Doctors Of Osteopathic Medicine Research Articles

Clinician-Level Knowledge and Barriers to Hepatocellular Carcinoma Surveillance

Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is underused. Identifying potentially modifiable factors to address barriers in HCC surveillance is critical to improve patient outcomes. To evaluate clinician-level factors contributing to underuse of HCC surveillance in patients with cirrhosis. This survey study included primary care clinicians (PCCs) and gastroenterology and hepatology clinicians at 5 safety-net health systems in the US. Clinicians were surveyed from March 15 to September 15, 2023, to assess knowledge, attitudes, beliefs, perceived barriers, and COVID-19-related disruptions in HCC surveillance in patients with cirrhosis. Data were analyzed from October to November 2023. HCC surveillance knowledge was assessed with 6 questions querying the respondent's ability to correctly identify appropriate use of HCC surveillance. Attitudes, perceived barriers, and beliefs regarding HCC surveillance and perceived impact of the COVID-19 pandemic-related disruptions with HCC surveillance were assessed with a series of statements using a 4-point Likert scale and compared PCCs and gastroenterology and hepatology clinicians. Overall, 347 of 1362 clinicians responded to the survey (25.5% response rate), among whom 142 of 237 (59.9%) were PCCs, 48 of 237 (20.3%) gastroenterology and hepatology, 190 of 236 (80.5%) were doctors of medicine and doctors of osteopathic medicine, and 46 of 236 (19.5%) were advanced practice clinicians. On HCC knowledge assessment, 144 of 270 (53.3%) scored 5 or more of 6 questions correctly, 37 of 48 (77.1%) among gastroenterology and hepatology vs 65 of 142 (45.8%) among PCCs (P < .001). Those with higher HCC knowledge scores were less likely to report barriers to HCC surveillance. PCCs were more likely to report inadequate time to discuss HCC surveillance (37 of 139 [26.6%] vs 2 of 48 [4.2%]; P = .001), difficulty identifying patients with cirrhosis (82 of 141 [58.2%] vs 5 of 48 [10.4%]; P < .001), and were not up-to-date with HCC surveillance guidelines (87 of 139 [62.6%] vs 5 of 48 [10.4%]; P < .001) compared with gastroenterology and hepatology clinicians. While most acknowledged delays during the COVID-19 pandemic, 62 of 136 PCCs (45.6%) and 27 of 45 gastroenterology and hepatology clinicians (60.0%) reported that patients with cirrhosis could currently complete HCC surveillance without delays. In this survey study, important gaps in knowledge and perceived barriers to HCC surveillance were identified. Effective delivery of HCC education to PCCs and health system-level interventions must be pursued in parallel to address the complex barriers affecting suboptimal HCC surveillance in patients with cirrhosis.

DO seniors and IMGs have lower match probabilities than MD seniors after adjusting for specialty choice and USMLE Step 1 score.

It is unknown if US residency applicants of different educational backgrounds (US allopathic [MD], Doctor of Osteopathic Medicine [DO], and international medical graduates [IMG]) but comparable academic performance have similar match success. Our objective was to compare match probabilities between applicant types after adjusting for specialty choice and United States Medical Licensing Examination (USMLE) Step 1 scores. We performed a secondary analysis of published data in National Resident Matching Program (NRMP) reports from 2016, 2018, 2020, and 2022 for US MD seniors, DO seniors, and IMGs (US citizens and non-US citizens). We examined the 10 specialties with the most available spots in 2022. Average marginal effects from a multiple variable logistic regression model were utilized to estimate each non-MD senior applicant type's probability of matching into their preferred specialty compared to MD seniors adjusting for specialty choice, Step 1 score, and match year. Each non-MD applicant type had a lower adjusted percent difference in matching to their preferred specialty than MD seniors,-7.1 % (95 % confidence interval [CI],-11.3 to-2.9) for DO seniors,-45.6 % (-50.6 to-40.5) for US IMGs, and-56.6 % (-61.5 to-51.6) for non-US IMGs. Similarly, each non-MD applicant type had a lower adjusted percent difference in matching than MD seniors across almost all Step 1 score ranges, except for DO seniors with Step 1 scores <200 (-2.0 % [-9.5 to 5.5]). After adjusting for specialty choice, Step 1 score, and match year, non-US MD applicants had lower probabilities of matching into their preferred specialties than their US MD colleagues.

