Second-year Osteopathic Medical Students Research Articles

Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective.

Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap. The objectives of this study are to determine ifthe provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students. This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24®). A two-sided, paired t test was conducted to determine changes in outcome variables. All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed. The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Environmental factors promoting the effective use of a computer-assisted clinical case for second-year osteopathic medical students.

Computer-aided clinical cases (CACC) have the potential to complement and/or supplement other types of problem-based learning exercises in modern medical curricula. Deploying a CACC learning experience requires institutional commitment to technology and a belief by administration, faculty, and students that "climbing a steep growth curve" is worth the effort. Several aspects of the institutional environment at the Kirksville College of Osteopathic Medicine (KCOM) led to the development of the CACC exercise described in this article, including the need to design a uniform, supplemental, Internet-based learning experience and assessment exercises for students doing clinical rotations at off-site facilities. The CACC learning experience was enthusiastically accepted by second-year medical students as an integrative and clinically relevant educational experience. The success of this CACC exercise has helped to promote the development of other innovative applications of technology to medical education at KCOM.

Osteopathic Medical Students’ Preferred Method of Participation in Online Lectures and Learning Activities

Abstract Introduction The demand for online education is on the rise as technology and a global community expand. In the context of COVID-19 pandemic, the Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine (NMM/OMM) Department at Western University of Health Sciences College of Osteopathic Medicine Pacific (COMP) and Pacific-Northwest (COMP-NW) was required to transition from a hands-on, in-person model to entirely virtual teaching. With the rapid transition, student feedback was paramount in determining the effectiveness of the virtual curriculum model and establishing evidence-based guidelines to inform future online delivery methods for the teaching of osteopathic manipulative medicine. Methods A 7-question Qualtrics survey was developed to assess the first and second-year osteopathic medical students’ perception of their online curriculum participation, the preferred method of participation, barriers to participation, and how the NMM/OMM department can improve the curriculum to increase student participation. The survey was distributed electronically to the students at Western University of Health Sciences COMP and COMP-NW. Results 85 students participated in the survey. The most preferred method of participation was an anonymous online polling platform such as “Kahoot!” The most frequently reported barrier to participation was lack of confidence. The most popular suggestion about increasing student participation was to increase more anonymous polls or gamification, such as “Jeopardy,” for review sessions. The logistic regression analysis showed that the following 3 student characteristics were the most decisive factors for a student to report that more participation would increase their OMM knowledge: fear of public speaking (p = 0.024), difficulty staying focused during online curriculum (p=0.041), and being a first-year osteopathic medical student (p<0.01). Conclusion Online curriculum design and delivery pose new and unique challenges to teachers and institutions worldwide. Understanding the creativity it allows, its limitations, and how to increase student engagement and participation needs to be continuously investigated as the technology and demand of online learning grow.

Instructor Methods and Curricular Effects on Students' Value of Lectures.

BackgroundLectures remain a common instructional method in medical education. Instructor methods, curricular factors, and technology affect students’ use of scheduled live lectures that may impact faculty job satisfaction.AimThis study identified instructor methods and curriculum issues that influenced preclinical medical students’ use of scheduled lectures as well as faculty perceptions of lectures and students’ attendance.MethodsFirst- and second-year osteopathic medical students (n = 304) were invited to complete a voluntary, anonymous semantic differential scale, Likert scale, and dichotomous question survey, rating 22 lecturer methods and 9 curriculum factors that influence use of live lectures. Preclinical faculty (n = 35) were also asked to complete a differential scale survey, rating 17 issues regarding live lectures and student attendance. Student and faculty surveys were analyzed using the appropriate central tendency and variability measures.ResultsStudents that completed the survey (n = 144) rated the ability to explain complex concepts in an understandable manner as “Very Important” and wearing professional attire as “Not Important” for attending lectures, respectively. Availability of recorded lectures, time to an upcoming exam, and unscheduled time gaps between lectures were rated as Very Important curricular factors for attending lectures. Faculty completed the survey (n = 21) and agree that lectures should continue as a major mode of instruction, while the majority reported spending over 9 h preparing new lectures.ConclusionsFaculty lecture methods and overarching curricular decisions greatly impact students’ attendance of live lectures. Regardless, most students and faculty believe that scheduled lectures should continue as an option for students who prefer to attend live lectures.

