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Background . Despite the promotion of international osteopathic recommendations and registration guidelines, relational competencies and patient education practices present a challenge in the clinical setting due to lack of training. In France, the latest national osteopathic standards for education and practice defined a relational competency that includes patient education. Little is known about its integration in curricula and how French osteopathic practitioners are subsequently trained for relational competency. Objective . To determine teaching, learning, and assessment methods related to relational competency in French initial osteopathic training programs and identify the role of patient education in this relational competency. Methods . An online questionnaire was designed and sent to all initial training institutes in France (n = 28). Eight institutes answered the survey. Results . The relational competency appeared in various courses, enhanced by clinical learning. However, the courses were not specific to this competency and the volume of hours was relatively low. Patient education was seen as part of the relational competency but was poorly implemented. This competency-based approach is still considered an emerging practice in these institutes. Conclusions . There is a misalignment among intended learning outcomes, teaching, and assessment. The current educational practices are not sufficient to support relational competency, specifically regarding patient education. Further research is needed on how French standards are understood, how they are assimilated by educators, and how they are translated into educational practice. In addition, the adequacy of educators training for effective implementation of the competency-based approach should be questioned.

Background Visceral techniques have taken their place in the established osteopathic treatment approaches, however, very little research exists on their use in clinical settings in Australia. This study reports on the prevalence, enablers of and barriers to visceral technique use by registered osteopaths currently practising in Australia utilising a nationally representative database from the Osteopathy Research and Innovation Network (ORION). Methods The recruitment invitation pack for this study was distributed via email to the ORION database during July 2019. The study utilised a 27-item survey with both Likert scale and free text responses. All data were imported into the statistical software package SPSSTM 25 for descriptive statistical analysis. Results A total of 143 Australian osteopaths participated in the study representing a response rate of 14.4%. The participants reported a mean number of 16.1 years in practice, with 55.3% identifying as female and approximately 70% reporting as working from a metropolitan location. The majority of respondents (71.5%) reported using visceral techniques within the preceding 6 months, with 12.8% indicating that they had previously used visceral techniques in practice but had subsequently elected to stop using them. Key barriers identified by the study in relation to visceral technique usage related to practitioner knowledge, confidence and a perceived lack of support, while enablers were linked to perceived benefit in patient management and private payment. Conclusion This study provides an important step forward in our understanding of the current use of visceral techniques by the Australian osteopathic workforce. Further research is required to better understand practitioners’ rationale for including visceral techniques in practice, patient outcomes where visceral techniques are used, and the cost-effectiveness of their inclusion in patient care.

Background: Health professionals involved in teaching future practitioners have been studied to some extent, but our knowledge of their clinical characteristics is variable. Our study sought to profile the clinical characteristics of osteopaths who teach in the three Australian universities delivering pre-professional osteopathy education. Materials: This study is a secondary analysis of data collected via the Australian Osteopathy Research and Innovation Network (ORION) project. Descriptive statistics were generated for each of the 27-item questionnaire variables. For binary responses, unadjusted odds ratios were calculated, and for continuous variables, independent t-tests were used. Backward step-wise regression modelling was used to identify significant characteristics associated with university teaching in osteopathy. Results: The survey demonstrated 9.9% of Australian osteopaths reported being involved in university teaching. Compared to non-teaching survey respondents, the osteopaths involved in university teaching were more likely to be female (OR 1.56), older ( p < 0.01) and in clinical practice for longer ( p < 0.01) but report fewer patient care hours ( p < 0.01) and patient visits per week ( p < 0.01). Osteopaths involved in university teaching were also more likely to be involved in research (OR 18.54) and clinical supervision (OR 12.39). They also reported a broader range of patient presentations and therapeutic modalities than their counterparts. Conclusions: This nationally representative survey demonstrates a small percentage of the Australian osteopathy profession are engaged in university teaching. Our secondary analysis has highlighted several characteristics associated with involvement in university teaching that begin to shed light on the composition of the Australian osteopathy teaching workforce. This data may inform development of a skilled and experienced teaching workforce.

