Lake Erie College Research Articles

The Early Impact of Deciding to Take the United States Medical Licensing Examination Step 1 for Osteopathic Medical Students in the Pass/Fail Era.

The United States Medical Licensing Examination (USMLE) Step 1 recently shifted from a three-digit scoring format to a pass/fail scoring rubric. Lake Erie College of Osteopathic Medicine (LECOM) is among a number of osteopathic medical schools that traditionally included passing Step 1 as a graduation requirement. However, LECOM removed this requirement following the change in scoring format. National Board of Medical Examiners (NBME) subject examinations have a significant impact on the clerkship grades of third-year medical students. Therefore, our pilot study compared NBME subject examination scores among third-year LECOM medical students that did and did not take and pass Step 1. We anticipate that both high pre-clinical grade point average (GPA) and having passed Step 1 will be associated with higher subject exam scores, but passing Step 1 will have a relationship with higher subject exam scores that is independent of pre-clinical GPA. Using voluntary response sampling, 201 osteopathic medical students from LECOM completed an online survey through Google Forms regarding their pre-clinical GPA, subject exam scores, whether they took and passed USMLE Step 1, and their study resources used throughout clerkships. Results: There was a positive correlation (p < 0.05) found between pre-clinical GPA and exam scores across all subjects among students that took Step 1. There was no relationship between pre-clinical GPA andexam scores across all subjects among students that did not take Step 1 (p> 0.05). Students that took Step 1 had a higher pre-clinical GPA than those that did not. Students that took and passed Step 1 scored higher on subject exams. Fifty-nine percent of respondents indicated they would have studied more for Step 1 if these exams were scored on the three-digit format, while zero respondents indicated they would have studied less. Although higher pre-clinical GPA and taking Step 1 were associated with higher scores on subject exams, taking Step 1 appears to have an independent influence on subject exams because there was no relationship found between pre-clinical GPA and subject exam scores among students that did not take Step 1. Therefore, there may be features related to preparing for this exam that better equip osteopathic medical students to perform well on subject exams.

Recipe for Success: Correlates of Student Performance in Human Gross Anatomy

Anatomy is the first subject incoming medical students must conquer at the Lake Erie College of Osteopathic Medicine (LECOM). As anatomy is so fundamental to clinical medicine, we sought to identify the characteristics and behaviors that most strongly influence success in the Human Gross Anatomy course. First‐year medical students at the Erie, Seton Hill, and Elmira campuses were surveyed about personal wellbeing, academic habits, test taking strategies, and perceived stress. Responses were compared to final course grades via principal component analysis (PCA) and Spearman’s rank correlation test. PCA indicates that 49.66% of the variance in final grades was due to six principal components (PC). PC1 (15.56% of variance) was associated with poor study techniques, such as cramming and lack of self‐assessment, and academic confidence. PC2 (10.20% of variance) was related to student anxiety and help seeking behavior. PC3 (7.21% of variance) emphasized student interaction with lecture material. PC4 (6.14% of variance) and PC5 (5.70% of variance) accounted for group studying and preparedness for lecture, respectively. PC6 (4.86% of variance) was associated with student stress. Spearman’s rank correlation test further identified key characteristics influencing final course grade. Academic confidence (r(133) = .41, p &lt; .0001) and life satisfaction (r(133) = .30, p = .0004) were positively correlated with final course grade whereas negative correlations were found with intra‐test anxiety (r(134) = ‐0.37, p &lt; .0001), cramming (r(135) = ‐.31, p = .0002), and fear of failure (r(135) = ‐.39, p &lt; .0001). These findings suggest that academic counseling for new medical students should focus on establishing effective study techniques early in the semester, properly engaging and preparing for lecture sessions, and encouraging students to utilize mental health resources at LECOM.

