Evolution of colleges of osteopathic medicine: a discussion of the COCA's "substantive change" policies.

This article is the second in a series of discussions on the major activities of the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA), which is recognized by the US Secretary of Education as the only accrediting agency for predoctoral osteopathic medical education in the United States. Last year's article outlined the process that an educational institution undergoes to obtain accreditation status from the COCA and addressed the expansion of approved class sizes at the nation's colleges of osteopathic medicine. This year, the authors further describe US federal administrative regulations regarding "substantive changes" to institutional mission and programs. Class-size increases osteopathic medical schools, the most common form of substantive change requiring COCA approval, are once again detailed.