of Neuromusculoskeletal Medicine (AOBNMM) or the American Osteopathic Board of Special Proficiency in Osteopathic Manipulative Medicine (AOBSPOMM), or board-eligible for AOBNMM certification. However, the physician must have current board certification as outlined in Program Requirement II.B.2.b). The resident should enter the entire patient encounter in the Case Log System, and select Attending, Not NMM Board Certified from the Attending drop-down menu. The injection procedure will count toward the injection totals; however, the patient encounter will not count toward meeting encounter minimums. No, residents who completed such a course in medical school, during their preliminary clinical year, or during a primary residency program are not required to repeat the experience. ONMM1 denotes the first year and ONMM2 denotes the second year of residency in a 24-month osteopathic neuromusculoskeletal medicine program. The Review Committee will allow program directors the discretion to accept into the ONMM2 level residents who have completed an ACGME-accredited programs that did not have Osteopathic Recognition or residents who were not in an osteopathic-focused position within a program with Osteopathic Recognition. If a program chooses to accept such a resident, it must apply the eligibility requirements outlined in Program Requirements III.A.1.a).(1).(a).(i)-III.A.1.a).(1).(a).(i).(c).(iii) Accreditation Council for Graduate Medical Education (ACGME) Page 3 of 9

4 How can residency programs without a Programs can collaborate with neuromusculoskeletal medicine specialists at other neuromusculoskeletal medicine specialist institutions to provide residents the appropriate clinical experience. An opportunity may on the faculty ensure their residents get the exist for a program to collaborate with a college of osteopathic medicine or an necessary neuromusculoskeletal medicine educational consortium, such as an Osteopathic Postdoctoral Training Institution patient encounters to be eligible for (OPTI), that has a relationship with neuromusculoskeletal medicine/osteopathic advanced entry (ONMM2) into an manipulative medicine board-certified specialists. Affiliations with these individuals osteopathic neuromusculoskeletal medicine and/or their institutions may provide the opportunity for residents to obtain the necessary program after completion of a residency patient encounters, where osteopathic manipulative treatment is provided, for entry in to program? the ONMM2 level of an ACGME-accredited osteopathic neuromusculoskeletal medicine program. [Program Requirement: III.A.1.a).(2)] Must the minimum of 12 rotations needed for entry into the ONMM2 level be supervised by a physician who is AOBNMM certified, and can these rotations be completed over the course of the primary residency? A rotation may be supervised by a physician certified in the specialty of that rotation. For example, a neurology rotation may be supervised by a board-certified neurologist. The minimum of 12 rotations can be completed over the duration of the educational program in the primary residency. [Program Requirement: III.A.1.a).(2).(a)] Can the required rotations needed for entry into the ONMM2 level have a pediatric focus for residents who complete a pediatric preliminary residency? Yes, the Review Committee will allow rotations completed in a primary pediatric residency with a pediatric focus to count toward the required rotations for eligibility for entry into the ONMM2 level. For example, a resident may complete a pediatric neurology rotation in place of an adult neurology rotation. [Program Requirement: III.A.1.a).(2).(a)] 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 4 of 9

5 Does the Review Committee recommend Yes, the Review Committee does recommend, but does not require, that a resident that residents have exposure to an have exposure to an osteopathic neuromusculoskeletal medicine clinic, supervised by a osteopathic neuromusculoskeletal medicine neuromusculoskeletal specialist, in his/her primary residency. The Review Committee clinic during their primary residency to would recommend the following patient encounters to help prepare a resident for entry prepare them for entry into the ONMM2 into the ONMM2 level of the program: level? a minimum of 300 clinic patient encounters a minimum of 75 designated continuity of care clinic panel patient encounters [Program Requirement: III.A.1.a).(2).(a)] a minimum of 15 documented patient contacts with a variety of surgical diagnoses, where an evaluation was completed and osteopathic manipulative treatment was provided a minimum of 15 documented patient contacts with a variety of pediatric diagnoses, where an evaluation was completed and osteopathic manipulative treatment was provided a minimum of 15 documented patient contacts with a variety of obstetric and gynecological diagnoses, where an evaluation was completed and osteopathic manipulative treatment was provided 2017 Accreditation Council for Graduate Medical Education (ACGME) Page 5 of 9