Context While 90% of former American Osteopathic Association (AOA) residency programs transitioned to Accreditation Council for Graduate Medical Education (ACGME) accreditation, surgical subspecialty programs such as ear, nose, and throat (ENT, 62%) and ophthalmology (47%) struggled to gain accreditation. Doctors of Osteopathic Medicine (DOs) actively participate in serving underserved communities, and the loss of AOA surgical specialty programs may decrease access to surgical care in rural and nonmetropolitan areas. Objectives To determine the challenges faced by former AOA-accredited surgical subspecialty programs during the transition to ACGME accreditation, particularly ENT and ophthalmology programs in underresourced settings. Methods A directory of former AOA ENT and Ophthalmology programs was obtained from the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS). A secured survey was sent out to 16 eligible ENT and ophthalmology program directors (PDs). The survey contained both quantitative and qualitative aspects to help assess why these programs did not pursue or failed to receive ACGME accreditation. Results Twelve of 16 eligible programs responded, com-prising six ophthalmology and six ENT PDs. Among the respondents, 83% did not pursue accreditation (6 ophthalmology and 4 ENT programs), and 17% were unsuccessful in achieving accreditation despite pursuing accreditation (2 ENT programs). Across 12 respondents, 7 (58%) cited a lack of hospital/administrative support and 5 (42%) cited excessive costs and lack of faculty support as reasons for not pursuing or obtaining ACGME accreditation. Conclusions The survey results reflect financial issues associated with rural hospitals. A lack of hospital/administrative support and excessive costs to transition to the ACGME were key drivers in closures of AOA surgical specialty programs. In light of these results, we have four recommendations for various stakeholders, including PDs, Designated Institutional Officials, hospital Chief Medical Officers, and health policy experts. These recommendations include expanding Teaching Health Center Graduate Medical Education to surgical subspecialties, identifying and learning from surgical fields such as urology that fared well during the transition to ACGME, addressing the lack of institutional commitment and the prohibitive costs of maintaining ACGME-accredited subspecialty programs in underresourced settings, and reconsidering the Centers for Medicare & Medicaid Services (CMS) pool approach to physician reimbursement.

Objective To develop a valid and reliable instrument for measuring attitudes toward osteopathic medicine. Methods Participants included 5,669 first-year students from 33 U.S. colleges of osteopathic medicine, who completed an online survey at the beginning of the 2019-2020 academic year. Using data from the nationwide Project in Osteopathic Medical Education and Empathy, we developed a 13-item instrument: Attitudes Toward Osteopathic Medicine Scale (ATOMS) and demonstrated the validity and reliability of its scores. The social desirability response bias was controlled in statistical analyses. Results The corrected item-total score correlations were all positive and statistically significant, and the effect sizes of item discrimination indices were large. Cronbach's coefficient alpha reliability was 0.83. Construct validity, corroborating face and content validity of the ATOMS, was supported by three components, emerged from factor analysis: "Perspectives on Osteopathic Medicine," "Osteopathic Diagnosis and Treatment," and "Holistic-Integrative Care." Correlations between ATOMS scores and scores of cognitive empathy, emotional empathy; orientation toward interprofessional collaboration; lifelong learning; and burnout were statistically significant in the expected direction, providing validity evidence for the ATOMS. Using the method of contrasted groups, significant differences in the ATOMS scores were found by gender, ethnicity, academic background, and career interest in the expected direction, supporting the validity of the ATOMS scores. National norms were developed to assess individual scores alongside national percentile ranks. Conclusions The ATOMS, developed in a nationwide study, supported by strong psychometric evidence for measuring orientation toward osteopathic medicine, has implications for the assessment of osteopathic medical education, patient outcomes, and admission decisions.

