• Mark Cummings.
• Michigan State University College of Osteopathic Medicine, East Lansing, Michigan. Electronic address: cummin67@msu.edu.
• J Surg Educ. 2021 Mar 22.

ObjectiveThis article examines the outcomes and impact of the AOA/ACGME Single Accreditation System (SAS) on 6 osteopathic surgical specialties, their program directors, residents, and students and how growth in osteopathic medical schools and students affects ACGME surgical training.DesignThe study charts the choices of 159 osteopathic surgical residencies regarding the acquisition of ACGME accreditation, decisions made by ACGME Review Committees, and how they affected program leadership, residents, and osteopathic medical students as reflected in results of residency matching programs.Setting And ParticipantsAccording to the SAS, the osteopathic profession ceded its accreditation operations and have its programs acquire ACGME accreditation between 2015 and 2020 to form a unified accreditation system under the ACGME.ResultsMore than one-fourth (26%) of eligible osteopathic surgical programs either did not submit an application or voluntarily withdrew from the ACGME accreditation process. For the 118 surgical programs that did achieve ACGME Initial Accreditation, subsequent site visits and Review Committee decisions sparingly granted Continuing Accreditation status. In addition, 49% of the osteopathic applications listed an MD program director. Osteopathic surgical residents encountered few disruptions in transitioning to the ACGME. The full impact of the SAS was felt by osteopathic graduates in 2020 who encountered fewer DO-oriented ACGME programs and the historic trend of established ACGME surgical programs favoring candidates from American allopathic medical schools. As the osteopathic profession continues its rapid growth, competition for surgical training will only increase.ConclusionsParticipation in the SAS resulted in the loss of 41 surgical programs and marked reductions in training positions during a period of rapid osteopathic growth. Results from matching programs indicate that integration of DOs into established ACGME surgical residencies will be a slow, gradual process. The SAS succeeded in creating a unified standard for surgical training yet generated negative consequences on osteopathic surgical training.Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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