Examining differences in trends in the orthopedic surgery match for osteopathic and allopathic medical graduates after the transition to single accreditation.

The landscape of medical education in the United States has undergone significant changes, particularly with the rise of osteopathic medical students, constituting a substantial portion of medical school entrants. The merger of the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) in 2020 opened residency slots to allopathic graduates that were previously historically allocated to osteopathic (Doctor of Osteopathic Medicine [DO]) physicians. This has impacted various medical specialties, notably orthopedic surgery. Despite an increase in orthopedic surgery applicants, the match rates for DO candidates have faced challenges, raising concerns about the impact of this merger on the future of orthopedic training for DO students. This research aims to analyze the trends in orthopedic surgery match rates for DO vs MD applicants since the single accreditation merger, which began in 2015 with a 5-year transition period that was finalized by 2020. By examining factors such as application numbers, research output, standardized test scores, and program director preferences, the study seeks to identify disparities and challenges faced by DO applicants in securing orthopedic surgery residencies. This study utilized publicly available data from the National Residency Match Program (NRMP) 2018, 2020, and 2022 reports. Data encompassed applicant characteristics, including standardized test scores, research experiences, and match outcomes. The study also incorporated insights from NRMP program director surveys, focusing on interview and ranking practices. The analysis involved comparisons of application numbers, match rates, research productivity, and test scores between DO and MD applicants. Statistical analysis was employed to identify any statistically significant differences among the examined variables for the 3 years included in the study. The research revealed a consistent increase in orthopedic surgery applicants from both DO and MD backgrounds. However, MD applicants consistently had higher match rates compared to their DO counterparts, with the gap narrowing over the years. Notably, disparities persisted in research output, with MD applicants demonstrating a significant advantage in publications and presentations. Standardized test scores, although slightly higher for MD applicants, did not significantly impact the differences in match rates. MD applicants had statistically significantly higher numbers of applicants (P = .0010), number of publications (P = .0091), and number of research experiences (P = .0216) over the years examined. However, there was no statistically significant difference in the scores on Step 1 (P = .5038) or Step 2 (P = .4714) between MD and DO candidates. Despite progress in the acceptance and ranking of DO applicants by program directors, the study highlights enduring challenges in orthopedic surgery match rates between DO and MD candidates. The lack of research opportunities for DO students stands out as a crucial area for improvement, necessitating systemic changes within medical education. Addressing this disparity and ensuring equal access to research experiences could mitigate the gap in match rates, promoting a more equitable environment for all aspiring orthopedic surgeons, regardless of their medical background. Such efforts are vital to fostering inclusivity and enhancing opportunities for osteopathic medical students pursuing competitive specialties like orthopedic surgery.

Racial, Ethnic, and Sex Diversity Trends in Health Professions Programs From Applicants to Graduates

Diversity is an essential element of an effective health care system. A key to developing a diverse workforce is establishing a diverse student population in health professions programs. To examine the diversity of students in Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), and Doctor of Pharmacy (PharmD) programs with emphasis on the trends of underrepresented minoritized groups (American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander) and sex relative to the overall age-adjusted US population. This cross-sectional study used deidentified, self-reported data from 2003 to 2019 from the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, American Dental Education Association, American Dental Association, and American Association of Colleges of Pharmacy. Data analysis was performed from 2003 to 2004 and from 2018 to 2019. Data on the race, ethnicity, and sex of applicants, matriculants, and degrees conferred by health professions programs were collected and compared with the age-adjusted population in the US Census (aged 20-34 years) over time. The main outcomes were trends in the proportions of underrepresented minoritized groups and sex diversity among applicants, matriculants, and degrees conferred relative to the overall age-adjusted US population. Trends were measured using the representation quotient, which is defined as the ratio of the proportion of each subgroup to the total population of applicants, matriculants, or graduates relative to the proportion for that subgroup within the US Census population of similar age. Regression analysis was used to evaluate the trend over time. A total of 594 352 applicants were analyzed across the examined programs. From 2003 to 2019, the proportions of individuals from underrepresented groups increased for DDS and DMD (applicants, from 1003 of 8176 to 1962 of 11 298 [5.1%]; matriculants, from 510 of 4528 to 966 of 6163 [4.2%]; degrees awarded, from 484 of 4350 to 878 of 6340 [2.7%]), PharmD (applicants, from 9045 of 71 966 to 11 653 of 50 482 [9.0%]; matriculants, from 5979 of 42 627 to 10 129 to 62 504 [6.3%]; degrees awarded, from 922 of 7770 to 2190 of 14 800 [3.0%]), and DO (applicants, from 740 of 6814 to 3478 of 21 090 [5.4%]; degrees awarded, 199 of 2713 to 582 of 6703 [1.4%]) programs, but decreased for MD programs (applicants, from 6066 of 34 791 to 7889 of 52 777 [-2.3%]; matriculants, 2506 of 16 541 to 2952 of 21 622 [-2.4%]; degrees awarded, from 2167 of 15 829 to 2349 of 19 937 [-0.1%]). Compared with age-adjusted US Census data, all programs had more Asian students and fewer male, American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander students (representation quotient <1). In this cross-sectional study, most of the health professions in the study saw increases in underrepresented minority applicants, matriculants, and degrees conferred from 2003 to 2019; however, all programs were below the age-adjusted US Census data. The increased racial, ethnic, and sex diversity in the programs illustrates progress, but additional strategies are needed to achieve a more representative health care workforce.