48-Hour Hospice Home Immersion Encourages Osteopathic Medical Students to Broaden Their Views on Dying and Death.

To augment learning about interprofessional palliative and end-of-life care, the University of New England College of Osteopathic Medicine immersed 2 second-year osteopathic medical students in an 18-bed acute care hospice home in Scarborough, Maine, for 48 hours. The students worked with an interprofessional staff and independently to provide patient care, family support, and postmortem care. For data collection, students wrote in journals before the immersion experience (prefieldwork), while living in the hospice home (fieldwork), and for 10 days following the immersion experience (postfieldwork). The students recorded their subjective and objective reporting of observations, experiences, feelings, and patient/family encounters. Data analyses included a review of the journals, identifying thematic categorizations, and coding through content analysis. Three themes identified in the students' journals reflected shared experiences: (1) shifting perspectives, (2) path to family acceptance, and (3) emotional journey. The students learned how to converse with patients and families about end-of-life care while ensuring attainment of patients' goals. They also learned about the importance of helping patients enjoy life's simple pleasures like taking them outside to enjoy the sunshine, and they learned to trust themselves when handling emotional and difficult situations. Each student gained confidence in her ability to help guide patients through this stage of life.

Burnout, Perceived Stress, Sleep Quality, and Smartphone Use: A Survey of Osteopathic Medical Students.

Burnout is a psychological syndrome that results from prolonged exposure to stressful work activities and includes 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and low sense of personal accomplishment (PA). Burnout is a widespread problem in numerous professions but is particularly high among medical students, residents, and early-career physicians compared with college graduates of similar age. However, minimal research has addressed burnout in osteopathic medical students. To assess levels of burnout in osteopathic medical students and to examine the relationship among burnout, perceived stress, sleep quality, and smartphone use. This study used a cross-sectional study design and an anonymous, electronic questionnaire service to administer the Maslach Burnout Inventory, the Perceived Stress Scale-4, the Pittsburgh Sleep Quality index, and the Smartphone Addiction Scale Short Version. A total of 385 participants (mean [SD] age, 25 [2.4] years; 208 [54.0%] women; 286 [74.3%] white; 138 [35.8%] second-year osteopathic medical students [OMSs]) completed the survey. Of the 385 participants, 9 (2.3%) reported high EE, 67 (17.4) reported high DP, and 310 (80.5) reported a high level of low PA. When comparing dimensions of burnout by gender, only levels of PA differed by gender, with men reporting higher levels of burnout compared with women (χ12=5.2, P=.022). Further, levels of DP differed by year in medical school (χ 2=17.3, P=.008), with post-hoc comparisons showing differences between OMS I and OMS III (F=4.530, df=3, P=.004). Linear regression models showed that higher perceived stress (standardized β=0.5, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.1, P<.001) were associated with higher EE. Similarly, higher perceived stress (standardized β=0.2, P<.001), poorer sleep quality (standardized β=0.2, P=.001), and higher smartphone addiction scores (standardized β=0.2, P=.001) were associated with higher DP. Only higher perceived stress was associated with higher levels of low PA (standardized β=-0.4, P<.001). These findings suggest independent associations with EE, DP, perceived stress, sleep quality, and smartphone use. Additional research with a larger, more diverse sample is needed to confirm these findings. If confirmed, wellness interventions can be designed to target 2 modifiable factors: sleep quality and smartphone use.

Introduction to Clerkship: Bridging the Gap Between Preclinical and Clinical Medical Education.

