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Dr. Stephen Shannon and AACOM: At the Vanguard of the Osteopathic Medicine Boom

Dr. Stephen C. Shannon has witnessed tremendous growth in his field ever since he earned his doctor of osteopathic medicine (D.O.) degree in 1986.

But in the years since 2006, when he became President and CEO of the American Association of Colleges of Osteopathic Medicine (AACOM), Dr. Shannon has assumed a particularly influential front-row seat for the boom in osteopathic medicine.

AACOM is one of more than 30 professional associations across academic disciplines that partners with Liaison International. It reports that nearly half of the 36 colleges of osteopathic medicine in the United States have been established in the last two decades alone, and that more than 25% of the nation’s medical students are now studying osteopathic medicine, which has become the fastest growing medical field in the U.S.

Now retired, Dr. Shannon served as a spokesperson on behalf of all 36 colleges of osteopathic medicine in the United States, articulating the community’s priorities and positions in a variety of national and international settings. (The role of President and CEO of AACOM is now served by Robert A. Cain, DO, FACOI, FAODME.) Prior to his time as AACOM’s President and CEO, he served as Vice President for Health Services and Dean of the College of Osteopathic Medicine at the University of New England.

Why has osteopathic medicine experienced such a dramatic surge in popularity? Dr. Shannon provides his insight into that trend in the following interview with Liaison, while describing AACOM’s role at the vanguard of promoting interprofessional collaboration and diversity in its discipline.

Liaison: What do you believe has led to the substantial growth in awareness of a patient-centered approach to healthcare through osteopathic medicine?

Dr. Stephen C. Shannon, AACOM (SS): The environment in which we’ve lived over the past decade or two is one that recognizes the growing complexity of a chronic disease epidemic and an aging population, in a country where there are already shortages and where there will be growing shortages of health professionals. Those issues have led people to focus more on prevention and population health, rather than on disease or organ-focused care. This patient-centered approach has emerged as a strong primary care basis for healthcare delivery. Everybody needs a way to not only get healthcare when they are sick, but also has access to ways to stay well.

Osteopathic medical education and osteopathic medicine align very closely with the needs of a rapidly changing healthcare landscape. Everyone from institutions to organizations to U.S. states looked at their own particular situation and thought about what type of professionals they might need. They looked at the track record of osteopathic medicine — particularly its community-based curriculum and outcomes — and saw that as a mechanism to help solve their needs.

AACOM has member schools that have developed throughout Appalachia in areas like Pikeville, Kentucky, where there are recognized shortages and needs in healthcare, as well as in other rural areas like Yakima, Washington. Our schools also address needs for underserved populations in urban areas like Harlem, home of the Touro College of Osteopathic Medicine.

To further demonstrate AACOM’s commitment to promoting osteopathic medical education as a preferred pathway for future physicians and help meet U.S. healthcare needs, we launched Choose DO, the Association’s first medical student recruitment brand. Choose DO serves the growing  community of osteopathic medical students in the United States by providing tailored resources that engage and guide students interested in becoming physicians to learn more about their options for osteopathic medical school. The initiative also offers branding, language, and resources to help advance and build upon osteopathic medical school recruitment efforts at AACOM’s member colleges.

These days, if you want to become a physician and you haven’t looked at osteopathic medicine as a potential track, you really haven’t explored your options enough. Osteopathic medical education provides all the sound scientific medical approaches to diagnosis and treatment in addition to the holistic, patient-centered hands-on approach that all of our students are trained in — and that people want to find.

Liaison: How are colleges of osteopathic medicine evolving their admissions and application review practices to find students who are best prepared for today’s — and tomorrow’s — healthcare environment?

SS: We used to train physicians on the assumption they were going to be solo or small-group practitioners. The reality now is that the cohort of physicians trained these days will go out and work in teams. From an admissions perspective, that necessitates the recruitment of individuals who have the background and skills enabling them to progress in that environment. So, you look beyond the numbers. You don’t just look at MCAT scores and GPAs, even if you do need to be sure that those you admit are up to the academic rigor they will encounter. You look for individuals who fit into the mission of the institution to which they’re applying. If they’re applying to a school which says its mission is to produce primary care physicians for rural and underserved areas, then you look at their background and what they have done outside academics. The more diversity of experiences they’re able to bring, the better.

It’s not just looking at the individuals, but it’s also thinking about the entire cohort you’re developing. These students will not only be learning as individuals, but more and more they’ll be learning in groups. There needs to be a recognition of the characteristics that are necessary for success in that environment. You want students with the character that will allow them to develop the professionalism needed within the field. The way you do that is not just by looking at the numbers, but by looking at their experiences and by using different types of interview techniques. The vision of the future medical student is different than it used to be. And it also varies, depending on the college and what their mission is, where they’re located, and what they’re trying to do.

Along these lines, our member schools have benefited tremendously from partnering with Liaison International, through utilizing its tools for admissions and enrollment. Liaison has such broad experience working within the health professions to gather and quantify information for admissions processes. In addition, they have a strong commitment to education and diversity in the health professions.