Perspectives and Ideas to Advance Integrative Medicine and Healthcare: Proceedings of the 4th Annual Jaseng Academic Conference

The 4&lt;sup&gt;th&lt;/sup&gt; Annual Jaseng Academic conference (August 13, 2023) in Seoul, South Korea, was a pivotal event in the realm of integrative medicine. Cohosted by Jaseng Hospital of Korean Medicine and Michigan State University College of Osteopathic Medicine, over 500 professionals including Korean medicine doctors, medical doctors, doctors of osteopathic medicine, acupuncturists, researchers, and students gathered at the conference. The theme, “Perspectives on Integrative Medicine,” marked a departure from previous conference themes and embraced a multidisciplinary approach to healthcare. The event highlighted the importance of holistic patient care and cross-disciplinary collaboration within healthcare. It offered a comprehensive overview of the current state of integrative medicine approaches in manual medicine, evidence-based acupuncture treatment, and acupuncture research. The Annual Jaseng Academic conference continues to serve as a platform for healthcare professionals to exchange ideas and perspectives, and bridges the gap between diverse medical systems to promote improved patient outcome and wellbeing.

Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care

Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care. To describe PCP perspectives on their role in dementia diagnosis and care. In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis. Overarching themes associated with PCP roles in dementia care. Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints. In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.

Patient, Provider, and Practice Characteristics Predicting Use of Diagnostic Imaging in Primary Care: Cross-Sectional Data From the National Ambulatory Medical Care Survey

ObjectiveTo determine imaging utilization rates in outpatient primary care visits and factors influencing likelihood of imaging use. MethodsWe used 2013 to 2018 National Ambulatory Medical Care Survey cross-sectional data. All visits to primary care clinics during the study period were included in the sample. Descriptive statistics on visit characteristics including imaging utilization were calculated. Logistic regression analyses evaluated the influence of a variety of patient-, provider-, and practice-level variables on the odds of obtaining diagnostic imaging, further subdivided by modality (radiographs, CT, MRI, and ultrasound). The data’s survey weighting was accounted for to produce valid national-level estimates of imaging use for US office-based primary care visits. ResultsUsing survey weights, approximately 2.8 billion patient visits were included. Diagnostic imaging was ordered at 12.5% of visits with radiographs the most common (4.3%) and MRI the least common (0.8%). Imaging utilization was similar or greater among minority patients compared with White, non-Hispanic patients. Physician assistants used imaging at higher rates than physicians, in particular CT at 6.5% of visits compared with 0.7% for doctors of medicine and doctors of osteopathic medicine (odds ratio 5.67, 95% confidence interval 4.07-7.88). ConclusionDisparities in rates of imaging utilization for minorities seen in other health care settings were not present in this sample of primary care visits, supporting that access to primary care is a path to promote health equity. Higher rates of imaging utilization among advanced-level practitioners highlight an opportunity to evaluate imaging appropriateness and promote equitable, high-value imaging among all practitioners.

