Osteopathic Education Research Articles

Advancing osteopathic education in Canada: New offerings, new direction

In September 2023, the first degree program for osteopathy, an Honours Bachelor of Science from Sheridan College in the province of Ontario welcomed its first cohort [1]. This is the first full-time academic degree in Canada that offers a career opportunity in osteopathy directly from high school. The degree will include two new full semester courses that have not been offered in osteopathy in Canada as part of the core curriculum. The courses, Critical Thinking (CT), and The Philosophy and Science of Pain (Pain) are currently in development to start in second year. They constitute an important part of evidence-based education, which is critical to recognition and regulation of the profession. Implications for practiceThere are no direct implications for current practices. The new courses and the change of education type from private business to an academic setting will have significant implications for future practice.

Australian Osteopath’s Attitudes towards Anatomy Training as Part of their Pre-Professional Education

Since the inception of osteopathy as a health profession in the late 19th century, anatomy has played a fundamental role in practitioners’ education. The aim of this study was to explore attitudes towards anatomy of Australian osteopathic practitioners (osteopaths) by way of a questionnaire-based survey. This survey was distributed to osteopathic practitioners at a national osteopathic conference and an osteopathic workshop in 2015. From 175 attendees, 168 surveys were returned (96.0% response rate), which represents 8.73% (168/1925) of Australian registered osteopaths in 2015. Among the respondents, 48.2% were male and 51.8% female, with an age distribution similar to that of the registered practitioners. Respondents had a mean of 11.1 years in clinical practice and 87.5% of them had studied osteopathy in Australia. Respondents considered that the anatomy curriculum in their pre-professional osteopathic programmes contained enough detail for safe clinical practice. A large majority (88.6%) of respondents agreed that the anatomy content should be integrated with clinical subjects and spread throughout the osteopathic programme. Respondents were provided with access to a wide range of anatomy learning resources in their anatomy training and 84.9% preferred the learning of anatomy content from cadavers. A clear majority of respondents favourably consider the anatomy curriculum within their pre-professional osteopathic programmes and the relevance of anatomy for safe clinical practice. They highlighted the importance of clinically integrated delivery and use of cadavers in anatomy teaching. These results will inform future osteopathic educators to ensure anatomy curriculum in preprofessional osteopathic programmes is relevant and adequate.

Physician Statistics based on Allopathic (M.D.) and Osteopathic (D.O.) Education.

Physician Statistics based on Allopathic (M.D.) and Osteopathic (D.O.) Education.

Looking beyond the pool: An intersectional feminist perspective on osteopathic education

This paper is a critical conflict-based intersectional feminist analysis of professional training that requires students to undress and expose their bodies in order to acquire knowledge. A premise of this essay is that such training is exclusive, harmful and rooted in aesthetic values that tend to percolate osteopathic discourse in multiple ways. The dangerous side of aesthetically guided professional behaviour renders potential harm to people who sit on the margins of what is considered beautiful and normal in the Global North, subsequently contributing to the wider health inequities and social injustice. This paper proposes alternative ways of acquiring knowledge that could support the osteopathic profession and education in becoming more inclusive and socially just, by adopting intersectional feminist framework. At the core of the essay are following questions: Are there ethical costs in prioritising aesthetic and body-based values? In the age of profound socio-political conflicts, what values truly matter in osteopathy? Also, has the time finally come to leave the confines of anatomical aestheticism, and enter the anatomical realm of social justice and transformative action?

The effect of the COVID-19 pandemic on osteopathic education in ACGME-OR residencies from February 2020 to February 2021.

