# Residency Program Characteristics Associated With Osteopathic Resident Representation

## TL;DR

This study identifies factors linked to higher representation of osteopathic medical students in U.S. residency programs.

## Contribution

The study reveals program characteristics associated with higher osteopathic resident representation in U.S. postgraduate training.

## Key findings

- Programs with ≥33% DO residents were more likely to have former AOA accreditation and community settings.
- USMLE requirements for DO applicants were less common in programs with higher DO representation.
- University settings and more full-time faculty were associated with lower DO representation.

## Abstract

Objective

Osteopathic (DO) medical students encounter unique challenges applying and matriculating to postgraduate training programs. To better understand these challenges and where DO students matriculate for residency, we aimed to examine program characteristics associated with higher DO resident representation among postgraduate programs in the United States.

Methodology

We conducted a retrospective, cross-sectional study of Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs within the 10 largest specialties (i.e., with the most training spots) cataloged within the Fellowship and Residency Electronic Interactive Database Access (FREIDA) dataset in 2022. We explored program-level characteristics associated with DO representation, DOs constituting ≥33% of residents, presenting descriptive statistics and risk ratios (RR) with 95% confidence intervals (CIs) clustered at the sponsor level. Each level of non-binary categorical variables was analyzed as an indicator variable, while continuous variables were rescaled by dividing by two standard deviations to facilitate comparing the strength of associations between DO representation and each program-level characteristic.

Results

Of the 3,364 programs from the 10 specialties included in the study, 2,284 (67.9%) had <33% DO residents, and 1,080 (32.1%) had ≥33%. Former American Osteopathic Association (AOA) accreditation was more common at programs with ≥33% DO residents (n = 461, 42.7%) than programs with <33% DO residents (n = 108, 4.7%) (RR 3.65, 95% CI 3.29-4.06, P < 0.001). Other variables associated with greater DO representation included osteopathic recognition, community setting, and family medicine specialty. A U.S. Medical Licensing Examination (USMLE) completion requirement for DO applicants was less common at programs with ≥33% DO residents (n = 38, 3.5%) than programs with <33% DO residents (n = 738, 32.3%) (RR 0.12, 95% CI 0.09-0.17, P < 0.001). Other variables associated with lower DO representation included university setting, more programs at the same sponsoring institution, full-time faculty, first-year positions, U.S. allopathic medical school graduates (USMD) residents, and sponsorship of J1, H1B, and F1 visas.

Conclusions

Postgraduate training programs in the United States with ≥33% DO residents were more common in community settings with fewer USMD residents, fewer first-year positions, fewer programs at the same sponsoring institution, and fewer full-time faculty as well as among programs with former AOA accreditation, osteopathic recognition, and no USMLE requirement for DO applicants.