Context Comprehensive sports medicine care goes beyond the treatment of injuries resulting from athletic activities. Ultimately, it is a competence that includes knowledge in physical therapy, training, nutrition, coaching, motivation, competition, mentoring, psychology, and spirituality that allows the physician and patient to collaborate on promoting the patient’s health goals. The current literature demonstrates a lack of knowledge in the Osteopathic Primary Care Sports Medicine Model’s effectiveness in performance. Objectives To determine whether a comprehensive osteopathic primary care sports medicine approach can improve performance and health outcomes in collegiate athletes. Methods A randomized controlled trial commenced just prior to the start of the lacrosse season and concluded at the end of the season. All the New York Institute of Technology (NYIT) collegiate lacrosse players were educated first in a 1-day seminar of the core competencies, and all participants had access to ask questions on their own volition. Then they were randomized into two groups, either the experimental group receiving the direct osteopathic primary care sports medicine intervention (n=18) or the control group not having active intervention (n=19). Also, the overall team winning percentage for that season was computed and compared to that for the previous years and the following year. Participants were assessed before and after the intervention with the Patient Health Questionnaire (PHQ-9), the 36-Item Short Form Survey (SF-36), custom Osteopathic Primary Care Sports Medicine questionnaire, and body fat composition, and their changes were compared between the experimental group and the control group. Collected data were analyzed using the repeated-measures analysis of variance. Results Thirty-seven participants were enrolled in the study. After 14 participants were excluded due to being lost to follow-up, 23 athlete records were analyzed. The winning percentage of the team was highest during the year of the study period time than in the 3 previous years and the following year. The test group did not have any statistically significant change in the PHQ-9, SF-36, custom Osteopathic Primary Care Sports Medicine questionnaire, as well as in body fat composition. Conclusions When used during a collegiate lacrosse season, this Osteopathic Primary Care Sports Medicine intervention did not significantly improve health outcomes. This preliminary study, despite its limitations in compliance and study population size, did demonstrate improvement in overall team performance when comparing the intervention sport season to other seasons but was not statistically significantly. Therefore, further studies are warranted to improve the understanding in this approach to athlete health outcomes and performance.

Background Anorexia nervosa (AN) mainly affects women (sex ratio 1/10) and most often starts during adolescence. The prognosis of AN remains poor (10% of deaths and high risk of chronicity). Body dissatisfaction, disturbances in recognition and identification of body sensations are some of the key symptoms of AN. However, there is a contrast between this consensual observation of body image disorders in AN, and the relative deficit of specifically targeted body treatments. Our proposal for a body approach specifically dedicated to AN is based on the understanding that posture, breathing, muscle tension and body perception are closely linked to our psychological and emotional state and are therefore disturbed in patients with AN. The purpose of this monocentric randomized controlled trial is to evaluate if a targeted osteopathic protocol treatment for AN in addition to treatment as usual (TAU) is significantly more effective than TAU alone. Methods In total, 72 patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups: one receiving the specific osteopathic treatment targeted for AN in addition to the TAU (group A) and the other one, receiving TAU only (group B). The patients in group A will receive 5 30-min osteopathic treatment sessions. Soft specific palpatory techniques on the diaphragm, digestive system and cervical region will be performed. The TAU is defined by the multidisciplinary approach recommended by the French health high authority. The primary outcome is the evaluation of interoceptive sensibility and secondary outcomes include clinical and psychopathology-related symptoms with assessment of somatic dysfunctions’ evolution. A qualitative study will also be carried out, applying the Interpretative Phenomenological Analysis method. Patients will be included for a maximum of 14 weeks between the inclusion time and the last evaluation. Discussion If the results of the study are positive (statistically significant efficacy of this osteopathic treatment protocol), the study will provide arguments in favor of osteopathic sessions as a possible non-invasive additional treatment option in the multidisciplinary care approach for patients with AN. Trial registration ClinicalTrials.gov ID: NCT04666415, Release Date: December 11, 2020; N° ID-RCB: 2019-A02613-54.

Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.

Context During the COVID-19 pandemic, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visits while simultaneously having to minimize direct patient care. The shift in direct clinical learning opportunities provided to third- and fourth-year medical students required a shift in the educational curriculum to develop learner skills around the appropriate use of telehealth in patient care. Objectives The aim of this project was to provide exposure to students so they could learn the telemedicine equipment and best practices, and how to identify infectious diseases to improve access to care and meet the needs of the patient. Methods In July and August of 2020, the Indiana Area Health Education Centers Program partnered with Marian University College of Osteopathic Medicine (MUCOM) to support a 1 day telehealth simulation (online curriculum, group lecture, and two standardized patient encounters) into their clerkship curriculum. We utilized a retrospective pretest-posttest to assess changes in learner knowledge around telehealth after the program. At the conclusion of the telehealth training program, students were asked to complete a retrospective pretest-posttest assessing their level of preparedness to utilize telehealth equipment, their preparedness to demonstrate “telehealth best practices” in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. Results A total of 96 learners completed the program in 2020. Posttest results demonstrate a statistically significant (p Conclusions Our telehealth curriculum involving a video, interactive learning session, and two standardized patient experiences provided osteopathic medical learners with realistic simulated case scenarios to work through in effort to improve their knowledge and self-efficacy around the utilization of telehealth in practice.