It remains to be determined exactly how the COVID-19 pandemic has and will continue to impact osteopathic resident education, in particular as it pertains to treatment with osteopathic manipulative medicine (OMM). Although the long-term effects of the pandemic cannot be determined yet, changes in current resident education can be analyzed. Here, we describe how the format, frequency, and environment of OMM training have changed in residency programs from prior to February 2020 to the "lockdown" period of February 2020 to June 2020, and then to the "recovery" period of July 2020 to February 2021. A 19-question survey inquiring about the above three categories was emailed via SurveyMonkey to 282 Accreditation Council for Graduate Medical Education (ACGME) residency programs with osteopathic recognition at the end of January 2021. Of the 282 programs surveyed, 24.5% (69) responded. Osteopathic neuromusculoskeletal medicine (ONMM) programs were excluded from the data analysis, resulting in a modified sample size of n=60. Responses indicated that residency programs dramatically decreased the frequency of OMM didactic education sessions (100.0% [60] reported offering OMM didactic education before the lockdown period; compared to 73.3% [44] during the lockdown period) and shifted their educational programs from an in-person-only environment (88.3% [53] before lockdown; 8.3% [5] during lockdown) to either a combined in-person/virtual platform (6.7% [4] before lockdown; 31.7% [19] during lockdown) or to a virtual-only platform (0.0% [0] before lockdown; 46.7% [28] during lockdown). During the recovery period, 91.7% (55) programs reported giving some form of OMM didactic education. The percentage of programs reporting in-person-only, combined in-person/virtual platform, and virtual-only didactic education were 3.3% (2), 53.3% (32), and 41.7% (25), respectively, during the recovery period. The preferred method of instruction changed from a combination of resident and attending lectures with a hands-on component (55.0%; 33) before lockdown, to the same but without a hands-on component (28.3%; 17) during lockdown, and back to the same but with a hands-on component (36.7%; 22) during the recovery period. Furthermore, the number of programs offering OMM didactic education [OMM patient care] at least once a month decreased from 70.0% (42) [78.3% (47)] before the lockdown period to 46.7% (28) [48.3% (29)] during the lockdown period. It then increased to 55.0% (33) [73.3% (44)] during the recovery period. Finally, before the lockdown period, programs offered OMM patient care predominantly in a combination of an inpatient/outpatient environment (63.3%; 38). The preferred patient care setting changed to an outpatient-only environment (43.3%; 26) during the lockdown period and then back to a combination of an inpatient/outpatient environment (45.0%; 27) during the recovery period. This study demonstrates that programs have been dramatically impacted by the COVID-19 pandemic, by the augmentation of the osteopathic learning environment, and by the delivery of OMM to patient care within the training programs. These impacts were still present 1year after the start of the pandemic. It will be imperative for ACGME Osteopathic Recognition (ACGME-OR) programs to continue an assessment of these impacts on resident physicians' learning and preparedness.

Preparing osteopathy graduates for future careers: A review of osteopathic education in Australia

Introduction: Osteopathy in Australia faces an uncertain future as an unprecedented number of graduates enter the profession. While most are destined to work in private practice, workforce data suggests that limited career diversity and practitioner maldistribution are associated with growing rates of job dissatisfaction and professional attrition. Cultivating employability skills that promote diverse careers is the responsibility of education providers, yet it is unclear whether existing osteopathy programs are achieving this. Our aim was to determine if osteopathic curricula provide the employability skills required to prepare graduates for diverse careers.Methods: This study was conducted as part of a larger project by RMIT University and Osteopathy Australia entitled “Strategic plan for the osteopathy profession 2030”. A two-part approach was utilised. Part A involved a comparison of core learning outcomes (contained within current Australian osteopathy curricula) against key employability skills required for success in a diverse range of careers. A consensus development panel was consulted in Part B to capture the perspectives of experts in the field. Results: Content analysis and expert panel discussions identified the curricula has a strong focus on critical thinking, communication and problem solving and less focus on teamwork, leadership, initiative and enterprise and technological skills. Furthermore, osteopathy programs offer limited elective and micro-credentialing opportunities. Conclusions: Career diversity and increased job satisfaction for osteopathy graduates may be achieved by empowering them with the skills to succeed in careers beyond private practice. This calls for curriculum reforms and expanded elective and micro-credentialing options to enable students to broaden their skills and widen their options.

