Episode 167: Myths and Misconceptions 4: DO students can't participate in the Visiting Student Learning Opportunities (VSLO)? Incorrect! Interview with the AAMC!

[ Music ] >> My name is Dr. Ian Storch. I'm a board-certified gastroenterologist and osteopathic physician. And you are listening to DO or DO not. If you are interested in joining our team or have suggestions or comments, please contact us at do or do not podcast.com. Share our link with your friends and like us on Apple Podcasts, Facebook, Twitter, and Instagram. We hope you enjoy this episode. This is another episode that we're entitling myths and myths, conceptions in osteopathic medicine. This episode will focus on V-SLO, V-S-L-O, or the visiting student learning opportunities. This is a way that students, both MDs and DOs, can apply for rotations in different specialties. Over 50% of students going through V-SLO are osteopathic medical students. This allows opportunities for DOs to get away from their home institution, visit other places, see if it's a good fit for them, and showcase their talents at other hospitals. Although generally, this system is great for DO students, occasionally there are some difficulties. There are a few studies published showing difficulties in select orthopedic programs, which raises the question, is this an issue? And there are occasional Reddit posts on issues as well as a few podcasts that I've listened to that sort of sensationalize an issue of DOs and the V-SLO. I want to highlight, in my own experience speaking to medical students, I have not found any specific problems. However, if there are issues, AACOM or the American Association of Colleges of Osteopathic Medicine does have a link on their website where this can be reported. The reason for this episode is to address those minority complaints about the V-SLO, and specifically, we sought out a representative from the AACOM or the American Association of Medical Colleges, the organization that organizes V-SLO to talk to them, and determine in their opinion whether this is a problem for DO students and if something needs to be done. We know you'll enjoy this episode. Robin Carl, thank you so much for being with us today. Thank you. You're from the AACOMC. Can you tell us about what the organization is and what the organization does, like in general? Certainly. So the AACOMC is the Association of American Medical Colleges, and we're a nonprofit membership driven organization focused on the health of everyone through our relationships with academic medicine, community supports, and research. So it's a very broad portfolio around the health of everyone. Can you tell us some specific tasks? I appreciate that. It's very general. Give us some nuts and bolts specific things that the AACOMC does, especially with medical education. Really, it is very broad, but I can speak for instance to the services where I work in Vizlo. So your listeners have probably heard about the MCAT program. Yes. You guys did the MCAT? The MCAT. For MD school students, we also manage the MCAT process, which is the application to medical schools, the AERAS process, the application to residences, and Vizlo is in between there. And we have programs like the FAC program, which is a support program for students who meet certain qualifications. It's a big program. It's over $20 million that go back and student support starting back when they are taking the MCAT with the FAC program. Then there's a big research component. We have relationships with the teaching hospitals and of course the medical school. So lots of support for the programming that they do individually and collectively. And then we have relationships with others in the nonprofit world who are in the same space. So ACOM and AMA. So I've listened to a few other online venues podcasts and they talk about how and they make statements about how the AMC makes money and how increasing applications to residences and the more applications basically that students have the more revenue that AMC makes. But the AMC is known for profit. Is that correct? And can you talk a little bit about that? Non-profit. It plows back into the various supports and by improvements to the systems like the AERAS system, data to help people make better decisions. There have been a lot of improvements and data to better understand students for students to understand how many applications is actually enough applications to feel confident about their strategies. That's really not the part of services I work with as much. This podcast is a DO podcast, right? We're talking to DOs and osteopathic students and people that are interested in osteopathic school. So would you say I appreciate that you have affiliation or relationships with ACOM, which does sort of entrance for DO schools, but it sounds like a lot more of the affiliation and you know, DO students take the MCAT also obviously, but do you feel like the AMC is an MD institution or what do you think the relationship DO and MD is? In terms of the membership of the organization, they are MD schools, but this low, for instance, half of the applications that we receive are from DO students. There are super users in the system and so seeking away rotations. So for us, it's quite a robust relationship with the DO students and the COMS. There's super users, you said. So you feel like there are more DOs actually using the V slow than MDs or at least equal. Is that what you're saying? Equal in terms of number of applications. Let me pull, I'll pull some numbers for you, but it's very close. We have some going to give you 23, 20, four numbers. The total applicants, 51% of the electives applied to DO students applied to those 45% were MD students, applications, and the difference were international students coming into the system. So a smaller number. Can you comment on this with the change of the COMLX and the steps to pass fail? It's been a lot of talk that addition rotations are one of the most important aspects for medical student application to residency, which obviously AMC is doing ERAS, which is for residencies also, especially if it's a competitive specialty. Can you comment on that? Do you think that that's true? Yes, we've seen an increase in the numbers of students going on away rotations about 10 to 15% annually. DO is tracking right with the MD students on that number. The fact that the USMLE has gone past fail in the last few years and many institutions encourage or virtual