Osteopathic Manipulative Medicine Practice Patterns of Third-Year and Fourth-Year Osteopathic Medical Students: An Educational Research Project

Abstract

Context Colleges of osteopathic medicine (COMs) are required to provide hands-on osteopathic manipulative medicine (OMM) training during clerkship years, but this can be challenging given that students are in a variety of clinical sites and often train with allopathic physicians. Objective To identify student OMM practice patterns documented on required OMM practice logs detailing 10 OMM treatments each semester as part of a 3-semester third- and fourth-year clerkship curriculum and to determine whether these practice patterns varied by supervisor type (osteopathic vs allopathic) and semester. Methods The OMM practice logs from 2 class years were retrospectively reviewed for patient and supervisor characteristics and OMM treatment details. Semesters included 2 third-year semesters and an extended fourth-year semester. Results Between July 2015 and March 2018, 1018 OMM practice logs were submitted detailing 10,150 treatments involving 4655 clinical (45.9%) and 5474 volunteer (53.9%) patients. Logs contained up to 10 treatments per log; 26.0% included only clinical patients, 17.4% included only volunteer patients, and 56.6% included both. Significantly more clinical patients (1708 [36.7%]) were treated during the first semester of the third year than the other 2 semesters (P<.001). The supervisor's credentials were identified as an osteopathic physician for 6639 treatments (65.4%) and an allopathic physician for 768 (7.6%). No difference was found in the proportion of clinical to volunteer patients supervised by osteopathic or allopathic physicians (P=.34). Neuromusculoskeletal complaints accounted for 10,847 (90.7%) chief complaints, and nonneuromusculoskeletal complaints accounted for 1115 (9.3%). The most commonly treated body regions were the thoracic (6255 [61.4%]), cervical (4932 [48.4%]), and lumbar (4249 [41.7%]). More body regions were treated on clinical patients than on volunteer patients (mean, 2.7 vs 2.6, respectively; P=.04). Commonly used techniques were muscle energy (6570 [64.5%]); high-velocity, low-amplitude (4054 [39.8%]); soft tissue (3615 [35.5%]); balanced ligamentous tension/indirect techniques (2700 [26.5%]); and myofascial release (1944 [19.2%]). Conclusion More than 80% of students documented OMM practice on clinical patients for their required OMM practice logs. Both osteopathic and allopathic physicians provided supervision. Chief complaints and types of osteopathic manipulative treatment used were consistent with current clinical practice. Areas identified for enhanced didactic education included OMM for nonneuromusculoskeletal complaints.

Puberty: An approach to diagnosis and management with an osteopathic component

“…The neurologic model addresses facilitated spinal cord segments, viscero-somatic and somato-visceral reflex phenomena, Chapman points, and abnormal parasympathetic effects from cranial or sacral nerve entrapment syndromes. 13,14 At every level of the central nervous system along the spine, the neurophysiology of somatic dysfunction inseparably links viscera, soma and psyche through complex viscero-somatic, somato-visceral, somatopsychological and psychosomatic feedback interrelationships. It is hypothesized that one component of these complex relationships cannot become problematic without impacting the others, and thus, treatment of any one aspect of somatic dysfunction is not complete without consideration of the others.…”

“…[15][16][17] The respiratory-circulatory model addresses respiratory and fluid mechanics in the body, such as congestive changes, lymphatic flow, venous return and edema formation. 13,14 The biomechanical model addresses factors that alter posture, motion and gait. The goal of treatment is the restoration of free motion within the musculoskeletal system.…”

“…The goal of treatment is the restoration of free motion within the musculoskeletal system. 13,14 The metabolic-nutritional model addresses metabolism, dietary deficiencies and excesses, food allergies, and effects of toxins. 13,14 Lastly, there is the biopsychosocial model, which addresses the psychological and social components of a patient's health, such as stress, which is a well-known contributor to illness.…”

“…13,14 Lastly, there is the biopsychosocial model, which addresses the psychological and social components of a patient's health, such as stress, which is a well-known contributor to illness. 13,14…”