BackgroundOsteopathy is a type of complementary medicine based on specific manual techniques. In many countries, including Germany, the profession is not officially regulated, and evidence for the effectiveness of osteopathy is insufficient for most diseases. Nevertheless, many health insurances in Germany offer reimbursement for therapy costs, if osteopathy is recommended by a physician.This cross-sectional survey of German general practitioners (GPs) explored beliefs and attitudes towards osteopathic medicine and described their daily interactions with it.MethodsA random sample of 1000 GPs from all federal states was surveyed by mail using a self-designed questionnaire. We collected data on sociodemographics, personal experiences with osteopathy, and attitudes and expectations towards osteopathy. In particular, participants were asked about indications for osteopathic treatment and their beliefs about its effectiveness for different patient groups and diagnoses. A self-designed score was used to estimate general attitudes towards osteopathy and identify factors correlated with greater openness. Additionally, we performed logistic regression to reveal factors associated with the frequency of recommending osteopathy to patients.ResultsResponse rate was 34.4%. 46.5% of participants were women, and the median age was 56.0 years. 91.3% of GPs had referred patients to an osteopath, and 88.0% had recommended osteopathy to their patients. However, 57.5% acknowledged having little or no knowledge about osteopathy. Most frequent reasons for a recommendation were spinal column disorders (46.2%), other complaints of the musculoskeletal system (18.2%) and headaches (9.8%). GPs estimated the highest benefit for chronically ill and middle-aged adults. Female gender (OR 2.09; 95%CI 1.29–3.38) and personal treatment experiences (OR 5.14; 95%CI 2.72–9.72) were independently positively associated with more frequent treatment recommendation.ConclusionGPs in Germany have frequent contact with osteopathy, and the vast majority have recommended osteopathic treatment to some extent in their practice, with foci and opinions comparable to other Western countries. The discrepancy between GPs making frequent referrals for osteopathic treatment while self-assessing to have little knowledge about it demonstrates need for intensified research on the collaboration with osteopaths and how to best integrate osteopathic treatments. Our results may help to focus future effectiveness studies on most relevant clinical conditions in general practice.

Background: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric medical community. Methods: A wellness needs assessment was developed and distributed to podiatric medical residents via electronic survey to assess overall wellness levels of residents and to highlight several subdomains of well-being in the training programs of the podiatric medical profession. Results: A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they experienced high levels of professional burnout, with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, levels of intellectual and environmental wellness were high, and levels of financial and physical wellness were reported as low. In addition, free response answers were recorded in the survey regarding well-being initiatives that have been implemented in residency programs, and in many cases no such programs are reported to exist. Conclusions: Podiatric medical residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analyzing well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms.