Assessing the United States' most frequently asked questions about osteopathic medicine, osteopathic education, and osteopathic manipulative treatment.

Osteopathic medicine in the United States continues to produce a substantial number of physicians and medical educators. However, recently popularized misconceptions about osteopathic medical practice, education, and manual therapy suggest an unsettling prevalence of inaccurate beliefs held by the public. The public often searches the internet to find out information about osteopathic medicine, but the content of questions and the transparency of the resulting information is unknown. We sought to explore frequently asked questions (FAQs) generated by Google to assess commonly searched questions about the osteopathic profession and to determine the level of information transparency associated with resulting sources. On June 16, 2021, we searched Google for three terms: "osteopathic medicine," "doctor of osteopathic medicine," and "DO," until a minimum of 100 FAQs and their answer links were extracted from each search. After excluding irrelevant FAQs, we used Rothwell's Classification of Questions to categorize the FAQs. We then used the Journal of the American Medical Association's Benchmark Criteria to assess information transparency for each corresponding answer source provided by Google. The answer sources were screened for the inappropriate use of "osteopathy" in place of "osteopathic medicine" and for "osteopath" in place of "DO," "Doctor of Osteopathic Medicine," or "Osteopathic Physician." We performed statistical tests to ascertain the differences in information transparency between osteopathic and nonosteopathic information sources. Our Google search revealed 110 unique FAQs about osteopathic medicine. The majority of FAQs were classified as fact-based (82/110; 74.55%), nearly half of which (45.12%) were related to the medical practicing privileges of DOs. The FAQs were most commonly answered by academic institutions (44/110, 40.0%). Nearly half (49.09%) of the linked answer sources were deemed inadequate by JAMA benchmark criteria. Of the 110 linked answer sources, 19 (17.27%) misused either osteopathy, osteopath, or both to describe osteopathic physicians. Only 30 sources were linked to US-based osteopathic organizations. Osteopathic organizations were statistically less likely to meet high-transparency criteria than nonosteopathic organizations (p=0.002). Our study shows that the US public may be unsure about the physician status of DOs, which may prevent securing the professional identity of osteopathic physicians in the eyes of the public. Osteopathic organizations should tailor awareness campaigns toward addressing the common misconceptions revealed by our study. Osteopathic organizations should use transparency criteria as a rubric when publishing information to enhance transparency.

Active learning in osteopathic education: Evaluation of think-pair-share in an undergraduate pathology unit

BackgroundFostering student engagement in low-resource learning environments is a common challenge in health professional education. Content-rich subjects, in particular, are associated with a high risk for disengagement. It is possible to enhance the student experience by incorporating principles of active learning and cognitive psychology within traditional forms of instruction. ObjectivesThis study explored osteopathy student perceptions of think-pair-share, a teaching strategy that combines elements of retrieval practice with cooperative learning. Furthermore, this study sought to quantify the effect of think-pair-share on self-reported engagement and academic achievement. MethodsOsteopathy students in year two of the program at Victoria University, Melbourne, Australia, were invited to participate. A pre-post design which conceptualised think-pair-share as an educational intervention was used. Twelve pathology lectures were divided into subtopics of 12–20 min duration. After each sub-topic, a short-answer question was posed to the class for consideration using the think-pair-share approach. A post-test survey assessed self-reported engagement and perceptions of the teaching strategy. ResultsSeventy-six second-year osteopathy students participated. Participants reported significantly higher levels of engagement (p < 0.001) following instruction with think-pair-share. Whilst the intervention did not appear to have an impact upon final grades, the majority of learners were satisfied with the approach. Qualitative feedback on the think-pair-share strategy was largely positive: perceived benefits to learning emerged as a dominant theme. Learners also valued the collaborative nature of this teaching strategy. ConclusionsThink-pair-share is an inexpensive teaching strategy that was received well by osteopathy students. This easily implemented technique can transform a didactic lecture into a collaborative community of active learners.