6 Educational Program Does a resident s time spent teaching medical students while under the supervision of a faculty member count toward the required minimum of four hours per week of structured educational activities? No, the time a resident spends teaching medical students, residents from another program, or junior residents does not count toward the required structured educational activities, regardless of whether there is faculty participation. Examples of activities that do not count toward the required structured educational activities would include the time residents spend as assistants in an OMM lab and as table trainers. [Program Requirement: IV.A.3.(b)] What is the scope of clinical medicine that is expected in training osteopathic neuromusculoskeletal medicine residents? [Program Requirement: IV.A.5.b).(2)] What qualifies as an in-depth study of osteopathic philosophy? [Program Requirement: IV.A.6.a).(1)] May required rotations be two weeks in length? [Program Requirement: IV.A.6.f)] Programs must include training in the evaluation and management of acute and chronic conditions with competence in diagnosis of new or undifferentiated neuromusculoskeletal disorders. Residents should be knowledgeable of a patient s complete care plan, including routine health maintenance and preventive, medical, pharmaceutical, and surgical treatments. A program may incorporate this into the osteopathic neuromusculoskeletal medicine training with an emphasis on areas such as primary care or sports or pain medicine. The scope of such training will be determined by the individual program director. This should reinforce the importance of the original philosophy, as expressed by Dr. A.T. Still in his writings, and other philosophy related to osteopathic principles and practice. The Review Committee strongly recommends that residents read at least one book by Dr. Still prior to completion of the program. This is considered a minimum and should promote a lifelong pursuit and commitment to understanding and implementing the osteopathic philosophy and practices. Required rotations must be four-week blocks, a calendar month, or 100 hours. Required rotations may be split into two two-week blocks, as long as they are completed in the same academic year. Elective rotations may be two-week blocks Accreditation Council for Graduate Medical Education (ACGME) Page 6 of 9

7 Do rotations listed as in an ambulatory setting have to take place entirely in the ambulatory setting or could inpatient experiences occur during such rotations as well? [Program Requirements: IV.A.6.f).(1).(c)- IV.A.6.f).(1).(d).(iii)] Is an academic medicine or teaching rotation where the resident primarily supervises and/or teaches neuromusculoskeletal medicine an acceptable elective rotation? The Review Committee s intent is for the rotations listed in Program Requirements IV.A.6.f).(1).(c)-IV.A.6.f).(1).(d).(iii) to occur in the ambulatory setting, however some of the rotational experience may take place in the inpatient setting, so long as the majority of the inpatient experience occurs at the bedside. No, these would not be acceptable as elective rotations, though such experiences may be incorporated longitudinally throughout the program as appropriate. [Program Requirement: IV.A.6.f).(1).(f).(ii)] Is orthotics an acceptable elective rotation? [Program Requirement: IV.A.6.f).(1).(f).(ii)] Does the time spent on an osteopathic neuromusculoskeletal medicine outpatient rotation count toward the half days required in the continuity of care clinic and vice versa? [Program Requirements: IV.A.6.f).(1).(a), IV.A.6.f).(2).(a), IV.A.6.g).(4).(a).(i), IV.A.6.g).(4).(b).(i)] Is the program required to provide residents with follow-up care experience for all of the following patient types: medical, surgical, obstetric, and pediatric patients? [Program Requirement: IV.A.6.g).(1).(b)] No, not if the rotation is supervised by an orthotist. Rotations must be supervised by appropriate board-certified physician faculty members, as defined in the Program Requirements. Orthotics may be an experience incorporated into a required or elective rotation, as long as the rotation is supervised by a qualified faculty member. Yes. Time spent on an osteopathic neuromusculoskeletal medicine outpatient rotation, completed in the continuity of care clinic, may count toward the required half-day time in the continuity of care clinic. Likewise, half days spent in the continuity of care clinic may count toward a longitudinal osteopathic neuromusculoskeletal medicine outpatient rotation. Residents must be able to provide follow-up care to patients on whom consultations are performed, and it is the intent of the Review Committee that those patients range in age and diagnosis. It is not required that follow-up care be provided to each of the following: medical, surgical, obstetric and pediatric patients. Residents must, however, be able to evaluate and provide osteopathic manipulative treatment to all of these patient types, as outlined in Program Requirements IV.A.6.g).(2)-IV.A.6.g).(3).(d) Accreditation Council for Graduate Medical Education (ACGME) Page 7 of 9