The Effect of Clinical Anatomy Integration on Medical Student Academic Performance and Learning Approach

IntroductionIntegration of clinical procedures have been shown to help motivate medical students to recognize the utility and importance of basic science concepts and develop independent problem‐solving skills. To date, no studies have quantified the effects clinical procedure demonstrations have on first‐year medical anatomy course performance and retention. The purpose of this study was to facilitate three anatomy learning sessions each with the integration of a clinical procedure. We hypothesized students who observe a clinical procedure demonstration would exhibit better academic performance, retention, and a deeper learning approach. Additionally, we hypothesized that students who perceive the demonstrator to have more clinical experience would exhibit the highest academic performance and deepest learning approach.MethodsFirst‐year medical students at Lake Erie College of Osteopathic Medicine were recruited (n=63) via email. Over three 30‐minute sessions, participants were exposed to the anatomy of the thigh (n= 45), thorax (n= 41), and neck (n= 42). Sessions were structurally similar and contained information regarding surface anatomy, muscles, neurovasculature, and clinical correlates. Each session included discussion of a clinical procedure: Femoral nerve block, thoracentesis, and fine needle aspiration of the thyroid gland, respectively. Participants were semi‐randomized into three groups based on learning approach, and each received clinical information using a different method: Physician demonstration, PhD student demonstration, or PowerPoint slide with no demonstration. Learning was assessed using a 15‐question multiple choice pre‐, post‐, and retention test. Learning approach was assessed using the Approach and Study Skills Inventory. Student opinions were collected using two open‐response questions. Anatomy course exams were also analyzed to compare differences between study participants and non‐participants.ResultsAll three study groups significantly increased knowledge from pre‐ to post‐test; no difference in post‐test scores across groups was detected. Participants displayed no differences in learning approach. Students who experienced a Physician demonstration during the Thorax Session displayed significantly higher retention of material compared to students without a physical demonstration. Thematic analysis of responses revealed participants found integration of clinical demonstrations to be helpful in reinforcing anatomy knowledge. Analysis of participant performance in the Anatomy course exams revealed those in the Physician and PhD student demonstration groups performed significantly higher on session‐related items than participants in the “no demonstration” group and non‐participants.ConclusionPreliminary results suggest clinical procedure demonstrations in anatomy effectively improve academic performance. Knowledge retention most dramatically improves when physical demonstrations are provided, regardless of the demonstrator’s clinical experience level. Lastly, the integration of clinical procedure demonstrations has no measurable relationship to student learning approach.

Fifth Annual Guthrie Research Day

The fifth annual Guthrie Research Day was held April 22, 2022, on the Robert Packer Hospital campus in Sayre, PA. The event showcases research and quality improvement projects from fellows and residents of Guthrie as well as medical students from Geisinger Commonwealth School of Medicine (GCSOM) and Lake Erie College of Osteopathic Medicine (LECOM). This year’s Research Day featured 13 oral presentations and 53 posters.

Judge rules against expelled student

Case name: Doe v. Lake Erie College, et al., No. 1: 19CV02619 (N.D. Ohio 01/27/21).

Judge rules against expelled student

Case name: Doe v. Lake Erie College, et al., No. 1:19CV02619 (N.D. Ohio 01/27/21).

Predicting Osteopathic Medical Student Performance on the United States Medical Licensing Examination Step 2 Clinical Knowledge From Results of the Comprehensive Osteopathic Medical Licensing Examination Level 2-Cognitive Evaluation.

BackgroundTo improve their standing in residency selection, many osteopathic medical students choose to take the United States Medical Licensing Examination (USMLE). Although scores on USMLE Step 1 and Level 1 of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) are known to be highly correlated, scarce data exist on the association between COMLEX-USA Level 2-Cognitive Evaluation (CE) and USMLE Step 2 Clinical Knowledge (CK) scores. In this study, we aimed to determine the association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores and derive an equation to predict performance on USMLE Step 2 CK for applicants who have only taken COMLEX-USA.MethodologyWe reviewed COMLEX-USA Level 2-CE and USMLE Step 2 CK scores for all students at the Lake Erie College of Osteopathic Medicine from May 2020 to April 2021. Linear regression was used to evaluate the relationship between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores.ResultsA total of 340 students took both COMLEX-USA Level 2-CE and USMLE Step 2 CK. There was a linear association between COMLEX-USA Level 2-CE and USMLE Step 2 CK scores such that every one-point increase in COMLEX-USA was associated with a 0.13-point increase in USMLE Step 2 CK score (standard error = 9.1; model R2 = 0.64).ConclusionsStudents or programs interested in predicting performance on USMLE Step 2 CK from performance on COMLEX-USA Level 2-CE can do so using the following equation: USMLE Step 2 CK = 0.13(COMLEX-USA Level 2-CE) + 163.5.