Osteopathic Medical Students’ Perceptions of their Medical Education due to COVID19

Objective: The SARS-CoV-2 (COVID19) pandemic has led to unprecedented changes in medical education globally. Published reports on these changes have given some insight as to both positive and negative effects for specific medical schools though none have looked at osteopathic education. Our study attempts to examine the effect of COVID19 more formally on osteopathic medical students’ perception of their medical education in the third and fourth years of medical training.

The Single Accreditation System: Risks to the Osteopathic Profession.

In August 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) signed a memorandum of understanding with the Accreditation Council for Graduate Medical Education (ACGME) to create the Single Accreditation System (SAS) for graduate medical education (GME) in the United States. The AOA made the decision that it would close its GME accreditation system in response to dramatic growth in colleges of osteopathic medicine, a shortfall in osteopathic GME positions with increasing dependence on the ACGME system, ACGME policy decisions that adversely impacted osteopathic students, and declining osteopathic student interest in primary care. Osteopathic teaching institutions bore responsibility for meeting ACGME accreditation standards between 2015 and 2020, including determining institutional sponsorship, which program applications to submit, program size, educational leadership, and whether to pursue Osteopathic Recognition. Approximately 692 of 954 (72.5%) eligible osteopathic GME programs in 2014-2015 obtained ACGME accreditation by June 1, 2020. There were sharp reductions in surgical and subspecialty programs and a significant drop of DOs in educational leadership positions. A low percentage of ACGME-accredited programs applied for Osteopathic Recognition. In closing its GME accreditation system and joining the ACGME, the AOA gave up control of its direct relationship with osteopathic residents, fellows, and teaching institutions to gain critical GME opportunities. In this article, the author considers whether this gain will offset the risks taken by the AOA, including decreased DO leadership opportunities and role models, lower than expected interest in Osteopathic Recognition, and possible decreased DO interest in osteopathic organizations and osteopathic specialty board certification. Time and the choices of current and future DO trainees in ACGME programs will determine the future of the osteopathic profession-and whether these risks were worth taking.

“Understanding patients' narratives” A qualitative study of osteopathic educators’ opinions about using Medical Humanities poetry in undergraduate education

BackgroundMedical Humanities (MH) and Narrative Medicine (NM) programmes have become increasingly recognised as valuable and innovative educational strategies that use literature, poetry and art to teach healthcare students about person-centred care (PCC). Osteopaths aim to provide PCC, but research into educational strategies that promote PCC in undergraduate curricula is lacking. AimTo explore educators’ opinions about potential value of MH poetry in osteopathic education and generate insights to inform educational institutions about potential strategies for strengthening undergraduate teaching about PCC. MethodsEleven semi-structured interviews were conducted with educators from one institution using purposive sampling, and analysed using elements of constructivist grounded theory situated within an interpretive paradigm. ResultsParticipants expressed varied views about the utility of MH poetry and pedagogical techniques for integrating it. Poems were considered to facilitate better understanding of patients’ life contexts by exploring the use of metaphorical language and employing techniques such as classroom interpretations and meaning co-construction, role-playing, perspective-taking and reflective writing to generate deeper awareness. ConclusionMedical Humanities poetry could be a potentially valuable teaching tool to increase students’ understanding of patients and to help them ground their practice within constructivist epistemology where value is placed on the relationship between patient and practitioner. Future research is needed to evaluate training and delivery methods for these educational interventions. Implication for education•The study outlines a provisional framework for using MH poetry as a means of assisting educational delivery of person-centred care in osteopathic education.•Poems were recognised as a potential teaching tool to increase students' awareness of broad aspects of human experience, awareness of metaphorical language patients may use in practice and self-awareness; potentially equipping them with interpretive, collaborative and reflective skills.•This would be of value in order to determine whether narrative educational methods would help in shaping a theoretical basis for PCC where focus is on constructivist relationship between the patient and practitioner.