interviews, all of a sudden the away rotation takes on even more importance for students in terms of being able to have that experience, but also to evaluate the environment to see if it's one they would be comfortable making a commitment to a residency program for instance. And so yes, I do think they are increasingly important in the process of becoming a physician. Okay, so now before I started mentoring students at getting a volume of podcasts and having these discussions for me and now I'm aging myself obviously. We just like call up a program and say, look, can I come for a gastroenterology rotation and hang out for the month? Can you talk to us about exactly? I don't even know what V slow stands for. He tells what it is and how it came about. Well, it's the visiting students learning opportunities program and we were two programs originally before 2018. There was the B SAS program and the glow program and glow was the international connection of international students and international opportunities and V SAS was the US based system. And in 2018, we moved to a new platform and both of those separate processes became visible. And since then we continue to have two separate programs, global network and the US network and the DO students and the MD students, US and D students are within our our US member. And so we have home institutions for the students are maturulating. We have host institutions, which are the hospitals for the most part and then students and those are our three communities of users and students at their home institutions. We have a platform where there's a standardized application process, students add in things like their immunization records, their letters, recommendation, whatever else they're putting into their application. Their school reviews that, adds their transcripts, checks the box that they are a student in good standing, and forwards that application to whatever host institution the student has applied to. And they apply within a catalog for particular specialties for particular rotation dates. They can apply for multiple dates for one unique elective. And they do some to be sure they get some things. Every student has a slightly different curriculum requirement on institution. So one of the things that's different about Vislow then for instance, eras or amcast is that although we have seasons, we never close because our students. We certainly that now is turning into the busy time for them to be in the system, but there are reasons for students to be looking for rotations and going on rotations throughout the year. So a student then has put their application in and the host institution then reviews that and figures out if they're a match for them and what dates are available and then sends an offer to that student. The student can then decide to accept it or not. And Dio students get an average of four offers and accept about 63% of those offers. And D students are kind of in that same range. They usually get two offers an average of two offers and accept a slightly higher than 66% of those offers. So they're fairly similar. Dio students apply to more dates because they want to be sure they have more skin in the game. They need to go on in the way rotation. And also although they have affiliated hospitals where they've been having their clinical experiences, they need to find one of these opportunities. So it's important for them and they apply their application number showing. If someone was in a rule follower, did they have to go through V slow? Can they call and try to make up their own rotations? Or is this if you want to do a rotation at a hospital that you're interested in, you have to go through V slow? Dio percentage, but I can say most institutions that offer away rotations do use V slow. There are some other companies that offer a platform of support. Some schools and some hosts have homegrown systems where and perhaps they have, you know, historical relationship and their students come and go and they don't use V slow. But for the most part and increasingly teaching hospitals use this low as their platform. So a wonderful process for them because I mean they get a broad selection of students who are already vetted. They know that they are qualified to come on a clinical rotation. So if you're at a host institution and you're busy and you're really wanting to get a broad look at who might come into residency in their institution. There are lots of reasons to use V slow, but that's a big one. So it dies as a process and makes it easier for the administration of it. So you're providing a good service. I have no doubt. You don't have to deal with me. So how much does it cost for a student wants to go through Vizlo? Sure the students listening know this, but for us older doc is a registration fee and then is there a fee perverse school? Does it go down if you apply to 100 or is it just like a per school fee? There's a school set the fee. How does that usually work? So we have a standard it's a processing fee for application and it's based on a unique application. So you want to go to this host site and you want to go on this specialty rotation. You pay $15 to process the application. If for that same away rotation, it's offered on multiple dates and you want to be sure you get one of them. And so you say I'm also available based on my curriculum and my schedule. I'm also available for these two additional blocks of time. Those don't cost more against that unique. So when you look at the number of applications in Vizlo, it's the number of unique applications that would be tied to the $15. The number of applications is really the unique collective plus the alternative date that a student would be available. Okay, my follow up question is do you know if there was a large number of osteopathic medical students, it sounds like Vizlo predated the combined accreditation right the residents. Yes, 20 and we're. Yes, did the number of osteopathic students going through Vizlo increase after the single accreditation came about the number of deosteans who is in the system has increased year over a year. But not necessarily tied to that because we also have of course lots more new schools and as those students are coming online. Right. There's more to fourth year students. That's some of the increase as well. Right. Got more deos schools, more deos students more Vizlo necessity. First of all, thank you so much for all that explanation. I think I totally