Context It is generally acknowledged that osteopathic physicians take a holistic approach to patient care. This style may help prevent the progression of painful musculoskeletal conditions, particularly if combined with osteopathic manipulative treatment (OMT). Objectives The study aimed to determine if osteopathic medical care lowers the risk of progression from localized chronic low back pain to widespread pain and lessens the impact of pain on health-related quality of life. Methods A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data acquired from April 2016 through March 2021. Registry participants aged 21–79 years with chronic low back pain at the baseline encounter were potentially eligible for inclusion if they had a treating physician, completed all four quarterly follow-up encounters, and did not report physician crossover at the final 12-month encounter. Eligible participants were classified according to the type of physician provider at baseline and thereby into osteopathic or allopathic medical care groups. Participants were also classified according to prior use of OMT at the final encounter. Widespread pain was measured at baseline and each quarterly encounter to determine the period prevalence rate of widespread pain and its severity over 12 months using the Minimum Dataset for Chronic Low Back Pain recommended by the National Institutes of Health. Participants who reported “not being bothered at all” by widespread pain during each encounter were classified as not having widespread pain, whereas those who were bothered “a little” or “a lot” at any quarterly encounter were classified as having widespread pain. The severity of widespread pain was measured by summing participant responses at each encounter. The Patient-Reported Outcomes Measurement Information System was used at each encounter to measure health-related quality-of-life (HRQOL) scores for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. Results A total of 462 participants were studied, including 101 (21.9%) in the osteopathic medical care group and 73 (15.8%) who used OMT. The mean age of participants at baseline was 52.7 ± 13.2 years (range, 22–79 years) and 336 (72.7%) were female. A lower period prevalence rate of widespread pain was observed in the osteopathic medical care group (OR, 0.47; 95% CI, 0.27–0.81; p=0.006) and in the OMT group (OR, 0.40; 95% CI, 0.21–0.75; p=0.004), although the latter finding did not persist after adjustment for potential confounders. The osteopathic medical care and OMT groups both reported lower widespread pain severity. The osteopathic medical care group also reported better age- and sex-adjusted outcomes for each of the seven HRQOL dimensions throughout the study. The OMT group reported better outcomes in five of the HRQOL dimensions. Conclusions This study supports the view that osteopathic physicians practice a holistic approach to medical care that manifests itself through a lower risk of progression from chronic low back pain to widespread pain, lower widespread pain severity, and lesser deficits in HRQOL. Similar findings were generally associated with OMT use.

The Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and other (LGBTQI+) community continues to experience health inequity and unmet needs. This manuscript examines the application of the Four Tenets of Osteopathic Medicine (FTOM) during a patient’s self-disclosure of their sexual orientation and/or gender identity to the provider, also known as coming out. Tenet One discusses the interplay between intersectionality and coming out. Tenet Two elucidates how coming out moves toward a balance of homeostasis and self-healing. Tenet Three examines how structure and function can be understood on a personal level and how society influences coming out. Tenet Four explains the resources available to facilitate the previously forementioned changes. By applying the Four Tenets, the provider may more readily understand what “coming out” means on personal and social levels and what implications they may have on their patients’ health.

This case study describes a joint pilot project to implement interprofessional education (IPE) between a United States college of osteopathic medicine and a college of pharmacy co-located on one campus. The pilot was intended to address the Interprofessional Education Collaborative (IPEC) domains and competencies and to serve as a first step and bridge toward future multidisciplinary endeavors. We describe the process of creating an IPE team, developing a workshop and gathering feedback. The key elements for a successful IPE program are identified as: administrative support, faculty engagement, and long-term planning. Challenges to effective implementation encountered were: scheduling conflicts, faculty engagement, and a specific IPE budget. The aim of this paper is to provide insights and share lessons learned regarding approaches taken to implement this IPE initiative. We advance the premise that while IPE is an essential foundation for preparing health professions students for interprofessional patient-centered practices, its implementation has many challenges.

Objective This article examines the outcomes and impact of the AOA/ACGME Single Accreditation System (SAS) on 6 osteopathic surgical specialties, their program directors, residents, and students and how growth in osteopathic medical schools and students affects ACGME surgical training. Design The study charts the choices of 159 osteopathic surgical residencies regarding the acquisition of ACGME accreditation, decisions made by ACGME Review Committees, and how they affected program leadership, residents, and osteopathic medical students as reflected in results of residency matching programs. Setting and Participants According to the SAS, the osteopathic profession ceded its accreditation operations and have its programs acquire ACGME accreditation between 2015 and 2020 to form a unified accreditation system under the ACGME. Results More than one-fourth (26%) of eligible osteopathic surgical programs either did not submit an application or voluntarily withdrew from the ACGME accreditation process. For the 118 surgical programs that did achieve ACGME Initial Accreditation, subsequent site visits and Review Committee decisions sparingly granted Continuing Accreditation status. In addition, 49% of the osteopathic applications listed an MD program director. Osteopathic surgical residents encountered few disruptions in transitioning to the ACGME. The full impact of the SAS was felt by osteopathic graduates in 2020 who encountered fewer DO-oriented ACGME programs and the historic trend of established ACGME surgical programs favoring candidates from American allopathic medical schools. As the osteopathic profession continues its rapid growth, competition for surgical training will only increase. Conclusions Participation in the SAS resulted in the loss of 41 surgical programs and marked reductions in training positions during a period of rapid osteopathic growth. Results from matching programs indicate that integration of DOs into established ACGME surgical residencies will be a slow, gradual process. The SAS succeeded in creating a unified standard for surgical training yet generated negative consequences on osteopathic surgical training.