Beyond the G.P.A.: Focusing on Student Well‐Being During First‐Year Professional Education

Background Nearly one-third of medical students experience significantly higher anxiety levels as compared to their non-medical counterparts. Elevated anxiety levels increase the likelihood of developing depression and result in loss of personal relationships and a lower quality of life. Specifically, in medical students, increased anxiety is correlated with decreased empathy, professionalism, and may negatively impact academic performance. Peer-support programs benefit not only student participants but also peer volunteers. Programs like these provide psychosocial support that students are otherwise without, as well as encourage professional development. We hypothesized that peer-support participants will experience decreased overall and exam-related anxiety, feel more prepared, and perform higher academically after participating in the program. Design A peer-support program was designed and implemented at the Lake Erie College of Osteopathic Medicine in Erie, PA during the Fall of 2020. Students participants were recruited from the Master's in Medical Science (M.M.S.) program to participate. First-year medical students (MS1s) who matriculated from the M.M.S. program were recruited to lead the peer support sessions. Three sessions were held throughout Fall 2020 and covered topics including goal setting, time management, and burnout and coping. The final session is scheduled for January 2021 and will cover self-reflection. M.M.S. participants were randomly assigned to one of 11 groups led by an MS1 volunteer and given 30 minutes to discuss the session topic. M.M.S. students were surveyed at five different time points by the State-Trait Anxiety Inventory (STAI) and the General Anxiety Disorder-7 (GAD-7) questionnaires. MS1 students were surveyed at two time points, using the STAI. Participant opinion was also collected using Likert scale and open-ended questions. Results A total of 67 M.M.S. students attended the first session, with 11 MS1 students volunteering to lead the sessions. Initial STAI results are consistent with that of an average college student and significantly higher than their age group, as expected. Similarly, GAD-7 results showed an expected increase in exam-related anxiety throughout the semester, specifically experiencing more restlessness and irritability. Written responses suggest students appreciated the opportunity to ask MS1 volunteers questions, discuss relevant topics, and form relationships otherwise difficult to due to curricula being entirely online. Full results are pending the final session. Conclusion Students transitioning to professional-level education find peer-support a helpful tool to improve their preparedness. Full conclusions will be drawn upon completion of the final session and analysis of the post-test STAI results.

Predicting Osteopathic Medical Students' Performance on the United States Medical Licensing Examination From Results of the Comprehensive Osteopathic Medical Licensing Examination

IntroductionThe reliance on the United States Medical Licensing Examination (USMLE) Step 1 scores in residency selection creates problems for osteopathic medical students and the programs that review their applications. Although many osteopathic students take the USMLE to improve their standing for residency selection, students who score poorly may harm their candidacy. Simultaneously, programs unfamiliar with the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) may struggle to evaluate applicants who have not taken USMLE.ObjectiveTo determine the association between COMLEX-USA Level 1 and USMLE Step 1 scores and derive an equation that could be used to predict USMLE performance or approximate USMLE scores for applicants who have only taken COMLEX-USA.MethodsWe reviewed COMLEX-USA Level 1 and USMLE Step 1 scores for all students at the Lake Erie College of Osteopathic Medicine (LECOM), Bradenton campus, from January 2012 until December 2016. Linear regression was used to evaluate the relationship between COMLEX-USA Level 1 and USMLE Step 1 scores.ResultsOverall, 2097 students took both examinations during the study period. Every one-point increase in COMLEX-USA was associated with a 0.15 point increase in USMLE Step 1 score (standard error 11.5; model R2 0.56). On average, students scored 30 percentile points lower on USMLE Step 1 than on COMLEX-USA, and 24% of students scoring <500 on COMLEX-USA Level 1 failed USMLE Step 1.ConclusionsStudents or programs interested in predicting performance on USMLE Step 1 from performance on COMLEX-USA Level 1 can do so with the following equation: USMLE Step 1 = 0.15 (COMLEX-USA Level 1) + 138.7.