get it now. So the reason that I wanted to speak to someone from AMC is because sometimes read these things on Reddit. You read these things online. There are some kidney doctors online that are talking about issues. Yeah, you're writing so funny stuff. But to me, it's the best way to have a conversation rather than just like get on a soapbox is just ask questions of people that are yourself were knowledgeable and can answer some of the issues. So one of the questions that I think a lot of osteopathic students have is you're do you think there's some discrimination against deos students at certain institutions who want to rotate there. I can never say never because no of someone right, but that anyone said I think that there isn't a lot in the same way that there are lots of reasons people going rotations. They go because they want to go there for their residency. They may go on a rotation because it's a specialty area. They'll never be able to deep dive in again. It's all over the board on when it's sort of the same when we look at the numbers. Theo students are getting offers and they are accepting offers and are there institutions that don't seem to ever accept a deo student they offer the opportunity to them, but then we don't have a good history on that. Yes, is that sometimes because they end up filling with their own students or the dates don't match or I mean there are lots of other reasons it could be. And I think that as we go there's just less and less of it because people are increasingly cognizant of what an important and well trained community of deos students we have. And I don't need to get right to go into specialties that matter to serve in communities that need care. I mean it's hard about right place right time. Right, absolutely. I agree. Going a little forward on that there was a paper that was published recently in the generally the American osteopathic association by white at all. And so they were on orthopedic residencies they said there were 18 programs publicly restricted rotations based on degree and that there were a few places where the cost stated on the website that the cost for a deo was different than the cost for an md could start with the first one. So I went about this study that says that there's 18 programs that overtly says that they won't take the road rotations do you know if that's true. I assume that it is and can you tell me what your thoughts are on that. Yeah, I assume that it is to although they did not ask me for data so there are 18 programs not every program uses us and that's a highly competitive specialty and so there are all those additional issues that come with some of these more these highly competitive specialties. As to the second part of that there are a handful of them four or five of them one I think of in particular that do charge deo students and one of them clearly a lot more than they charge other students. We encourage all of our hosts not to charge students for these away rotations they're expensive undertakings for them to begin with even if they're sleeping on their ants couch and it's and there's a lot of pressure on them so we and we look regularly in our system to see if they've listed things that that we're unaware of. And there are also lots of reasons that people will give you for that we have schools that have historical relationships with other schools and they move their students in a fairly seamless way and they feel that there's some balance to that they see students come it where they don't have that similar sort of professional recipe. to do. and feel the need to add a process and fee or add as something or other fee. Because as you know, all these places are under pressure in terms of their own budgets. But I don't think there's as much of it as sometimes people assume. I mean, when these things come up, and as I said, we review what's in our system regularly, but when these come up, and I've talked to people particularly in the ACON community, that I think that it really is up having to be building a level of understanding and trust at those institutions, is that they just, sometimes it's just a function of they don't understand. Or it is a function of, they just don't have the bandwidth to take the students that are interested in coming their way. And this is a way to reduce the number. And then you've got things on the other end. Like I have some of our host sites, even within that host site, how they review applications is different by specialty. And so we'll have somewhere, they do them on the first come, first serve some that wait until May 20th and look at them all at once. And then we have some that look at the DO students first because they know they need the rotations. And so for every one of these that is adding a charge, there's somebody who is putting them first in line. - My little side note, my view, and then I have a question at the end of it. Sometimes I have students that come to me and they say, listen, it's not fair. There are MD students that got this rotation. I didn't get the rotation. But meanwhile, the MD student went to Harvard undergrad, went to Harvard Med School, again, you know, whatever, who cares about Harvard? But you know, went to Harvard undergrad, went to Harvard Med School as a perfect MCAT, had a perfect depth score, and did a ton of research, and the DO students done nothing and like flunked a couple of their classes. Obviously that's not the average. And in those cases, I just think it's totally ridiculous that the DO students saying they're being biased against because they're a DO, that's not fair. But then on the other hand, and this is where the issue comes in, you have that DO student who's a rock star, who that's the guy or the gal that you want to be your orthopedic surgeon, 'cause they're awesome and they've done everything and above and went to an osteopathic school. Now they're going up against maybe, you know, maybe there's an MD student that's a lackluster, and now that the DO students being told that they have to pay 400 bucks and the MD student's paying five. You know, I mean, that's certainly not fair. So my question is acknowledging that this does exist and acknowledging that the DOs are more than 50% of the applications and the revenue from this whole process is coming from the DO students. So the DO students who doesn't or does the AAMC have a policy on any of the program decides that they don't want to interview purple people or they don't