8 Can a patient treated only once with osteopathic manipulative treatment be counted toward the required patient encounters for the continuity clinic? A single patient encounter may count toward the 1,000 required patient encounters; however, that patient would not count toward the resident s required 250 continuity of care panel patients. [Program Requirement: IV.A.6.g).(2).(a)] Can a single patient encounter be counted as a patient contact for multiple diagnoses, e.g., can a patient contact in the continuity clinic also be counted as surgical, pediatric, or obstetric and gynecological patient contact, and is the same true for patient contacts during hospital consultations? [Program Requirements: IV.A.6.g).(2).(a)- IV.A.6.g).(3).(c).(i)] In order for a resident to include a continuity patient encounter in his/her count toward the minimum 250 designated patients in the continuity of care clinic or the 1,000 patient care encounters in the continuity clinic, must the resident be supervised by an AOBNMM-certified physician? Yes, at the discretion of the program director, a patient encounter may be counted toward the minimum patient contacts for multiple diagnoses (surgical, pediatric, and obstetric and gynecological). At the discretion of the program director, a clinic patient encounter could count toward the minimum continuity of care patient encounters and toward the minimum patient contacts for patients with a surgical, pediatric, or obstetric and gynecological diagnosis. The same is true for patient encounters through hospital consultation. Those patient encounters may be counted toward the minimum hospital consultations and toward the minimum patient contacts for patients with a surgical, pediatric, or obstetric and gynecological diagnosis. An osteopathic neuromusculoskeletal medicine resident seeing patients for specialty evaluation in the continuity clinic needs to be supervised by an AOBNMM-certified, AOBSPOMM-certified, or board-eligible attending physician. A supervising physician without such certification or eligibility would not be able to direct a resident to the depth and breadth of knowledge expected of a board-certified physician. [Program Requirements: IV.A.6.g).(4).(a).(ii)-IV.A.6.g).(4).(a).(iii)] How does the Review Committee define a designated patient? [Program Requirements: IV.A.6.g).(4).(a).(ii) and IV.A.6.g).(4).(b).(ii)] The Committee defines a designated patient as a patient seen at least twice, with at least one of the visits occurring in the resident s continuity of care clinic. For example, a resident may have his or her first encounter with a designated patient in the hospital inpatient setting, with a subsequent encounter(s) in the continuity of care clinic. Alternatively, a resident may have a designated patient encounter in the continuity of care clinic, with a subsequent encounter(s) in the hospital inpatient setting Accreditation Council for Graduate Medical Education (ACGME) Page 8 of 9

9 What is recognized as acceptable resident scholarly activity? [Program Requirement: IV.B.2.a)] Other In the application for accreditation, does a program need to demonstrate compliance with all Program Requirements if the program only plans to offer entry into the ONMM2 level? If a program requests a complement increase for the ONMM1 year and the current complement for that year is zero, what information must be provided to the Review Committee? The participation of each resident in scholarly activity is required prior to completion of the program. This requirement can be met by any of the following: a) an original paper on a neuromusculoskeletal medicine topic intended for publication b) a scholarly project within the scope of neuromusculoskeletal medicine, such as a quality assurance or practice improvement project c) institutional or regional research programs in which neuromusculoskeletal medicine preceptors or faculty members are actively involved d) preparation and presentation of a neuromusculoskeletal medicine-related topic at a state, regional, or national meeting No, if the program plans to offer only entry into the ONMM2 level and that is reflected in the requested complement (i.e., a complement of zero in the ONMM1 year) then the program will not be required to demonstrate compliance with the ONMM1 level requirements. The block diagram would therefore only need to show the ONMM2 level curriculum. Additionally, the program can respond to any specialty-specific questions pertaining specifically to the ONMM1 level of entry with not applicable. The Review Committee requires the following information in order to make a complement increase decision: Educational rationale for the increase Block Diagram showing both ONMM1 and ONMM2 levels of entry Case Log Reports Faculty to resident ratio Outline of major changes since the last review by the Review Committee Updated responses to previous citations (if any) The program is encouraged to contact the Review Committee Executive Director for additional information Accreditation Council for Graduate Medical Education (ACGME) Page 9 of 9