Despite a diverse range of curricular advancements to address the difficult transition from classroom learning to clinical training during medical education, hurdles persist. A 4-week course was designed at the Philadelphia College of Osteopathic Medicine (PCOM) to make this transition easier. To determine whether PCOM students' comfort and preparedness increased after taking a 4-week clinical transition course before third-year clinical clerkships, and to determine whether faculty perceptions of student preparedness and comfort were improved after participation in the course compared with previous third-year students. Second-year osteopathic medical students at PCOM participated in a 4-week course, Introduction to Clinical Clerkship (I2C). The course included 16 small-group exercises, which all took place before students began their third-year clerkship rotations. The exercises in the course extended beyond the skills learned during their classroom years. Students were given a pre- and postcourse survey to evaluate their comfort level with 58 different aspects of clinical practice. Participating faculty were surveyed to evaluate their perception of student preparedness and comfort compared with previous third-year students who had not undergone the exercise. After completing the I2C course, third-year osteopathic medical students (n=232) reported increased comfort with 57 of the 58 learning objectives and each of the 5 coded clinical competency areas (patient assessment, effective communication, hospital logistics, procedural skills, and core knowledge) (P<.01). Preceptors reported that students who completed the I2C course were more prepared (54.5%) and more comfortable (63.4%) with clinical duties, as compared with their recollections of previous third-year osteopathic medical students. Within the 5 competencies, students on average felt more comfortable and were perceived by faculty as better prepared than previous students who had not taken the I2C course. The establishment of a preclinical transition exercise appears to help bridge the gap between the preclinical and clinical years. This learning model allows medical students to feel both more comfortable and better prepared throughout the transition from classroom learning to clinical rotations.

WVSOM Anatomy Lab Tour Program: An Osteopathic Medicine Pipeline With Student Teaching Opportunities.

In spring 2013, the West Virginia School of Osteopathic Medicine (WVSOM) reformatted its Anatomy Lab Tour Program to include interactive stations in the gross anatomy laboratory. The design of the outreach program introduces high school and allied health learners to osteopathic medicine while working through anatomy laboratory stations and how the tenets of osteopathic medicine relate to a person's overall health and wellness. Throughout the history of the program, first- and second-year osteopathic medical students at WVSOM have helped teach visiting learners in the laboratory experience. The new program design allows more time for one-on-one time between the student teachers and the learners. Exit surveys have reported that the current program design creates a synergistic learning environment in which both the learners and student teachers benefit through the encounter. The authors present this case study of the WVSOM Anatomy Lab Tour Program to establish a baseline for the collection of information gained through participant surveys to assess the impact of the program on learners and student teachers.

The Other 45: Improving Patients' Chronic Disease Self-Management and Medical Students' Communication Skills.

To improve chronic disease self-management among an underserved population and to improve the skills of second-year osteopathic medical students, an educational curriculum, The Other 45, was developed. In addition to a typical 15-minute office visit, this program allows second-year students to provide chronic disease education to patients for 45 minutes in an effort to improve patient disease self-management and associated health outcomes. To determine whether patients who participate in The Other 45 report improvements in their ability to manage their chronic disease(s) and their health outcomes and whether second-year osteopathic medical students report changes in patient-centered care, clinical confidence, and medical/teaching knowledge. Patients with a previously diagnosed chronic disease participated in 3 visits for The Other 45. Chronic disease self-management and health outcomes were measured using the Health Education Impact Questionnaire, which participants completed at each visit. Students received a formal presentation on teaching skills, and those who participated in The Other 45 completed a pre- and postclinic survey measuring 3 focused domains: patient-centered care, clinical confidence, and medical/teaching knowledge. A total of 47 patients and 69 students participated in the study. As measured by the Health Education Impact Questionnaire, patients' skill and technique acquisition (P=.01), constructive attitudes and approaches (P=.01), and health services navigation (P=.03) showed significant improvement at the 3-week follow-up visit, and self-monitoring and insight showed significant improvement (P=.01) at the 3-month follow-up visit. Patients' positive and active engagement in life (P=.04 and P=.03) and emotional well-being (P=.003 and P=.0007) significantly improved at the 3-week and 3-month follow-up, respectively. The students improved significantly in all 3 domains as a result of participating in the program: patient-centered care (P=.012), clinical confidence (P<.001), and medical/teaching knowledge (P=.002). The Other 45 was effective in improving patients' ability to manage their chronic disease(s), as well as improving second-year osteopathic medical students' ability to educate a patient with chronic disease. Implementing this type of program has the potential to affect patients with chronic disease as well as medical students in a rural underserved setting.