want to have purple people rotate in their organization. It's hard to tell them what they have to do, but to overtly make a statement that they're not taking these people, seems again, unfair in my opinion. Does the AAMC as the gatekeeper to these rotations have a policy on this and are they planning on anything in the future if they don't, or do you think that they should? - I haven't read this paper, the orthopedic paper. So I would like to see what schools they reference and it would give me better sense of it. But I honestly think that when students come into this law, they see good variety of opportunities. There are almost no host programs in this law that say they do not review applications of DO students. So we're moving to a new platform at the end of this year. And one of the outcomes is that we'll be in a better position to pull data and use it more effectively than we do now. And I think it will also help advisors and students because we will be able to pull data so they can do comparisons their school against the national, their school against this region, their school against this special. And then we can kind of dig to the bottom of some of these things. And if there are institutions that accept an application but have never placed a student, then if you know that on the front end, two things. Then I think you could tell the student that you don't think they should waste $15. But also I think that for the comm, for the advisors and the academic leadership, creating relationships, communicating, and also this is where I have talked to ACOM about and just the professional organizations themselves making it clear that this is not a lack of educational chops and just to be sure that it really is a level playing field in terms of the qualification of the students. There may be reasons they may not have the bandwidth to support more students in a rotation. And I get that because everybody's under stress. But I want to get to a place where there is confidence that it's a level playing field. And we can only do so. And Vizlo is a service. We're an application service at the end of the day. And so we can be open about it. I go to the ACOM meetings and talk to people and share data. And if someone comes our way from one of our home schools and concerned about a particular thing, we try to address their unique issue or question, getting more data in the water, I think will help. But it's an iterative process because you have a site that's taken students forever, but then they get a new DIO with a different set of priorities. And all of a sudden students who've been hyperlining there aren't going there anymore. There's always something. I've been listening very intently. I appreciate all the information that you've given. I think one of the interesting things for our listeners is the importance for DIOs and DIO students to participate in the American Osteopathic Association to ACOM because I think through those organizations, especially as a quote unquote supermajority in Vizlo, that's where the voice of the DIOs is going to come from. I think that relationship sounds like it's super important. So I would say if a student had an issue, obviously speaking to the AOA or speaking to ACOM would be a good place to start. But let's say, and you sound interested in things that don't seem to be fair, if there's a student listening, and they really saw something egregious, and that student with a perfect complex score, more research than anybody else around that's done everything, that's the Eagle Scout, and helping Granny's cross the street. And they're being told that they have to pay $500 for the rotation while somebody else from a different school has to pay $5, and they really just think this is not fair. Is there a place in AMC that they could reach out and speak to someone? Yes, so it could absolutely come straight to Vizlo. Visting students at AMC.org, and they can come forward that way, and we'll call them. We'll continue the conversation with them. The other thing that I didn't mention before, so Vistlo has an advisory committee, and we have DIOs on our committee. We have MD schools, and we have DO schools represented, and we are in the process of actually at expanding it to include students, one, DO and one, and DO students, who will be part of the advisory committee. And we also offer training sessions, we just finished the third in our series for students. We have advisor webinars for DO advisors, as well as MD advisors. When we did the first one, we did them separate me the first year, because we were trying to figure out what would make sense, assuming that the next year we would combine them. But there really were enough unique differences for the advisors that we've kept them as two separate webinars. People could go to either one, they're not allowed us. But we have a DO webinar, advisor webinar, and an MD one with a panel of advisors, MD advisors and DO advisor. And so we have other places where we're trying to, and we take questions and those, and they respond to where we can in real-time questions for the advisors, it's hard for the students, because we have so many students coming to the webinar. So they have to front-load the questions they have to be addressed by the panelists. But so we try to find other avenues for people to voice concerns or give opinion or ideas on how something could be done differently. And we really do want that, because it's good for our program to have all these students feel that they have gotten an equitable shot at a rotation. We're also actively increasing the number of host institutions that we have to get rid of some of this problem that feels like an equity when it's often a volume issue. We want to be sure that we've got a broader array. We also, we expanded our definition of who could be a vis-low host. they have to be an ACGME sponsor. or participating site. And our goal there is hopefully to get some of the smaller sites, more rural sites, community sites, on into the system where they were not before. And we think that's really going to be helpful, particularly to the DO students who might be looking for one of those experiences that's not necessarily at an academic health center. - That's great. All right. And thank you so much for spending time with us today. I really appreciate it. - I appreciate being invited. Thank you. - This concludes our episode of DO or DO NOT. 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