Survey of Dual Degree Oral and Maxillofacial Surgeons: A Review of their Decision to Pursue a Medical Degree as Part of their Oral and Maxillofacial Surgery Training

A survey was conducted of practicing oral and maxillofacial surgeons with double degrees, a Doctor of Dental Surgery or Doctor of Dental Medicine, (DDS/DMD) and Doctor of Medicine or Doctor of Osteopathic Medicine (MD/DO). These responding dual degree, oral and maxillofacial surgeons were all current members of the American College of Oral and Maxillofacial Surgeons (ACOMS).

Six practical tips to prepare for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA level 1

Sophisticated high-stakes licensure and specialty certification maintenance examinations are educational requirements in osteopathic medicine. Passing the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) USA Level 1 is one of the crucial milestones that osteopathic medical students (DO students) must achieve while starting clinical rotations and before applying to residency programs. While standardized examinations are often used for gatekeeping purposes, the broader goal of COMLEX USA Level 1 is to assess competent osteopathic physicians. This manuscript aims to assist DO students as well as osteopathic medical educators, learning specialists, medical advisors, and administrators in preparing a successful plan for the COMLEX USA Level 1. The tips within this manuscript align with the information taught in osteopathic medical school curricula, including osteopathic principles and practice (OPP), osteopathic manipulative treatment (OMT) and the content outline found within the National Board of Osteopathic Medical Examiners (NBOME) blueprint. The planning tip system is (1) Doctor of Osteopathic Medicine (DO) curriculum focus; (2) OPP/OMT content study; (3) Practice using clinical scenarios; (4) Review the NBOME blueprint; (5) Effective practice using question banks; and (6) Practice using full-length exams. Issues related to allocating DO students' time in preparation for the exam while providing useful resources to learn planning strategies and practice with board-style questions are discussed. Using the DO PREP tip system in this manuscript, DO students can develop more effective board preparation strategies to improve their success on COMLEX USA Level 1. This opinion-based article describes some but not all tips for osteopathic medical students to plan their COMLEX USA Level 1 board preparation.

Associations of clinical personnel characteristics and controlled substance prescribing practices.

Over 68,000 deaths were attributed to opioid-related overdose in 2020. Evaluative studies have shown that states that utilized Prescription Drug Monitoring Program (PDMP) systems have decreased opioid-related deaths. With the growing use of PDMPs and an ongoing opioid epidemic, determining the demographics of physicians at risk of overprescribing can elucidate prescribing practices and inform recommendations to change prescribing behaviors. This study aims to assess prescribing behaviors by physicians in 2021 based on four demographics utilizing the National Electronic Health Record System (NEHRS): physician's age, sex, specialty, and degree (MD or Doctor of Osteopathic Medicine [DO]). We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and PDMP use on opioid-prescribing behaviors. Differences between groups were measured via design-based chi-square tests. We constructed multivariable logistic regression models to assess the relationships, via adjusted odds ratios (AOR), between physician characteristics and alternate prescribing patterns. Compared to female physicians, male physicians were more likely to alter their original prescription to reduce morphine milligram equivalents (MMWs) prescribed for a patient (AOR: 1.60; CI: 1.06-2.39; p=0.02), to change to a nonopioid/nonpharmacologic option (AOR: 1.91; 95 % CI: 1.28-2.86; p=0.002), to prescribe naloxone (AOR=2.06; p=0.039), or to refer for additional treatment (AOR=2.07; CI: 1.36-3.16; p<0.001). Compared to younger physicians, those over the age of 50 were less likely to change their prescription to a nonopioid/nonpharmacologic option (AOR=0.63; CI: 0.44-0.90; p=0.01) or prescribe naloxone (AOR=0.56, CI: 0.33-0.92; p=0.02). Our results showed a statistically significant difference between specialty category and frequency of prescribing controlled substances. After checking the PDMP, male physicians were more likely to alter their original prescription to include harm-reduction strategies. Optimizing the use of PDMP systems may serve to improve prescribing among US physicians.

Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?