Impact of community paramedicine program on APPE student skillsets

Background and purposeThis article describes the clinical and educational impact resulting from interprofessional (IP) collaboration between fourth-year advanced pharmacy practice experience (APPE) pharmacy students and community paramedics within a community paramedicine (CP) program. Educational activity and settingThe Manatee County, Florida CP program partnered with Lake Erie College of Osteopathic Medicine School of Pharmacy faculty to reduce 911 calls, emergency room visits, and hospital readmissions for underserved populations. The CP-pharmacist partnership optimized medication therapy, chronic disease management, and access to care through scheduled in-home visits with an IP team. With guidance from the pharmacist, APPE student responsibilities included comprehensive medication review, medication action plan development, communication with providers, and patient counseling to resolve medication issues. FindingsSurvey data demonstrated this approach to APPEs increased student confidence in optimizing care plans (100%), assessing vitals (76%), identifying medical emergencies (84%), and communicating with patients (96%). Student incorporation into a CP program augmented the pharmacist's ability to successfully correct medication use errors and improve nonadherence through patient counseling. Medication interventions were successful in 693 of 799 scenarios, for a success rate of 86.7%. SummaryResults from this analysis reinforced prior research indicating pharmacy students can be successfully incorporated into a CP program, with resulting improvement in student clinical skills, communication strategies, and successful medication intervention outcomes.

Peer Instruction Fosters Student Engagement During Anatomy Large Group Active Learning Sessions

At Lake Erie College of Osteopathic Medicine (LECOM), each unit of the Medical Gross Anatomy course is reviewed through a large group active learning session that has been traditionally termed a “forum”. Medical students are given a list of 10–15 open‐ended questions covering clinically relevant anatomy for each regional area of anatomy prior to each session. During this two hour session, students are randomly selected to answer the open‐ended questions in front of their peers. Student surveys highly rate these sessions and students traditionally have requested more of these sessions throughout the 13 week course. However, a downfall of the forum is that only 10–15 students get to participate in each of these sessions while the other students passively listen to their peers. In order to involve more students in the session, Peer Instruction was utilized during the Pelvis and Perineum forum. Peer Instruction, as introduced by Eric Mazur in 1991, has been used in large undergraduate introductory courses to encourage student engagement and learning. Our modified Peer Instruction activity asked learners to independently answer multiple choice questions through the online classroom response system DirectPoll, which covered similar topics as asked in the open‐ended questions given out prior to the session. If student performance was below 80%, the class would be asked to converse with their classmates and then answer the question again. Regardless of class performance, a student was randomly selected to answer the question and provide a rationale for how they answered that question. Further, the student was then asked follow up questions that covered the material relevant to the question. Our study hypothesized that students that participated in the Peer Instruction Forum will perform better on the Pelvis and Perineum anatomy exam when compared to performance in the previous year. Overall, the average performance on the pelvis and perineum exam between 2018 and 2019 was unchanged. However, student survey data suggests the students were more engaged during the sessions and found the Peer Instruction activity helped solidify concepts. In conclusion, Peer Instruction was well received by our students and we hope to expand its use throughout the anatomy curriculum.

The Impact of Spatial Ability on Learning with a 3D Stereoscopic Model of the Mediastinum

Three‐dimensional (3D) stereoscopic anatomy models have shown success in demonstrating complex spatial anatomical relationships. However, there is conflicting evidence as to whether or not such models are beneficial for students with low spatial visualization ability (Vz). A previous study suggests that students with low Vz may be hindered by the complex spatial cues provided by a 3D stereoscopic resource compared to students with high Vz. This study aimed to investigate the educational effectiveness of a digital 3D stereoscopic model of the human mediastinum, compared to a cadaveric specimen, for novice students in a biomedical masters‐level graduate program. In addition, this study aimed to further examine the effect of Vz on learning with a 3D stereoscopic anatomy model. We hypothesized that participants learning with the 3D stereoscopic model of the mediastinum would improve performance overall on an anatomy knowledge post‐test more than participants learning with a cadaveric specimen, and that high Vz participants would benefit more from the use of the 3D stereoscopic model compared to their low Vz counterparts. In addition, we hypothesized that participants learning with the 3D model of the mediastinum would rate the model more favorably on a post‐session survey compared to those learning with a cadaveric specimen. Participants were recruited from the Master of Medical Science (MMS) program at Lake Erie College of Osteopathic Medicine (LECOM), prior to the start of their Gross Anatomy course.Participants completed a demographic survey and Mental Rotations Test (MRT) pretest to determine their level of Vz. Participants were then assigned to either a 3D Group or a Cadaver Group, normalized for MRT score and sex. Each group was invited to a brief learning session using either a 3D stereoscopic model or cadaveric specimen of the mediastinum respectively. The 3D model was developed at LECOM using Amira® software, and projected stereoscopically using a dual projection system. All participants completed a pre‐ and post‐test in each session, consisting of spatially‐oriented multiple choice questions pertaining to anatomy of the mediastinum. Student satisfaction with either resource was also examined using a qualitative survey. Data collection and analysis will be completed in Spring 2020. Results of this study should be considered when developing and implementing anatomical resources for health professional education, to maximize learning for students of varying Vz.Support or Funding InformationFunded by the Lake Erie Consortium for Osteopathic Medical Training and the LECOM Internal Seed Grant

Rabies.

