The Sword of Damocles, Redux

It has been some time (two years) since I last posted in this forum.  I wanted to share comments published recently in the POMA Newsletter.


The title of April’s Another Voice, “ACGME Sword of Damocles Poised to Strike a Devastating Blow”(POMA Newsletter, April 10, 2014), well describes the current state for osteopathic graduate medical education (OGME), but not for the reasons the author intends.  Please see the link to the meaning of the legend of Damocles’ sword.

One reason for my support for moving to a unified accreditation system is that the OGME system currently exists in a state “of foreboding engendered by a precarious situation, especially one in which the onset of tragedy is restrained only by a delicate trigger or chance.”  In the current state, multiple swords hang over OGME.  These include:  graduate medical education (GME) financing, governance of OGME by a membership organization, lack of reliability, relevance to graduates of colleges of osteopathic medicine (COM), lack of positions for future COM graduates, and yes, the actions of the Accreditation Council for Graduate Medical Education (ACGME), who is the provider of the majority of GME for COM graduates.  A unified system removes many of these swords hanging “from a single horse hair” above the head of OGME.  Other swords may remain, but they are better tethered.  I’m confident that these can be removed by the future educational leadership of the osteopathic profession having a governance stake in GME within the United States.

Reliance on the status quo leaves all swords hanging over OGME’s head.  While I do not possess a crystal ball, I believe that one or more of the noted swords will fall within the not-too-distant future.  This would result in a GME system where the osteopathic profession has no governance stake.  If that happens, there will be no opportunity to teach osteopathic philosophy.  This would guarantee the fulfillment of Still’s admonition:  “unless you teach, neither you, nor osteopathic medicine will survive.”

It is a false interpretation that a unified system with shared governance precludes teaching osteopathic philosophy and tenets.  In fact, the unified system perpetuates osteopathic principles by explicitly including them in the accreditation standards.  One has to ask themselves:  is it more likely to have osteopathic philosophy taught in a system where the osteopathic profession shares a governance stake or a system where the osteopathic profession has no governance stake?  I recognize that all do not share my concern for the swords hanging over our heads which are “poised to strike a devastating blow.”  They would say that the status quo is acceptable and a full governance stake in a fraction of GME is preferable to shared governance of entire United States GME system.  I addressed this topic in the April JAOA.

The professional exploration of this topic is quite valuable.  The scientific method stipulates that the first step in any evaluation is to define the question.  This question is not the worth of osteopathic values.  The question is:  what is the most likely path to ensure that those values continue to be taught?  The evidence points to a unified system of GME accreditation being the answer.

Originally published in the POMA Newsletter, April 25, 2014