Association of Mindfulness With Residency Preference and Curriculum Selection in Preclinical Osteopathic Medical Students.

Recent studies suggest the shortage of US primary care physicians will be more than 50,000 by the year 2025. Mindful osteopathic medical students may be more inclined to pursue a career in primary care practice than those demonstrating lower levels of mindfulness. If so, assessing mindfulness before and after admission to medical school may reduce this shortage. In this cross-sectional survey-based study, the authors assessed whether mindfulness among preclinical osteopathic medical students was associated with (a) their current preference for primary care practice as a residency, and (b) their choice between 2 alternative curricula. Participants were first- and second-year osteopathic medical students enrolled at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM). They completed a 7-factor questionnaire of demographic variables and the online Five Facet Mindfulness Questionnaire (FFMQ) to determine their mindfulness score. They also identified their current preference for a residency. Data were then presented using various descriptive statistics and analyzed using independent t tests, χ2 tests, and multiple logistic regression. Among the 208 respondents, authors found that osteopathic medical students who expressed a preference for primary care practice showed no significant differences in mindfulness compared with those interested in specialist fields, as indicated by mean (SD) mindfulness scores of 3.34 (0.44) vs 3.33 (0.41), respectively (P=.88). However, among demographic variables, female students expressed a preference for primary care practice fields at significantly higher rates than male students (OR, 4.4; 95% CI, 2.2-8.5; P<.001). Also, students who matriculated less than 6 months after completing their undergraduate education were drawn to primary care practice at higher rates than those who delayed enrollment (OR, 2.3; 95% CI, 1.2-4.5; P=.016). None of the remaining demographic variables were associated with students' residency preference. Being female and matriculating immediately after undergraduate education was associated with a preference for primary care residency. However, no significant association was found between mindfulness and either residency preference or choice of alternative curricula.

Increasing Self-Awareness of Medical Students Through the Use of Ultrasonography.

Self-awareness is vital for the health and development of medical students, but few reported modalities successfully increase medical student self-awareness. To assess the effect of ultrasonography on medical student self-awareness and health status. In 2016, first- and second-year osteopathic medical students completed a 9-item survey, created specifically for the current study, which included questions about the use of ultrasonography, health status, and self-awareness after completing at least 1 ultrasonography course. Differences between student responses by class were analyzed using χ2 analysis for items assessing experience with ultrasonography and t tests for items assessing self-awareness. Of the 329 students surveyed, 192 (58.4%) reported using ultrasonography to explore or monitor their own health or body. Forty-nine students (14.9%) found out something about their health that they did not know before their exposure to ultrasonography. Significant differences were found in the use of ultrasonography between first-year and second-year students; more second-year students reported using ultrasonography outside of laboratory hours (P<.05) and discovering incidental findings (P<.05). The largest portions of students reported average health status for exercise (106 of 325 [32.6%]), stress management (174 of 324 [53.7%]), and sleep (137 of 326 [42.0%]). The largest portions of students reported very good health status for tobacco use (282 of 322 [87.6%]), alcohol use (138 of 323 [42.7%]), and healthy relationships (118 of 326 [36.2%]). Statistically significant differences existed in responses between first- and second-year students regarding exercise (P=.007) and alcohol use (P=.001). The majority of students agreed or strongly agreed (182 of 326 [55.8%]) that access to ultrasonography equipment and ultrasonography training during the first and second years of medical school increased their self-awareness. The results suggest that the incorporation of ultrasonography into medical education could potentially increase medical student health status and self-awareness.