At the time this article was written, David Gelbart was a medical student at Lake Erie College of Osteopathic Medicine and a PA in emergency medicine. He is now a resident physician in the University of Kentucky emergency medicine residency program. The author has disclosed no potential conflicts of interest, financial or otherwise. Dawn Colomb-Lippa, MHS, PA-C, department editor

Foreign body aspiration.

At the time this article was written, Matthew D. Crane was a medical student at Lake Erie College of Osteopathic Medicine in Erie, Pa. He is now an anesthesiology resident at University of Rochester (N.Y.) Medical Center. The author has disclosed no potential conflicts of interest, financial or otherwise. Dawn Colomb-Lippa, MHS, PA-C, department editor

Seeing in Stereo: Exploring the Relationship between 3D Anatomical Resources and Spatial Ability

Three‐dimensional (3D) digital anatomical models have been shown to promote student engagement and satisfaction, while demonstrating complex spatial anatomical relationships. However, there is limited research to suggest that 3D digital anatomy models are more effective in improving spatial anatomy performance over traditional resources, particularly for students with varying spatial visualization ability (Vz). The present study aims to investigate the educational effectiveness of a digital 3D stereoscopic anatomy model compared to a 2D visualization and cadaveric specimen of the human pelvis. This study also aims to examine the relationship between Vz and learning from a 3D stereoscopic anatomy model of the human pelvis. We hypothesized that participants learning from the 3D stereoscopic model of the pelvis would improve performance overall on an anatomy knowledge post‐test more than participants learning from a 2D visualization or cadaveric specimen, and that low Vz participants would benefit more from the use of the 3D stereoscopic model compared to their high Vz counterparts.Participants were recruited from the Post‐Baccalaureate, Medical Year 1, and Medical Year 2 classes at Lake Erie College of Osteopathic Medicine (n=64). All participants completed a demographic survey and Mental Rotations Test (MRT) pretest to determine initial Vz. Participants were then sorted into three groups, normalized for MRT score, sex, and education level. Each group was invited to a brief learning session using a 3D stereoscopic model (n=21), 2D visualization (n=21), or cadaveric specimen of the pelvis (n=22) respectively. The 3D model, developed using Amira® software, was projected stereoscopically using a dual projection system. All participants completed a pre‐ and post‐test in each session, consisting of 10 spatially‐oriented multiple choice questions pertaining to pelvis anatomy. Results show no significant difference in improvement from pre‐test to post‐test between the three groups. A linear regression analysis showed no significant correlations between MRT score and anatomy test improvement; however, Post‐Baccalaureate (novice) participants with high Vz tended to improve more after learning with the 3D model than Post‐Baccalaureate participants with low Vz. Participants with high Vz, irrespective of education level, improved more on a spatial anatomy test after learning with the 3D model compared to either of the other resources. Contrary to current literature, participants with low Vz appeared to benefit most from the 2D visualizations. Results of this study can be used to inform resource selection and curriculum design for health professional students, with special attention to the impact of Vz on learning.Support or Funding InformationFunded by a LECOMT Research Support Grant.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Characterization of Three Foodborne Bacteria using Hyperspectral Microscopy

