Attracting Osteopathic Medical Students Into Nephrology

What you need to know about osteopathic medical training

Osteopathic training was established in 1892, with 10% of currently practicing physicians being osteopathically trained. Because of significant expansion, 25% of current medical students in the United States are receiving osteopathic training across 58 campuses. Many are located in smaller communities, and most are private institutions not affiliated with a major university.

The holistic approach used in patient care is also seen in applicant selection. Osteopathic learners are slightly older (26 vs. 24 years old), more likely to have had prior work experiences, and more non-science degrees (3). Classes are very similar to allopathic training in the first two years of osteopathic medical school, with additional training provided in osteopathic manipulative medicine, which focuses on alignment of the musculoskeletal system to enhance healing. This provides very early patient contact to learners.

The osteopathic assessment is administered by the National Board of Osteopathic Medical Examiners and is called the COMLEX (Comprehensive Osteopathic Medical Licensing Examination of the United States). It aligns with each step examination of the USMLE (United States Medical Licensing Examination). Whereas large comparative research between the COMLEX and USMLE exams is lacking, a study was conducted with osteopathic students taking both exams showing correlation. From this, comparative equations were developed (4). Even with the added cost and anxiety, 60% of osteopathic learners elect to take both tests (5). Many program directors across a variety of fields recommend this practice, although this is not an ACGME (Accreditation Council for Graduate Medical Education) requirement for residency applications (6) (Figure 2).

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Highlighting the similarities and differences between osteopathic and allopathic training

Citation: Kidney News 13, 4

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The residency match system is set up to use research as a tool to gain opportunities. Regardless of degree, students with research experience are 1.4 times more likely to match. Allopathic medical students were 2.27 times more likely to have research accomplishments (abstracts, publications, or presentations) than their osteopathic counterparts (7). This same trend continues post-graduation, as fewer Doctors of Osteopathic Medicine (DOs) are represented in academic medicine, serve as senior authors, obtain research grants, or serve on editorial boards of major journals (0.15% likely to be DOs) (8, 9). Research accomplishments have not been a focus of many of the osteopathic training institutions; therefore, DOs lack the infrastructure to gain research experience. Ultimately, this disadvantages osteopathic students in fields using research to measure success.

Matching with a nephrology career

Historically, there were separate residency match systems used for osteopathic and allopathic students. However, in March 2020, students from both systems applied together, using one common match and into one residency system that represents all types of training. Now, more than ever, residency program directors must look at factors to determine the best candidate, including shared experiences or opportunities available to both groups. As many in the field of nephrology search for ways to attract career interest, having an acceptance of osteopathic training can aid in encouraging more osteopathic students to consider a nephrology career.

ASN Council members’ idea to consider ways to connect with osteopathic learners is novel among medicine subspecialties. The effort to connect with the common goal of attracting great physicians no matter the training path is an excellent example of the inclusivity ASN strives to achieve. Through discussions with DOs, both inside and out of nephrology, the following plan was developed around themes in education, mentorship, and leadership but will need the entire ASN community to accomplish it (Figure 3).

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Enhancing osteopathic nephrology careers

Citation: Kidney News 13, 4

A summary of the action plan to enhance osteopathic learners to join nephrology.

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Education Improve knowledge of osteopathic training by decreasing bias and changing strategies of reviewing learners for the skills needed to be successful physicians. ASN will build its relationship with organizations such as the American College of Osteopathic Internists (ACOI) to discuss avenues of collaboration, such as developing training for nephrology fellowship programs to gain a greater understanding of similarities and differences between osteopathic and allopathic tracks. This will suggest consideration of the evaluation process to limit selection bias. Osteopathic-designated Continuing Medical Education (CME) credit will be considered for ASN events. Last, as an ASN community, we will gather a list of nephrology rotation opportunities (academic or community based) for interested students, who may lack other opportunities, to gain experience that could influence a career choice.

Mentorship Utilize the ASN network to showcase the field of nephrology. We will make or enhance connections to the 58 osteopathic medical schools in order to promote the programs that ASN already offers to students—Kidney TREKS (Tutored Research and Education for Kidney Scholars) and STARS (Students and Residents). We hope these connections will spur development of programs, such as nephrology interest groups, noon discussion, or medical school lectures, to meet the needs of each institution. Additionally, there is a significant amount of research potential in osteopathic students that has yet to be accessed. By utilizing the ASN research mentorship connection, innovative relationships and projects can be developed to enhance scholarships for students.

Leadership It is easier for students to envision fulfilling nephrology careers when there are successful leaders who share similar backgrounds. Highlighting leaders on social media for various types of career accomplishments is one important way to start. It will be essential to incorporate osteopathic physicians into various ASN committees and for these physicians to be represented on editorial boards.

ASN is an innovative leader in the medical community by being a pioneer in an effort to broaden the appeal of nephrology to osteopathic students who have traditionally been limited in representation. With the significant rise in the proportion of osteopathic medical students, it is important to encourage career development to attract excellent nephrologists for the future.