Simulating Early Clinical Experiences With Surgical Procedures in the Anatomy Laboratory.

BackgroundThere is evidence to suggest that early exposure to clinical experiences could bolster a medical student’s education and prepare them to tackle the problem-based learning encountered during clinical rotations. We hypothesized that incorporating common surgical procedures into the gross anatomy laboratory during preclinical years would enhance the anatomical learning experience for students. The incorporation of these procedures would not be disruptive to the normal conduct of the anatomy laboratory, nor result in exorbitant costs.ObjectivesThe goal of a more integrated curriculum is to better enable medical students by providing them a unique learning experience, so that they may more readily recall the knowledge needed to deal with the complex problems of clinical work. Recognizing the importance of this concept, we have incorporated multiple common clinical procedures into our anatomy curriculum as a pilot program.MethodsSeven common surgical procedures, including intraosseous needle insertion, venous cut-down, chest tube insertion, surgical cricothyroidotomy, core needle liver biopsy, appendectomy, and hysterectomy, were taught as a part of this study. Video instructions on each of the surgical procedures were provided before each corresponding laboratory. Surveys were distributed to study participants to measure their satisfaction with the procedures and whether or not it was disruptive to the allotted laboratory time.ResultsBoth students and faculty who were sampled in the study reported that they were satisfied with the procedures (96.5% and 100%, respectively), that the procedures did not interfere with laboratory times (96% and 100%), and that the procedures facilitated clinical learning (98% and 100%).ConclusionThis study demonstrated that providing a novel surgical teaching program to medical students was beneficial to their education and non-disruptive to the conventional anatomy curriculum. This exercise further facilitates osteopathic education by demonstrating how structure and function organize surgical practice. The integration of Edward Via College of Osteopathic Medicine, Auburn Campus's (VCOM-AC’s) surgical procedures into other medical school anatomy courses can yield more prepared and confident students as they venture into their clinical rotations.

Osteopathy students profile in Italy: A cross sectional census.

The Osteopathy Students Analysis (OSA) aims to profile osteopathy students in Italy as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. The OSA used a cross-sectional design. A Web-based survey was distributed to the Italian Osteopathic Education Institutions (OEIs). The OSA survey was composed of items organised into four sections: 1. Sociodemographic characteristics (11 items); 2. Geographical distribution (5 items); 3. Health status (3 items); 4. Previous and ongoing education specifications (16 items). A descriptive sample population analysis was performed. Dichotomous and categorical variables were presented as frequencies and percentages, and continuous variables were displayed as means and standard deviations. Some variables were analysed using a pentenary distribution. 49 out of the 61 OEIs identified matched the inclusion criteria, and among these, 22 accepted to propose the enrolment of their students into the study. The survey was administered to 4,720 students from all the participant OEIs. A total of 3,762 students responded to the survey, accounting for an estimated response rate of 53.7%. The majority of respondents were men (54%), with an average age of 26.9 ± 6.5 years. Almost the totality of the sample was composed of the European ethnic group (99.1%). Respondents were predominantly born in Italy (97.2%). The majority of the sample reported being in good (49.5%) to excellent (38.6%) health. To date, osteopathy students are almost evenly distributed between the two types of curricula (T1 = 46.6%; T2 = 53.4%). The OSA is the first study that aims to profile Italian osteopathy students as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Future studies should focus on investigating the correlation between the sociodemographic characteristics of students and their academic performance.

Osteopathic manipulative treatment for allopathic physicians: piloting a longitudinal curriculum.