Liaison: How do you suggest that schools ensure their students graduate with the skills and knowledge they need in the area of interprofessional collaboration?

SS: Going back to when I was a medical student, interprofessional education has been part of the curriculum of osteopathic medical schools for years. It really began to emerge as a key component that we needed to formally recognize, build tools for and adopt accreditation standards for as we transition into a healthcare system that’s focused on both quality of outcomes as well as value of care. This means emphasizing not only prevention of disease and limiting negative outcomes that might occur within a healthcare system, but also advancing team-based care and health promotion.

At the same time, I joined with several colleague leaders in other health professions education associations[1] to work on how to advance education for health professional students for team-based care. That led to us developing an organization called the Interprofessional Education Collaborative that has now expanded to over 20 different associations in the health professions. One of the first things we recognized was that we needed a common language and common competencies to talk about this issue. The published Core Competencies for Interprofessional Collaborative Practice is now cited nationally and internationally regarding what interprofessional education means for students in all health professions, and what competencies they should be getting from their curriculum. It has had a big impact on the educational system that we’re living with now and in shaping changes we will continue to see unfold.

The need for team-based care as health systems evolve has also led to collaboration between the accrediting bodies for most health professions, who are looking at common goals relative to accreditation. Many organizations in our field, including the Commission on Osteopathic College Accreditation, have adopted core standards for interprofessional education. It’s becoming more and more important as we focus on prevention, caring for individuals with chronic diseases and limiting the impact of disease — and on trying to do this all as economically as possible. I think the schools have to focus on where they fit in on this issue. And it varies. We have some stand-alone colleges of osteopathic medicine that have teamed up with other health professions schools to develop experiences and work in the clinical scenarios around these issues. We also have colleges that are part of universities and larger academic health systems, meaning they have natural connections with other health professions education programs as well as hospitals and clinics that enable these kinds of interactions.

It’s an evolution of how we structure health professions education, evolving accreditation standards, how clinical care is delivered and how financing works. All those factors are coming together to move this forward.

Liaison: AACOM reports that in the 2016-17 academic year, underrepresented minorities represented just 12% of total enrollment in U.S. medical schools. How is AACOM addressing this concern and others pertaining to diversity?

SS: We certainly need health professionals who reflect the populations they’re serving. We don’t have that with the current underrepresentation of minorities in virtually all of the health professions.

However, there are some good areas of progress to celebrate. At the association level, we have established a council on diversity. We have a program that’s seeking to provide scholarship funds for underrepresented minorities and has a track record of doing that. And we are creating opportunities for all our colleges to get together and share best practices on diversity.

Many of our schools have developed a relationship with high schools or colleges that have strong underrepresented minority populations. That provides avenues for students to experience what it’s like in the health professions and to envision their careers developing along those lines.

For example, the OSU (Oklahoma State University) College of Osteopathic Medicine is entering a partnership with Cherokee Nation to establish a campus on tribal land in Oklahoma, where there will be a focus on training both Native American and rural physicians. We have a strong Hispanic presence within our member schools in New Mexico, Texas and Florida. For the University of Pikeville, their mission is providing care for those living in eastern Kentucky, so their focus has been on socioeconomic diversity as much as racial and ethnic diversity. And other schools have similar missions and initiatives.

In terms of delivery, A.T. Still University in Arizona has developed a curriculum whereby students in their second through their fourth years go into community health centers around the country and complete their education working with populations in need of healthcare. Graduates of those programs are much more likely to go into underrepresented primary care areas and then stay in the community healthcare system.

Liaison: AACOM’s grassroots “ED to MED” campaign focuses on bringing medical students, medical educators, graduate and professional students and other advocates together to join the conversation about graduate student debt issues on Capitol Hill. Why should healthcare students get involved with this initiative?

SS: ED to MED is aimed at educating people about the Higher Education Act, which is up for reauthorization this year. It’s the law which governs federal financial aid programs that graduate students rely on to finance their education. Across the health professions, student debt is a tremendous challenge when you’re talking about providing clinicians in underserved and rural areas. The debt level in and of itself can be a disincentive to be able to fulfill one’s mission as an institution.

Since congressional leaders say they are going to be handling reauthorization of the Higher Education Act this year, this is a crucial time that will determine the future of federal programs such as Grad PLUS loans and Public Service Loan Forgiveness (PSLF). Grad PLUS loans help cover the cost of health professionals’ education, and PSLF provides incentives for careers in public service by assisting those who qualify to give back to their communities and have loan forgiveness as a part of that. These programs work well in terms of providing access to medically underserved populations.

ED to MED developed a set of principles, and then we went out and talked to other organizations about them. Now, we have 18 partner organizations that have endorsed the campaign principles and are participating in efforts to educate our congressional representatives about the importance of these programs. Through social media, publications and blogs by students who talk about their debt experiences, I think we’re getting a good reaction on Capitol Hill. And it’s really important, especially this year, to keep speaking up and taking action as a community.

[1] American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools and Programs of Public Health

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