The field of hyperspectral imaging (HSI) has progressed exponentially since its inception in 1972 and is applied to various research fields including agriculture, food quality and archeology. The purpose of the technology is to acquire images containing spatial and spectral data that can be used for detection and/or identification purposes. Our goal was to use HSI technology to differentiate between 3 different bacteria that are common foodborne organisms in 3 phases of growth: log, late log and stationary.For our study we used the Cytoviva hyperspectral imaging system to extract the individual hyperspectral profiles produced by Salmonella enterica serotype Typhimurium, Escherichia coli O157: H7, and Listeria monocytogenes. All organisms were cultured in Brain Heart Infusion (BHI) broth, pelleted at 10,000× rpm and washed in 1× PBS buffer prior to imaging. 0.8 μL of each sample was transferred to a poly‐l‐lysine coated slide for immobilization and topped with a glass cover slip to extract the profiles of each organism. Our protocol was enhanced to extract spectral profiles of intact live microorganisms.Data is collected by the pushbroom approach through which an image is made that has both hyperspectral and spatial data by moving the sample pixel line by pixel line to produce distinct profiles for each specimen. The use of a patented enhanced darkfield condenser in conjunction with high resolution optical and hyperspectral imaging creates sharp spectral profiles based upon the unique surface chemistries of each organism. The hyperspectral profiles of the cells were composed from each image through the ENVI software.The unique spectral graphs produced by each organism appear to align with increased growth, especially at the 24 hour time point. However, these organisms do exhibit different hyperspectral patterns at each time point and they are not the same for any organism. Hyperspectral imaging has the potential to be used as a rapid diagnostic tool that does not damage the sample while reporting data that can be shared and analyzed by multiple people at the same time.Support or Funding InformationThis work was supported in part by a grant from the Lake Erie College of Osteopathic Medicine, USA, Department of Biological Sciences and Department of Anatomy, Physiology and Pharmacology at Auburn University.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Assessment of Pulmonary Function After Osteopathic Manipulative Treatment vs Standard Pulmonary Rehabilitation in a Healthy Population.

Standard pulmonary rehabilitation (SPR) does not use osteopathic manipulative treatment (OMT), but OMT has potential to improve lung function and patient perception of breathing. To analyze the immediate effects of OMT and SPR techniques on pulmonary function using spirometry and subjective ratings in young, healthy persons. Participants were healthy students recruited from the Lake Erie College of Osteopathic Medicine-Bradenton and were randomly assigned to either the OMT or SPR group. During the first 4 weeks, each participant in the OMT group received 1 OMT technique (rib raising, doming of the diaphragm, thoracic lymphatic pump, and thoracic high velocity, low amplitude), and each participant in the SPR group received 1 SPR treatment (tapotement, pursed lip breathing, saline nebulizer, and rest) per week. Treatments were then ranked based on positive change in pulmonary function as measured by forced expiratory volume in the first second of expiration (FEV1) and forced vital capacity (FVC). During the fifth week, the OMT group received the 2 highest-ranked OMT techniques, and the SPR group received the 2 highest-ranked SPR treatments. During the sixth week, the OMT group received the highest-ranked OMT and SPR treatment, while the SPR group received the same treatment combination but in the reverse order. Pulmonary function, as measured through FEV1, FVC, and FEV1/FVC, were collected before and after each treatment or treatment combination. Participants subjectively rated change in breathing after each treatment. A total of 53 students participated in the study, with 28 in the OMT group and 25 in the SPR group. In the OMT group, rib raising yielded the highest positive mean (SD) change of 0.001 (0.136) L in FEV1 and 0.052 (0.183) L in FVC, followed by lymphatic pump, with a change of 0.080 (0.169) L in FEV1 and -0.031 (0.229) L in FVC. In the SPR group, pursed lip breathing yielded the highest positive mean (SD) change of 0.101 (0.278) L in FEV1 and 0.031 (0.179) L in FVC, followed by tapotement, with a change of 0.045 (0.229) L in FEV1 and 0.061 (0.239) L in FVC. Saline treatment significantly decreased lung function. All other treatments did not result in any significant changes in lung function. Overall, SPR subjective ratings were significantly lower than ratings for both OMT and combination (OMT+SPR) treatments. Saline significantly reduced lung function and had low subjective posttreatment ratings in young healthy adults. Additionally, OMT and combination OMT and SPR significantly improved subjective breathing more than SPR alone. Future applications of this study include evaluating OMT and SPR effects on lung function in patients with various pulmonary conditions.

First-Year Experience Implementing an Adaptive Learning Platform for First- and Second-Year Medical Students at the Lake Erie College of Osteopathic Medicine.