Under the Accreditation for Graduate Medical Education (ACGME) single accreditation system, there is likely to be increasing interest and opportunity for teaching osteopathic manipulative treatment (OMT) to allopathic residents and residency faculty. When learning OMT, allopathic physicians (MDs) have distinct needs compared with osteopathic medical students. For example, MDs already have a foundation in anatomy and medical vocabulary, but incorporating an osteopathic approach to patient care may require a paradigm shift. Thus, a unique approach to osteopathic education for MDs in residency programs with osteopathic recognition (OR) is needed. To create a longitudinal OMT elective for allopathic residents and residency faculty and assess its impact on attitudes and confidence regarding osteopathic principles and treatment. Drawing from standard texts used during preclinical osteopathic education, a blended online and in-person laboratory modular curriculum for the OMT elective course was developed by osteopathic residents and faculty within the Department of Family Medicine and Community Health at the University of Wisconsin in Madison. The modalities of muscle energy, counterstrain, myofascial release, and soft tissue were included; the curriculum also reviewed autonomic physiology, somatovisceral, and viscerosomatic reflexes. A quality improvement study of the course was conducted via pre- and postcourse surveys to assess its impact on perceptions and confidence regarding the theory and practice, referral, and use of OMT. A precourse survey was distributed before the first module to obtain background information and assess participants' prior OMT exposure, among other things. Nine months after the course ended, a corresponding postcourse survey was distributed. Pre- and postcourse surveys were individually matched to improve statistical analysis, using unique identifiers. Also, following each laboratory, a postlaboratory survey was collected about the participant's experience for that lecture and for laboratory-specific quality improvement purposes. Two years after course completion, graduates were reached via phone or email for informal interviews to assess the perceived long-term impact from the elective. Eleven MDs from a total potential pool of 26 residents and approximately 120 attending physicians enrolled in the course; eight (72.7%) completed all modules and pre- and postcourse evaluations. Participants reported statistically significant gains in attitudes and confidence regarding OMT ("knowledgeable regarding OMT principles": precourse mean, 2.50 [0.76], vs. postcourse mean, 3.37 [0.52]; p=0.021; "know how to treat using OMT": precourse mean, 2.25 [1.39], vs. postcourse mean, 3.12 [1.25]; p=0.041). Several participants (five; 62.5%) had completed prior OMT training. There was an increase, albeit nonsignificant, in the use of OMT, with more providers using OMT (precourse mean, five, vs. postcourse mean, six; p=0.171), and providers using OMT more often (precourse OMT use monthly or more often, three, vs. postcourse OMT use monthly or more often, six; p=0.131). Implementing a longitudinal elective curriculum is a feasible way to improve attitudes and confidence in OMT for MDs involved in a family medicine residency. Whether our elective leads to competency in OMT for allopathic residents and faculty remains to be formally evaluated. Our pilot established the feasibility and led to a revision of our curriculum; the elective continues to occur yearly. Future analyses will focus on competency assessment.

Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine.

Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6weeksat 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA. A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.

Impact of an osteopathic presence in a large categorical pediatric residency training program

Nationwide Children's Hospital (NCH) has a large pediatric residency program with 43 residents in the categorical pediatric program and 10 residents in the Internal Medicine-Pediatrics (IM-Peds) program per class. Of the 43 categorical pediatric residents, four are in the osteopathic recognition track (ORT) and continue their osteopathic education throughout residency. There is currently a lack of data examining the effect of an ORT, and specifically a pediatric ORT, on a residency program. To evaluate the impact of an ORT osteopathic recognition track on an overall residency program's perceptions of osteopathic manipulative treatment (OMT) and to evaluate allopathic (MD) resident perception of osteopathic educational sessions. An anonymous survey was conducted in June 2017 and distributed to 141 residents (both categorical andIM-Peds) to gather baseline information regarding perceptions and knowledge of OMT. Based on the initial results, a four-part case-based educational series was implemented during the 2018-2019 academic year to teach osteopathic principles to MD residents. A second survey was distributed following each session. For the initial survey, 59 (41.8%) residents responded. Survey results demonstrated that resident perceptions of OMT as an efficacious treatment option increased after starting their residency at NCH (p=0.04), and 25 of 43 (58.1%) MD residents stated an interest in learning OMT skills. A total of 140 attendees were present at the four educational sessions. One hundred and thirty-eight residents (98.5%) found the educational sessions beneficial and 132 (94.2%) stated they would refer a patient for OMT. ORT residents make a significant impact on their colleagues' perceptions and knowledge of OMT. This study suggests that further efforts to highlight the clinical applications of OMT in pediatric patients would be welcomed by residents.