Osteopathic manipulative treatment (OMT) for the allopathic resident is an elective at the University of Minnesota North Memorial Residency that engages the resident in the basic tenants of osteopathic medicine, with exposure to the vast application of OMT with a curricular focus on low back pain management. Implementing an elective curriculum is a feasible way to improve attitudes in OMT for MDs in a Family Medicine residency, and residents can learn OMT in an elective rotation. This article aims to determine if MDs who complete an OMT for the allopathic physician elective rotation have higher comfort caring for patients with back pain compared to those who do not complete the elective. Further, this article is designed to evaluate if these MDs continue to incorporate OMT into the care they provide once they graduate from their residency programs. Graduates from the University of Minnesota North Memorial Family Medicine Residency (2013 to 2019) were sent an email invitation in August 2020 to complete a Qualtrics survey regarding their comfort with caring for patients with back pain, referral patterns for these patients, and the ongoing use of OMT in their practices. Doctor of Osteopathic Medicine (DO) graduates who responded to the survey were removed from the analysis. Among emailed graduates, 61.8% (42/68) completed the survey, with representation from each class ranging from 1 to 7years postresidency. The five DO graduates who responded were removed from the analysis. Among the remaining 37 respondents, 27 had completed the OMT for the allopathic rotation ("elective participants") during their residency training and 10 had not ("control"). Half (50.0%) of the control group provide OMT care compared to 66.7% of the elective participants, with a comfort score of 22.6 (standard deviation [SD] 32.7) in the control group vs. 34.0 (SD 21.0) in elective participants (on a 0-100 scale; 100 being completely comfortable; p=0.091). Among the control group, 40.0% regularly refer to a DO provider compared to 66.7% of those who completed the elective (p=0.257). The mean comfort score for performing a physical examination on patients presenting with back pain was 78.7 (SD 13.1) and 80.9 (SD 19.3) in the control and elective participants groups, respectively (p=0.198). Allopathic Family Medicine residents who completed an elective rotation in OMT have a slight increase in frequency of referring to DOs. They also have a meaningful increase in comfort performing OMT. With the limited number of DOs being a common barrier to OMT care, more widely implemented training in OMT for allopathic Family Medicine residents may be a reasonable intervention to improve the care of patients with back pain.

The Majority of Orthopaedic Surgery Residency Faculty in the United States are Allopathic Males

Introduction There is a paucity of information regarding the demographic characteristics of faculty at Accreditation Council for Graduate Medical Education (ACGME) orthopaedic surgery residency programs. The purpose of this study was to determine the demographics and education training of all current orthopaedic surgery residency program faculty members. We hypothesized that there would be a sex discrepancy among orthopaedic surgery faculty, and that there would be fewer DO (Doctor of Osteopathic Medicine) than MD (Medical Doctor) orthopaedic surgeons in academic medicine. Methods The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. The following information was collected from each program website: faculty sex, degree, academic role, administrative title, and subspecialty. Faculty roles, titles, and subspecialties were compared across type of institution, degree earned, and sex using Chi squared and Analysis of Variance (ANOVA). Results Of the 4,325 faculty members identified, 3,893 were male (90%) and 4,033 were MDs (93%). The most common subspecialty was sports medicine (789, 18%). While traditional ACGME programs still had more MD faculty (3,728, 97.5%) (p&lt;0.001), the majority of faculty at traditional American Osteopathic Association (AOA) programs were also MDs (305, 61%). There were more male DOs than male MDs (95.6% vs. 89.3%, p&lt;0.001). More DOs practiced general orthopaedics (14.8% vs. 4.1%), whereas more MDs practiced upper extremity and orthopaedic oncology (p&lt;0.001). More male faculty practiced adult reconstruction (616, 15.8%), trauma (489, 12.6%), spine (471, 12.1%), and sports medicine (719, 18.5%), whereas more female faculty practiced pediatrics (135, 31.3%), upper extremity (100, 23.1%), and oncology (33, 7.6%). More male faculty held titles as chair of orthopaedic surgery (145, 3.7%) and fellowship director (111, 2.9%) than females (5, 1.2% and 5, 1.2%). Males were also listed as assistant professor (1057, 27.2% vs 188, 43.5%), associate professor (636, 16.3% vs 86, 19.9%), and professor (618, 15.9% vs 41, 9.5%) more commonly than females. Conclusion The current faculty of orthopaedic surgery residency programs is heavily male dominated, holding higher academic roles and administrative titles than women. There is also a high prevalence of MDs with higher academic roles and administrative titles than DOs.