Objective: The aim of this study is to determine if a specific tablet-based training module can be used as an effective tool for independently training novice sonographers in the components of the focused assessment for sonography in trauma (FAST) exam. Design: Participants attended a 15-minute orientation presentation followed by a 2-hour ultrasound scanning workshop where they used a novel tablet-based training module to learn the components of the FAST exam independently. Setting: This study took place at an accredited United States college of osteopathic medicine. Participants: Thirty-two first-year medical student volunteers without any prior ultrasound training in abdominal scanning. Interventions: Training activities included brief didactic training and participation in an independent learning FAST exam workshop. Main outcome measures: Participants filled out subjective pre- and post-training self-confidence questionnaires and were objectively assessed and scored on their scanning skills. Results: Comparison of the pre- and post-training subjective questionnaires showed a statistically significant (p < 0.001) increase in participant confidence in performing all components of the FAST exam. During skill evaluation, participants collectively demonstrated correct technique in 366 (82 percent) of the 448 total FAST exam scanning tasks they attempted. Conclusions: Based on these findings, the authors believe that learning to perform the FAST exam with this digital training module is an effective means of independently acquiring ultrasound skill. Digital ultrasound training modules like this one could have several useful applications, such as serving as an educational resource, or functioning as a point-of- care scanning adjunct to medical professionals in underdeveloped and rural areas where formal ultrasound training is not available.

Background. In recent decades, diagnostic and therapeutic procedures related to classical orthopedics, manual medicine and osteopathy have become widespread in Russian clinical medicine. Osteopathy expands the possibilities of diagnosis and treatment of various diseases due to the fact that its methods are not addressed to individual symptoms of the disease, but to violations of the system organization of physiological functions of the body and to establishing cause-and-effect relationships between mechanical damage of human tissues and the development of subsequent pathologies. Currently, the problem of studying the relationship of indicators of the osteopathic status of preschool children having perinatal signs of dysarthria is relevant for osteopathic doctors. Materials and methods. On the basis of the department of osteopathy of the Yaroslav-the-Wise Novgorod State University and the V.L. Andrianov Institute of the osteopathic medicine, a study was conducted aimed at assessing the clinical and physiological parameters of children aged 2.5 to 4.5 years with dysarthria and further substantiating the effectiveness of oteopathic treatment of adverse functional disorders of the brain that affect oral speech. The work used a computer electroencephalograph Mizar. Ultrasound dopplerography of the brain vessels of the subjects using the transcranial dopplerography device EME/Nicolet as well as ultrasound examination of the cervical spine was performed. The materials obtained in the course of the study were subjected to mathematical and statistical processing using the Statistica 6.0 software package, nonparametric (Wilcoxon test) and parametric methods were used with applying the Students t-test to assess the reliability of differences, and correlation analysis was performed to establish the relationship between clinical, physiological and osteopathic indicators in children before and after treatment. Conclusions. The results of the assessment of the clinical and physiological parameters of the subjects allowed us to infer that the osteopathic treatment was effective.

Social isolation and loneliness present significant challenges for the mental and physical health of older adults. Social distancing, mask wearing, and other precautions necessitated by the COVID-19 pandemic add to these challenges. This article details a telecollaborative service-learning project to engage older adults online and provide applied experiences for students. From March through October 2020, 54 students from Social Work (Master, Bachelor), the College of Osteopathic Medicine (COM; DO), and Occupational Therapy (Master) provided telephone support and Zoom™ based programming for older adults affiliated with the University of New England. Creative offerings were piloted weekly and debriefed on Friday afternoons in the spring, leading to more structured 8-week schedules in summer and fall. Peer-to-peer support took place between older adults with experience in video meetings and those willing to learn. Bidirectional and intergenerational benefits were noted as older adults and students navigated the exigencies of the pandemic and learned important lessons with and from each other to advance knowledge and improve quality of life.