Predictors of research self efficacy in first-year osteopathic medical students

BackgroundThere has been a decline in the number of physician-scientists which has promoted interest in developing research initiatives for students in medical school. While it is unclear what might promote student success in research endeavors, it has been postulated that research self-efficacy (RSE) may be contribute to student engagement in research. It is thus important to consider what factors contribute to student engagement in research in the early years of medical training. ObjectiveThe purpose of this study was to assess first-year osteopathic medical students’ (OMS) attitudes towards research and identify factors contributing to RSE. MethodsData were collected from 357 first-year OMS via an online questionnaire on attitudes of and opinions towards research. Multiple regression modeling was used to determine if certain attitudinal factors would be associated with RSE. Hypothesis testing was conducted using Pearson correlation coefficients (r) and multiple regression analysis. ResultsRegression modeling successfully explained 33% of the variance in predicting RSE: F(4,350) = 44.475, p < 0.001 with an R2 of 0.337 (adj. R2 = 0.329). Greater security in understanding research, greater belief in ability to conduct research, feeling research was important in their future career, and wanting more research education and opportunities while in medical school contributed to greater RSE. ConclusionsEvidence-based medicine and the importance of research continue to influence osteopathic education and medical practice. Cultivating RSE should be a goal for medical educators as they design curricular initiatives to facilitate critical thinking and improve chances to apply research skills in residency and beyond.

The Italian Osteopathic Practitioners Estimates and RAtes (OPERA) study: How osteopaths work.

The scope of practice of the osteopathic profession in Italy is underreported. The first part of the present study investigated the Italian osteopaths' profile, focusing on the socio-demographic information and geographical distribution together with the main characteristics of their education. The OPERA-IT study highlighted that the majority of respondents declared to work as sole practitioners (58.4%), while the remaining declared to work as part of a team. Since teamwork and networking are recognized as fundamental aspects of healthcare, the present study aims to compare the osteopathic practice, diagnostic and treatment modalities of osteopaths who work as a sole practitioner and osteopaths who work as part of a team to highlight possible differences. Moreover, patients' characteristics will be presented. The OPERA-IT study population was chosen to provide a representative sample. A web campaign was set up to inform the Italian osteopaths before the beginning of the study. The OPERA IT study used a previously tested questionnaire. The questionnaire was translated into Italian following the World Health Organization recommendation. The questionnaire was composed of 57 items grouped in five sections, namely: socio-demographics, osteopathic education and training, working profile, organization, and management of the clinical practice and patient profile. The survey was delivered online through a dedicated platform. The survey was completed by 4,816 individuals. Osteopaths who work as sole practitioners represented the majority of the sample (n = 2814; 58.4%). Osteopaths who work as part of a team declared to collaborate mostly with physiotherapists (n = 1121; 23.3%), physicians with speciality (n = 1040; 21.6%), and other osteopaths (n = 943; 19.6%). The two groups showed heterogeneous characteristics. Significative differences were observed in all the factors, namely: geographical distribution, age, gender, training, working contract and working place, daily consultations and time for each consultation, fees, and the average waiting period to book an appointment. The principal component analysis supported a ten-component model and explained 80.5% of the total variance. The analysis showed that osteopaths working as sole practitioners have an increased probability (OR = 0.91; CI 95%: 0.88-0.94; p<0.01) of using systemic diagnostic and treatment techniques and have distinct clinical features with higher probability (OR = 0.92; 0.88-0.96; p<0.01) of spending less time with patients, being paid less but treating a higher number of patients per week. The most represented patients' age groups were 41-64 years old (n = 4452; 92.4%) and 21-40 years old (n = 4291; 89.1%). Similarly, the most reported new patients' age groups were 41-64 years old (n = 4221; 87.7%) and 21-40 years old (n = 3364; 69.9%). The most common presenting complaints were back pain, neck pain, cervical radiculopathy, sciatica, shoulder pain, and headaches. Osteopathic practice in Italy seems to be characterised by interprofessional collaboration, mostly with physiotherapists. Our results highlighted two different profiles in terms of sociodemographic characteristics and work modalities between osteopaths who work as sole practitioners and those who work as part of a team. Although according to the respondents, people of all ages consult Italian osteopaths, the majority of patients are adults. Most of them have been referred to osteopathy by other patients or acquaintances. Patients seek osteopathic care mostly for musculoskeletal related complaints.