Plastic Surgery Roles in Wound Centers in the Northeastern United States.

Wound care is a substantial industry costing nearly $19 billion USD, and dedicated wound care centers play a critical role via a multidisciplinary team-based approach. At the same time, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, the extent of direct involvement of plastic surgeons in wound care centers is unclear. In this study, we sought to evaluate the presence of plastic surgeons and other specialties in wound care centers across all Northeastern states Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, Virginia, West Virginia, and Vermont. A comprehensive list of wound care clinics in northeastern United States was obtained from the Healogics website. For each site, information was gathered via website listings, including number of providers and the professional certification/specialization for each provider. Providers were those with qualifications including Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Physical Therapy (DPT), Doctor of Podiatric Medicine (DPM), Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner (CRNP), Physician Associate (PA), and Physical Therapist (PT). A total of 118 Healogics wound care clinics and 492 providers were located across 14 northeastern states including District of Columbia. After researching each location, updated in November 2022, plastic surgeons were only 3.7% (18 of 492) providers employed. Specialties such as internal medicine (90 of 492 [18%]), general surgery (76 of 492 [15%]), podiatry (68 of 292 [13.8% ]), and other midlevel providers such as nurse practitioners (35 of 492 [7.1%]) were more frequently employed over plastic surgery. All plastic surgeons were board certified the American Board of Plastic Surgery. Wound care requires collaboration between specialties, with significant repercussions on health care costs and patient outcomes. Plastic surgery provides unique surgical services for the healing of wounds, and the natural expectation would be that plastic surgery should be heavily involved at wound care centers. However, the data do not reflect significant involvement at an official level. Further studies will investigate causes and the societal, financial, and patient impacts of this lack of direct engagement. Although many plastic surgeons may not desire the majority of their practice to be wound care management, it stands to reason that some affiliation, at least for patient awareness and referral, may be warranted.

Allopathic and Osteopathic Residents Perform Similarly on the Orthopedic In-Training Examination (OITE)

There is a bias in the medical community that allopathic training is superior to osteopathic training, despite the lack of substantiation. The orthopedic in-training examination (OITE) is a yearly exam evaluating educational advancement and orthopedic surgery resident's scope of knowledge. The purpose of this study was to compare OITE scores between doctor of osteopathic medicine (DO) and medical doctor (MD) orthopedic surgery residents to determine whether any appreciable differences exist in the achievement levels between the 2 groups. The American Academy of Orthopedic Surgeons 2019 OITE technical report, which reports the scores from the 2019 OITE for MDs and DOs, was evaluated to determine OITE scores for MD and DO residents. The progression of scores obtained during various postgraduate years (PGY) for both groups was also analyzed. MD and DO scores throughout PGY 1-5 were compared with independent t-tests. PGY-1 DO residents outperformed MD residents on the OITE (145.8 vs 138.8, p < 0.001). The mean scores achieved by DO and MD residents during PGY-2 (153.2 vs 153.2), 3 (176.2 vs 175.2), and 4 (182.0 vs 183.7) did not differ (p = 0.997, 0.440, and 0.149, respectively). However, for PGY-5, the mean scores for MD residents (188.6) were higher than those of DO residents (183.5, p < 0.001). Both groups had trends of improvement seen throughout PGY 1 to 5 years, with both groups showing an increase in average PGY scores when compared to each preceding PGY. This study provides evidence that DO and MD orthopedic surgery residents perform similarly on the OITE within PGY 2 to 4, thus displaying equivalencies in orthopedic knowledge within the majority of PGYs. Program directors at allopathic and osteopathic orthopedic residency programs should take this into account when considering applicants for residency.

Healthcare Provider Experience in Diagnosing and Treating Cutaneous T-Cell Lymphoma.

