Comparing Residency Milestones: MD vs DO Performance
Publication Title: Different letters, same results: a comparison of milestones among US allopathic and osteopathic residents
Summary
- Question
- This study aimed to compare the performance of U.S. medical residents trained in osteopathic (DO) and allopathic (MD) programs across six competency domains defined by the Accreditation Council for Graduate Medical Education (ACGME). These domains include patient care (PC), medical knowledge (MK), systems-based practice (SBP), practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal and communication skills (ICS). The researchers hypothesized that there would be no significant differences in milestone assessments throughout residency.
- Why it Matters
Understanding whether differences exist between DO- and MD-trained residents is crucial for addressing potential biases in medical residency selection and promoting fair access and opportunity in medical education. Despite a unified accreditation system since 2020, osteopathic graduates face lower acceptance rates in competitive specialties. This study provides evidence that can help reduce misconceptions about the qualifications of DOs, promote fairer evaluations, and ultimately broaden the range of perspectives and training backgrounds in the healthcare workforce.
- Methods
- The researchers conducted a retrospective analysis of milestone assessment data from 13,544 residents in four specialties: family medicine, internal medicine, pediatrics, and emergency medicine. Data were drawn from two cohorts who began training in 2016 and 2017, with assessments conducted at the start and near the end of residency. To minimize bias, the study excluded international graduates and programs with only MD or DO residents.
- Key Findings
- At the start of residency, DO residents scored slightly lower than MD residents in several competencies, depending on the specialty. However, by the penultimate assessment, most differences disappeared. In emergency medicine, DO residents consistently outperformed MD residents in certain areas, such as patient care and systems-based practice. Overall, the differences were small (0.05 to 0.12 points on a 5-point scale) and lacked consistent trends across specialties or cohorts.
- Implications
The findings indicate that both DO and MD training pathways prepare residents equally well for practice, challenging assumptions that DO graduates are less qualified. Addressing these assumptions in residency selection could expand opportunities for DOs, potentially alleviating physician shortages in specialties with fewer resources and improving access to care.
- Next Steps
- Future research should explore patient care outcomes to confirm whether any meaningful differences exist between DO- and MD-trained physicians. Additional studies using updated milestone assessment tools (Milestones 2.0) are also needed to validate these findings in a broader range of specialties.
- Funding Information
Yale University provided funding and support for this research.
Full Citation
Authors
Melissa Langhan, MD, MHS
First AuthorProfessor of Pediatrics (Emergency Medicine) and Emergency Medicine
Sean O. Hogan
Last Author
Other Authors
Research Themes
Concepts
- doctors of osteopathic medicine;
- Accreditation Council for Graduate Medical Education;
- emergency medicine;
- milestone assessment;
- medical specialties;
- milestone scores;
- medical schools;
- competency assessment;
- Generalized Estimating Equation models;
- Graduate Medical Education;
- international medical schools;
- milestone achievement;
- DO residents;
- DO graduates;
- osteopathic residents;
- pediatric PC;
- allopathic physicians;
- family medicine;
- lack of evidence;
- eligible residents;
- osteopathic medicine;
- patient care;
- Doctor of Medicine;
- medical training;
- milestone ratings