Simulation can offer a sustainable contribution to clinical education in osteopathy

BackgroundClinical education forms a substantial component of health professional education. Increased cohorts in Australian osteopathic education have led to consideration of alternatives to traditional placements to ensure adequate clinical exposure and learning opportunities. Simulated learning offers a new avenue for sustainable clinical education. The aim of the study was to explore whether directed observation of simulated scenarios, as part replacement of clinical hours, could provide an equivalent learning experience as measured by performance in an objective structured clinical examination (OSCE).MethodsThe year 3 osteopathy cohort were invited to participate in replacement of 50% of their clinical placement hours with online facilitated, video-based simulation exercises (intervention). Competency was assessed by an OSCE at the end of the teaching period. Inferential statistics were used to explore any differences between the control and intervention groups as a post-test control design.ResultsThe funding model allowed ten learners to participate in the intervention, with sixty-six in the control group. Only one OSCE item was significantly different between groups, that being technique selection (p = 0.038, d = 0.72) in favour of the intervention group, although this may be a type 1 error. Grade point average was moderately positively correlated with the manual therapy technique station total score (r = 0.35, p < 0.01) and a trivial relationship with the treatment reasoning station total score (r = 0.17, p = 0.132).ConclusionsThe current study provides support for further investigation into part replacement of clinical placements with directed observation of simulated scenarios in osteopathy.

Deletion of T1R3 reduces atherosclerosis and liver triglyceride accumulation in ApoE−/− mice fed a high‐fat diet

To maintain homeostasis, cells continuously evaluate and adjust to their nutrient availability and current energy state. A cell's response to the fed state requires the presence of amino acids and other nutrients, which signal to the mammalian target of rapamycin complex 1 (mTORC1) coordinating cell growth, protein translation, and autophagy. The umami taste receptor, which is a heterodimer between the G protein‐coupled receptors T1R1 and T1R3, is a direct sensor of amino acid availability and signals to mTORC1. Reducing the expression of T1R1/T1R3 in mice and pancreatic beta and cardiomyocyte cell lines diminishes the activation of mTORC1 by amino acids, thereby inducing autophagy. Previous research suggests that elevated autophagic flux reduces the development and progression of atherosclerosis by protecting cells from oxidative stress, reducing apoptosis within atherosclerotic lesions, and promoting lesion stabilization by degrading intracellular components that are harmful to the cell. Other studies suggest that increased autophagic flux decreases the progression of Non‐Alcoholic Fatty Liver Disease (NAFLD) by reducing hepatocyte lipid accumulation and liver inflammation. We hypothesized that the deletion of T1R3 in ApoE−/− mice would decrease aortic atherosclerotic plaque buildup and decrease hepatosteatosis by increasing autophagic flux. Our data suggest that T1R3−/− ApoE−/− mice have less liver lipid accumulation and reduced atherosclerotic plaque area when compared to T1R3+/+ApoE−/− mice. Taken together, these data suggest that modulation of nutrient and amino acid‐sensing GPCRs like T1R1/T1R3 could be used as a potential therapeutic strategy for cardiovascular disease.Support or Funding InformationAmerican Heart Association (15SDG25090279) and Iowa Osteopathic Education and Research Funds (E.M.W.).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.