Cutaneous T-cell lymphoma (CTCL) is a rare, heterogeneous group of non-Hodgkin lymphomas characterized by various clinical, molecular, and histopathologic features of the skin. Variants of CTCL share many clinical features with common inflammatory skin diseases such as atopic dermatitis and psoriasis, making accurate and early diagnosis challenging in clinical settings. Inappropriate treatment or a delay in diagnosis can lead to increased morbidity and mortality. Here, we report findings from an online survey that investigated dermatology community practice, knowledge, and education surrounding CTCL. An electronic survey of ten questions was developed and approved by physician experts in CTCL to assess experiences in diagnosing and treating CTCL among healthcare providers (HCPs). The survey was deployed to 10,600 US dermatology HCPs, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) and excluding HCPs associated with CTCL centers of excellence. Among 44 HCPs who responded and were eligible for inclusion, 82% had diagnosed between one and ten CTCL cases in the last 5years. Most respondents (91%) reported that they include CTCL in their differential diagnoses after patients do not respond to treatment of more common conditions. Patients with CTCL were frequently diagnosed with other inflammatory dermatoses-most commonly dermatitis and psoriasis-before a CTCL diagnosis, and many were treated with ineffective therapies for years. The most common length of time before a CTCL diagnosis was made was between 1 and 3years, though 16% of HCPs reported that patients were treated for other diseases or skin conditions for ≥ 5years. Two-thirds of HCPs agreed that further education surrounding CTCL is needed. Given the infrequency of CTCL and its similar presentation to other common dermatologic conditions, increased education of CTCL is needed in the dermatology community to improve patient outcomes.

564. Patient and Prescriber Characteristics Associated with Inappropriately Long Antibiotic Duration for Skin and Soft Tissue Infections

Abstract Background For common infections, previous studies suggest more seasoned prescribers more commonly use inappropriately long antibiotic durations however, there is a paucity of data regarding patient and provider factors associated with antibiotic prescription duration for pediatric skin and soft tissue (SSTI). Methods Retrospective analysis of patients age 0-21 years prescribed enteral antibiotics for cellulitis, abscess, impetigo, or other SSTI in one of 13 Nationwide Children’s Hospital’s primary care clinics in 2020. Encounters for paronychia, facial abscess, and immunocompromised patients were excluded. Based on national and local SSTI guidelines, antibiotic duration was considered inappropriately long if &amp;gt;5 days for cellulitis or drained abscess or &amp;gt;7 days for undrained abscess, impetigo, or other SSTI. Patient and prescriber factors were collected (Table 1) then univariate and multivariable analyses performed to determine which factors were associated with long antibiotic duration. Statistical analyses accounted for within prescriber correlation. Results From 1/1/2020 to 12/31/2020, we identified 1248 encounters for SSTI. After exclusions, 577 encounters with enteral prescriptions written by 89 prescribers were analyzed. Patient age ranged from 11 days to 20 years, 314 (54%) were female, and 497 (86%) had public insurance. The most common diagnosis was impetigo in 165 (29%). Similar rates of long duration were seen across patients of all ages and insurance categories. No difference in prescriber degree type was associated with antibiotic duration. Mean years since completion of medical training for prescribers of long vs guideline concordant prescriptions was 13 vs 10 in univariate analysis (p=.001). In the multivariable analysis, only diagnosis was associated with increased odds of long duration (Table 2). Compared to impetigo, the adjusted odds ratio for inappropriately long duration was 9.36 for cellulitis and 2.03 for abscess. Patient and Prescriber Characteristics for SSTI Antibiotic Prescriptions IQR, interquartile range, MD, Doctor of Medicine, DO, Doctor of Osteopathic Medicine, NP, Nurse Practitioner †Mann Whitney ‡Fisher’s exact *Chi-square ¶N=556 due to missing data for 21 encounters Multivariable Analysis of Patient and Provider Factors and Inappropriately Long Antibiotic Duration for SSTI Multivariable Analysis of Patient and Provider Factors and adjusted odds ratios for inappropriately long antibiotic duration. *Unknown insurance type for 24 encounters †Missing data for 21 encounters Conclusion In this study of antibiotic duration for SSTI, diagnosis of cellulitis was most strongly associated with inappropriately long duration- providing a focus for future stewardship efforts. Contrary to prior studies, no other patient or provider factor was associated with long duration in our pediatric primary care network. Disclosures Jack Stevens, PhD, Colgate Palmolive (although this abstract does not pertain to any products/services of that highly diversified company): Stocks/Bonds|Procter and Gamble (although this abstract does not pertain to any products/services of that highly diversiified company): Stocks/Bonds.

Assessment Briefs

Assessment Briefs

Understanding and preference toward DOs and OMT before and after an osteopathic principles and practice fellow lecture series.