Effects of Group Fitness Classes on Stress and Quality of Life of Medical Students.

Medical school can produce intense psychological distress in its students; however, there is a paucity of research exploring potential means of improving medical students' well-being. To investigate the relationship between physical exercise and stress and quality of life (QOL) in a medical student population. This nonrandomized, controlled, 12-week study used a survey research design. First- and second-year osteopathic medical students at the University of New England College of Osteopathic Medicine were recruited to participate in 1 of 3 groups: (1) students participating in 30-minute CXWORX (Les Mills International LTD) group fitness classes; (2) students exercising alone or with up to 2 additional partners regularly (eg, running, weight lifting), henceforth called the health-enhancement group; and (3) students in a control group who did not engage in regular exercise. Participants completed the Perceived Stress Scale survey once every 4 weeks, as well as visual analog scale surveys to assess physical, mental, and emotional QOL weekly during the course of the study. Statistical significance was defined as P<.05. Sixty-nine participants met the inclusion criteria and completed the study protocol, with 25 in the fitness class group, 29 in the health-enhancement group, and 15 in the control group. Compared with baseline values, the fitness class group demonstrated decreased perceived stress (P=.038) and increased physical QOL (P=.007), mental QOL (P=.046), and emotional QOL (P=.004) after 12 weeks. Participants in the health-enhancement and control groups showed no statistically significant changes between baseline and week 12 for any of these parameters, with the exception of mental QOL, which improved in the health-enhancement group (P=.023). Participation in regular group fitness classes led to a statistically significant decrease in perceived stress and an increase in physical, mental, and emotional QOL compared with exercising regularly on one's own or not engaging in regular exercise. Attending weekly group fitness classes could be a solution to improving the emotional well-being and stress level of medical students.

Assessment of Nutrition Knowledge and Attitudes in Preclinical Osteopathic Medical Students

Nutrition is often overlooked in everyday health care despite the definitive connection between diet and health. Many practicing physicians and medical students feel unqualified to discuss specific dietary recommendations with patients, which may be attributed to inadequate nutrition education during medical school. To assess the nutrition knowledge of osteopathic medical students and their attitudes regarding the importance of nutrition counseling in their future role as practicing physicians. Using a descriptive, cross-sectional study design, the authors evaluated first- and second-year osteopathic medical students' nutrition knowledge and attitudes toward nutrition counseling. A questionnaire that assessed attitudes toward nutrition counseling and a quiz that tested nutrition knowledge were used. A total of 257 first-year (n=139) and second-year (n=118) medical students (mean [SD] age, 24.8 [3.4] years; 52.8% female and 78.2% white) completed the quiz and survey. The average score of the nutrition knowledge quiz was 69.5%, with 130 participants (50.6%) scoring below the school's passing rate of 72.5%. Second-year students performed better than first-year students on the quiz (mean, 74.2% vs 65.9%; t=-5.17; P<.001). The majority of participants (143 [55.6%]) felt comfortable counseling patients on nutrition recommendations; however, only 30 (11.9%) were aware of the current dietary reference intakes. Qualitatively, most participants acknowledged the importance of providing patient education, promoting overall health and wellness, and preventing and treating disease. The majority of participants felt comfortable counseling future patients on nutrition recommendations; however, most participants lacked knowledge of dietary reference intakes and medical nutrition therapy. Because half of osteopathic medical students typically enter primary care, students and their future patients would benefit from the integration of more nutrition education in medical school.

Osteopathic Philosophy and Manipulation Enhancement Program: Influence on Osteopathic Medical Students' Interest in Osteopathic Manipulative Medicine.