The Lake Erie College of Osteopathic Medicine (LECOM) is a large, diverse medical school spread across 3 campuses, which makes it challenging to deliver comparable learning experiences to all students. Osmosis is a Web and mobile application that can integrate with a variety of existing curricula and, through its content creation and sharing features, can foster student cohesion in an online environment. To analyze the first year of use for the Osmosis platform among LECOM students at each campus and to identify barriers to this use. Medical education at LECOM is delivered across 3 campus locations using 3 main pathways: the lecture-discussion, problem-based learning, and directed-study pathways. Beginning in the 2016-2017 academic year, all LECOM first-year medical students could use the Osmosis platform free of charge; second-year students were informed about the platform but were required to pay for a subscription. For all students, engagement metrics were tracked within the platform, and periodic student surveys and informal student feedback supplemented these metrics. Of 1135 LECOM students, 567 (50%) signed up for an account, including 416 (73%) of 573 first-year and 151 (27%) of 562 second-year students. In aggregate, students created 17,901 items and answered 123,050 practice questions and flashcards. Student use of the platform varied considerably, with the highest use at the Erie campus, where the platform was championed by faculty, and among a portion of second-year students preparing for board examinations. Some students were "superusers"; 2 students completed more than 20,000 items, and 5 created more than 1000 items each. The greatest barriers to use of the platform were preferences for previous study methods and lack of time to learn new study habits. Although the use of the platform across LECOM campuses was uneven, it was greatest when there was overt support by faculty and when students were already motivated to use the platform. The lessons learned during the first year of the program will be used to improve use of the platform. The authors offer their insights into this new technology.

Ten-Year Comparison of a Traditional Lecture Curriculum with an Independent Study Curriculum on COMLEX Performance

The Lake Erie College of Osteopathic Medicine offers several curricular pathways to address different adult learning styles, including the traditional Lecture Discussion Pathway (LDP) and the Directed Study Pathway (DSP), which are designed for learners who learn best through reading. We compared pre-matriculation outcomes, preclinical grades, and COMLEX level 1 scores between LDP and DSP students over a 10-year period. DSP students had significantly higher verbal MCAT scores and MS2 GPAs; however, all other variables examined were not significantly different. Thus, students can be equally and successfully educated in distinct learning pathways suited best to their style of learning.

Assessing Musculoskeletal Competency in Osteopathic Medical Students

Musculoskeletal related conditions are the second most common reason patients seek medical attention in the primary care setting and the second most costly cause of morbidity behind cardiovascular disease. Furthermore, due to the changes that occur in the musculoskeletal system during the aging process, the frequency of musculoskeletal related office visits will increase as the number of elderly patients increases in the U.S. Therefore, it is very important that physicians are thoroughly educated, competent, and confident to diagnose and treat musculoskeletal conditions. However, previous research examining a cohort of graduating osteopathic medical students and a cohort of allopathic medical residents has demonstrated that musculoskeletal knowledge retention, based on a standardized competency exam, is less than optimal. Our study evaluated first‐year osteopathic medical students before and after they had taken a Musculoskeletal System course through administration of a 25‐question examination developed by internal medicine and orthopedic residency directors utilized in previous studies. The competency examination covered a broad area of topics that were considered important by surgical and nonsurgical criteria. We administered the examination before and after the course to two separate cohorts of first year medical students, the class of 2014 and the class of 2017. We compared these two cohorts to determine if changes within our Musculoskeletal course enhanced overall performance on the competency examination. The results show that the Musculoskeletal System course significantly improved examination performance by 27.8% for the class of 2014 and 28.4% for the class of 2017. But what was more interesting was that the average post‐course score of the class of 2017 was significantly higher than the average score of students in the class of 2014 showing 23% more students demonstrated competency. Our first‐year osteopathic medical students performed similarly to graduating osteopathic medical students (32% vs. 33%) and outperformed allopathic medical residents (32% vs. 22%) in the portion of students demonstrating competence. In summary, our Musculoskeletal System course improved musculoskeletal knowledge in students, and our first‐year osteopathic medical students did as well or better compared to graduating osteopathic students and allopathic residents, respectively. This study indicates that despite first‐year students comparing favorably with more experienced students in musculoskeletal knowledge there is room for improvement within our Musculoskeletal System course. Future changes to the course may include more case study scenarios and a focus on more high impact, high frequency musculoskeletal related presentations and management.Support or Funding InformationThis work was supported by an internal grant from Lake Erie College of Osteopathic Medicine.