One of the two major pathways to become a physician in the United States is the Doctor of Osteopathic Medicine (DO) degree. A major distinctive feature is often perceived as the addition of manual training in osteopathic manipulative treatment (OMT) in the DO education. However, the profession also has a distinct philosophy imbedded in the curriculum of all osteopathic medical schools. Many medical schools offer professional degrees with graduates who may choose to continue their education in medicine, such as the Master of Science in Biomedical Sciences (MSBS). At our institution, there is no formal exposure to the differences between osteopathic and allopathic medicine in the MSBS curriculum, and most of this understanding is gained through out-of-classroom conversations. During the SARS-CoV-2 pandemic, virtual learning prohibited the usual gathering and discourse that occurs when students are learning on campus. The objective of this study is to create a curriculum in the form of a seminar series to assist premedical students in making an informed choice about which profession is the best fit for their own education and to gain an appreciation for osteopathic medicine. This appreciation could also aid in the future collaboration of premedical students with osteopathic providers, recommendations to patients, and potentially their own medical care. Questionnaires were utilized to determine if our osteopathic seminar series was effective at changing the preferences and understanding of MSBS students. We also sought to determine the effectiveness of virtual vs. in-person delivery of our curriculum. A seminar series with pre-established objectives was developed and presented to MSBS students at an osteopathic institution during the Fall of 2020 and 2021. The 2020 seminar was delivered through a virtual conference platform, and the 2021 seminar was delivered in-person. An eight question pre-and postquestionnaire was given to participants to evaluate their preferences and understanding. Internal validity and differences between delivery formats were assessed. Both seminar series produced equally effective, significant changes in the preferences and perceptions of osteopathic medicine in both virtual and in-person delivery formats. Differences in pre-vs. post understanding across both seminar series were not consistently significant and were smaller than those observed in preferences and perceptions. Positive changes included an increased willingness to see a DO and to recommend a loved one see a DO as their personal physician. Preference changes between the in-person vs. virtual delivery platforms did not show significant differences; however, understanding did show some inconsistent differences. This study demonstrates the utility of a virtual or in-person seminar to improve the preferences and perceptions of the osteopathic profession in MSBS students. The seminar series was successful in its goal of offering formal exposure to the osteopathic profession. The improved preferences and perceptions will have potential substantial benefits to the field of osteopathic medicine in the future. Further research is warranted to determine the most effective way to increase understanding of the osteopathic profession.

Exploring New Patient Understanding of Osteopathic Manipulative Medicine using a Cross-Sectional Survey and Mixed Methods Approach.

INTRODUCTIONOsteopathic manipulative medicine (OMM), a patient-focused approach to medical treatment utilized by doctors of osteopathic medicine (DO), continues to be an under-utilized resource in treating musculoskeletal disorders. Lack of familiarity by both referring physicians and patients of OMM can impact patient-physician communication and impede patient-centered care approaches. This 2020-2021 study was conducted to investigate new patient understanding of OMM within the Michigan State University OMM Clinic.METHODSA set of 18 survey questions developed by the authors within their MSU OMM clinic were utilized for the study. The main purpose of the questions was to generally ascertain new patient’s understanding of OMM, its role in patient care, who can place clinic referrals and the services an OMM clinic provides. Respondents were new adult patients at the MSU OMM clinic.RESULTSThe convenience study sample of 83 respondents was primarily female, 60 (72.3%). Few respondents were familiar with OMM, as only eight (9.64%) reported prior experience with OMM. Of the 83 patients in this study, 69 (80.7%) reported back pain. When examining referral patterns, there were low numbers of referrals from non-PCP providers, especially from advanced practice providers (APP), including physician assistants (n = three, 3.66%) and nurse practitioners (n = eight, 7.96%). Most surveyed patients 61 (73.5%) had been referred by their primary care providers.CONCLUSIONSResults indicate that communication directed to non-DO physicians, advanced practice providers and patients about OMM services may be helpful to provide noninvasive symptomatic treatment options for musculoskeletal conditions. Further larger-scale studies examining both non-DO provider and new patient perceptions concerning OMM are clearly warranted.

The Doctor of Osteopathic Medicine: The Affiliation to Orthopaedic Surgery.

The Doctor of Osteopathic Medicine: The Affiliation to Orthopaedic Surgery.