Interest in osteopathic manipulative medicine (OMM) among first- and second-year osteopathic medical students typically declines toward the end of the second year of medical school. An osteopathic philosophy and manipulation enhancement (OPME) program was implemented for osteopathic medical students to gain additional exposure to OMM at the Touro College of Osteopathic Medicine in New York, New York. To assess how additional exposure to OMM through the OPME program influenced first- and second-year students' interest in using OMM. A survey of first- and second-year osteopathic medical students was conducted at the end of the school years to evaluate students' demographics, exposure to OMM before matriculation, reasons for participating in the OPME program, and level of interest in OMM before and after participating in the OPME program. Of 390 students, 204 returned the survey. Respondents reported that their exposure to OMM before enrollment was mostly from reading about OMM philosophy (112 [54.9%]). Respondents also gained exposure from learning about OMM from family members or friends who had been treated by an osteopathic physician (37 [18.1%]), shadowing an osteopathic physician before matriculation (33 [16.2%]), and being treated by an osteopathic physician themselves (22 [10.8%]). After the OPME sessions, respondents reported improved practical skills (98 of 170 [57.6%]) and increased level of confidence in applying OMM (87 of 170 [51.2%]). Nearly half of respondents reported that being treated by a faculty member (100 [49.0%]) was very likely to increase their level of interest in OMM, followed by treating other classmates (77 [37.7%]) and being treated by classmates (73 [35.8%]). The OPME program improved students' interest in OMM and can be modified and implemented in any college of osteopathic medicine.

Accuracy of Anterior Superior Iliac Spine Symmetry Assessment by Routine Structural Examination.

Assessment of the anterior superior iliac spine (ASIS) is a key component in generating the pelvic diagnosis of somatic dysfunction, but studies have shown poor reliability between examiners. To assess the influence of homogeneous training, years of experience, and eye dominance on the percentage of correctness, sensitivity, and specificity of ASIS evaluation. Osteopathic physicians, predoctoral teaching fellows, and first- and second-year osteopathic medical students from a single teaching institute assessed 3 plastic pelvic models with ASIS anatomic landmarks set at different levels: even and 5- and 10-mm descrepancies. Dominant and nondominant eyes were used independently to assess ASIS levels. A total of 147 examiners (participants) participated in this study (66 first-year and 61 second-year medical students, 15 fellows, and 5 osteopathic physicians). The overall percentages of correct results were 31.0% (even levels), 82.8% (5-mm discrepancy), and 91.7% (10-mm discrepancy). Differences by level of training were statistically significant only for the 5-mm ASIS discrepancy, where participants with more experience performed better. The overall sensitivity was 82.8% (5-mm discrepancy) and 91.7% (10-mm discrepancy), and the specificity was 31.0%. No statistically significant differences were found in the percentage of correct results by eye dominance. Assessment of ASIS is sensitive but not specific at discrepancies of 5 mm or greater. Length of experience positively influences the percentage of correct results, and eye dominance does not significantly change this outcome. This form of assessment can be used to screen for ASIS asymmetry.

Innovative Approach to Teaching Osteopathic Manipulative Medicine: The Integration of Ultrasonography

Noninvasive diagnostic methods and palpatory physical examination skills are especially important for osteopathic medical students intending to work in rural, underresourced, or underserved areas. The A.T. Still University-Kirksville College of Osteopathic Medicine integrates ultrasonography into the osteopathic manipulative medicine (OMM) courses required during the first 2 years of medical school, allowing students to learn the technology and to visualize anatomical structures and regions. To assess the feasibility of integrating ultrasonography into the first-year and second-year OMM curriculum through the evaluation of students' success in demonstrating the technology and visualizing the anatomy. As part of their OMM requirements at the A.T. Still University-Kirksville College of Osteopathic Medicine, all first- and second-year students in OMM courses were given ultrasonography assignments that required them to obtain images of musculoskeletal structures in different regions of the body. First-year students studied craniocervical structures and the thoracic, lumbar, and sacral regions. Second-year students studied the glenohumeral joint and the suprapatellar recess. The assignments focused on identifying structures of interest, making annotations, and measuring the structures of interest. Handouts with detailed instructions and a demonstration were provided before each assignment. A total of 183 first-year students and 165 second-year students participated. Of the first-year students, on average, 177 of 181 were able to successfully complete the assignments, with an average completion rate of 98%. The costotransverse joint assignment yielded the lowest completion rate (97%), and the craniocervical landmarks assignment had the highest completion rate (99%). Of the second-year students, 162 of 165 participants were able to successfully complete the assignments, with an average completion rate of 98%. Mean scores were the same for both second-year assignments. First-year and second-year osteopathic medical students successfully demonstrated their use and understanding of ultrasonography and found their assigned structures using live ultrasound imaging. The skills gained through these assignments added another dimension to students' understanding of normal and pathologic musculoskeletal anatomy and vasculature. The integration of ultrasonography into OMM courses may have created a foundation for learning ultrasound-guided injection techniques.

Osteopathic Medical Students' Understanding of the Patient Protection and Affordable Care Act: A First Step Toward a Policy-Informed Curriculum

Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum. To assess first- and second-year osteopathic medical students' beliefs about the ACA. In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013. A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care. These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.

Perception-based effects of clinical exposure to osteopathic manipulative treatment on first- and second-year osteopathic medical students.

Little research has been done regarding osteopathic medical students' clinical exposure to osteopathic manipulative treatment (OMT). Most existing research focuses on third- and fourth-year students. To determine the effects of clinical exposure to OMT on first- and second-year osteopathic medical students by assessing the same population's perceptions of OMT. In the present survey-based study, conducted at the New York Institute of Technology College of Osteopathic Medicine, first- and second-year osteopathic medical students were administered an electronic survey containing 18 multiple-choice questions. The first 2 questions were demographic. The next 6 questions had participants identify what, if any, clinical exposure to OMT they had, including clinical shadowing, the MedPrep program, and the Summer Student American Academy of Osteopathy Osteopathic Manipulative Medicine Preceptorship program. The 10 questions that followed assessed the participant's perception of OMT: (1) understanding, (2) attitude toward OMT, (3) scope of practice of OMT, and (4) intention to use OMT in future clinical practice. The survey used the statistically validated Likert scale for all of the scaled questions. Analysis was performed using the Pearson χ(2) test and the Fisher exact test. Of the 600 students who were sent surveys, 364 replied, for a response rate of 60.7%. There was an association with students' anticipated use of OMT in their future clinical practice and the following types of clinical exposures to OMT: MedPrep (P=.04), Summer Student American Academy of Osteopathy Osteopathic Manipulative Medicine Preceptorship (P=.04), extracurricular OMT didactics (P=.048), and shadowing a physician performing OMT before attending osteopathic medical school (P=.007). Being treated with OMT had no association with anticipated future use of OMT. More OMT clinical exposures were associated with more positive responses to the perception questions ([Formula: see text], P<.001). Participants with clinical exposure to OMT before entering clinical training were more likely to plan to use OMT in future practice. Early clinical exposure to OMT before or during the first 2 years of osteopathic medical school was associated with a positive perception of OMT.

Association between cervical and thoracic somatic dysfunction among second-year osteopathic medical students.

The ubiquitous nature of cervical and thoracic somatic dysfunction requires osteopathic physicians to have a strong working knowledge of regional spinal mechanics and their functional and dysfunctional interrelationships. To determine whether cervical and thoracic somatic dysfunction occur concomitantly, particularly somatic dysfunction of the occipitoatlantal (OA) and upper thoracic (T1-T4) region of the spine. A retrospective analysis of cervical and thoracic somatic dysfunction prevalence diagnosed by faculty in second-year osteopathic medical students was conducted. Somatic dysfunction was defined as a vertebral unit possessing any of the following palpatory characteristics: tissue texture changes, asymmetry of motion and relative position, restriction of motion, or tenderness (ie, TART criteria). For each instance of somatic dysfunction diagnosed, the segmental level identifying the superior segment of the involved vertebral unit was recorded, as well as the spinal region (ie, cervical [OA, atlantoaxial (AA), and C2-C7] or thoracic [T1-T12]). Descriptive analyses, a Pearson χ(2) test, and a regression model using an analysis of variance were performed on the data. Among 338 students included in the study, the following 5 vertebral segments were found to have the highest prevalence of somatic dysfunction: OA (257 [76.0%]), C3 (257 [76.0%]), T3 (247 [73.1%]), T5 (226 [66.9%]), and T4 (223 [66.0%]). A Pearson χ(2) test of association between the OA vertebral segment and the following segments were found to be statistically significant: AA (P=.024), C2 (P=.032), and T4 (P=.045). An analysis of variance revealed statistical significance between the prevalence of upper cervical (OA, AA, C2) somatic dysfunction and the prevalence of upper thoracic (P<.001) and midthoracic (T5-T8) (P<.001) somatic dysfunction; the prevalence of lower cervical (C3-C7) (P=.74) and lower thoracic (T9-T12) (P=.085) somatic dysfunction was not found to be significant. A statistically significant association between cervical somatic dysfunction and thoracic somatic dysfunction was confirmed. In addition, there was a statistically significant association between dysfunction of the OA and the AA, C2, and T4 vertebral segments. These results suggest that the number of dysfunctional vertebral segments in the upper thoracic and midthoracic spinal regions is directly proportional to the number of dysfunctional segments found in the upper cervical spinal region.

Preventive Osteopathic Manipulative Treatment and Stress Fracture Incidence Among Collegiate Cross-Country Athletes

Stress fractures are common among athletes, particularly distance runners, with many theories regarding the etiologic process of stress fractures and various studies identifying risk factors or suggesting preventive techniques. To our knowledge, no previous studies have discussed the possible causative effects of somatic dysfunction or the preventive capabilities of osteopathic manipulative treatment (OMT). To apply a preventive OMT protocol for cross-country athletes to reduce the incidence of stress fractures. Cohort study. Examinations of cross-country athletes at an NCAA (National Collegiate Athletic Association) Division I university were performed by supervising physician-examiners and first- and second-year osteopathic medical students during several consecutive academic years. Athletes re-enrolled in the study each year they continued to be eligible. The intervention included osteopathic structural examination and OMT that focused on somatic dysfunction identified in the pelvis, sacrum, and lower extremities. More than 1800 participant examinations were performed on 124 male and female participants by 3 supervising physician-examiners and 141 osteopathic medical students over the course of 5 consecutive academic years (2004-2005 to 2008-2009). Data from these academic years were compared with data from the previous 8 academic years (1996-1997 to 2003-2004). An average of 20 new participants enrolled yearly. The number of annual stress fractures per team ranged from 0 to 6 for male participants and 1 to 6 for female participants. The cumulative annual incidence of stress fractures for male participants demonstrated a statistically significant decrease from 13.9% (20 of 144) before intervention to 1.0% (1 of 105) after intervention, resulting in a 98.7% relative reduction in stress-fracture diagnosis (P=.019). The cumulative annual incidence for female participants showed a minimal decrease from 12.9% (23 of 178) before intervention to 12.0% (17 of 142) after intervention, an 8.5% relative reduction in stress-fracture diagnosis (P=.671). The cumulative annual incidence of all participants decreased from 13.4% (43 of 322) before intervention to 7.3% (18 of 247) after intervention, a 45% relative reduction in stress-fracture diagnosis (P=.156). There was a statistically significant decrease in the cumulative annual incidence of stress fractures in male, but not female, cross-country athletes after receiving OMT.