Context Patient-centered care is often considered a characteristic of osteopathic medicine, in addition to the use of osteopathic manipulative treatment (OMT) in such musculoskeletal conditions as low back pain. Objectives This study aimed to determine if patient-centered care or OMT are mediators of the clinical outcomes of osteopathic medicine in patients with chronic low back pain. Methods A comparative effectiveness study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry). Eligible patients met the diagnostic criteria recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain and completed four consecutive quarterly encounters between April 2016 and November 2020. The Consultation and Relational Empathy instrument for patient-centered care was used at the baseline encounter and OMT use was measured at the final encounter. The clinical outcome measures included low back pain intensity on a numerical rating scale (NRS) from 0 to 10, back-related functioning on the Roland-Morris Disability Questionnaire (RMDQ), and pain impact on the National Institutes of Health Minimum Dataset for Chronic Low Back Pain (NIH-MDS). A parallel multiple mediator model was used to compute the direct and indirect effects of osteopathic medicine in achieving each of the three clinical outcomes. Results The 404 study patients had a mean age of 52.2 years (standard deviation, 13.1 years) and 288 (71.3%) were female. The 88 (21.8%) patients treated by osteopathic physicians reported more favorable scores for patient-centered care (mean, 41.3; 95% CI 39.0–43.5) than patients treated by allopathic physicians (mean, 38.0; 95% CI 36.8–39.3) (p=0.02). Fifty-six (63.6%) patients treated by osteopathic physicians used OMT. The age- and sex-adjusted outcomes for patients of osteopathic vs. allopathic physicians across all four encounters were: mean, 5.4; 95% CI 5.0–5.7 vs. mean, 5.9; 95% CI 5.7–6.1 on the NRS for pain intensity (p=0.01); mean, 11.3; 95% CI 10.1–12.6 vs. mean, 14.0; 95% CI 13.3–14.7 on the RMDQ for back-related disability (p Conclusions This appears to be the first study to simultaneously address both patient-centered care and OMT as potential mediators of the effect of osteopathic medicine in treating chronic pain. Patient-centered care did not mediate the effects of osteopathic medicine and OMT only mediated outcomes relating to low back pain intensity. More research is needed to identify other aspects of osteopathic medicine that mediate its beneficial effects in patients with chronic low back pain.

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 2015-2020, 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.

Background As rhinology fellowship positions outpace the availability of academic rhinology jobs, it is increasingly important to identify characteristics that are associated with academic placement after fellowship completion. In this study, we evaluated the association of academic characteristics during training with current job placement and posttraining scholarly impact. Methods Previous rhinology fellows were identified using publicly available data. Bibliometric indices, training institutions, graduate degrees, and job placement data were used in bivariate and multivariable regression analyses to assess for association with predictors and academic trajectory. Results Data from 265 rhinologists, all graduating between 1991 and 2020, were included. Most surgeons (n = 185, 70%) held an academic position and 80 (30%) surgeons worked in a nonacademic setting; 93.2% had a Doctor of Medicine (MD) degree and 80.3% were male. Multivariable logistic regression indicated that a designation of MD, compared with Doctor of Osteopathic Medicine (DO; odds ratio [OR], 5.93; 95% confidence interval [CI], 1.97-21.9), number of publications during fellowship (OR, 1.19; 95% CI, 1.02-1.41), and h-index during training (OR, 1.25; 95% CI, 1.07-1.49]) were independently predictive of academic job placement. Meanwhile, number of primary authorships during fellowship (β = 1.47; 95% CI, 1.07-1.88]), h-index during training (β = 0.48; 95% CI, 0.25-0.71), and PhD (β = 4.16; 95% CI, 1.57-6.76) were associated with posttraining h-index. Medical school ranking; graduate degrees, including Master of Science (MS), Master of Business Administration (MBA), and Master of Public Health (MPH); and research metrics before residency were not associated with either academic placement or posttraining h-index. Conclusion The predictors of academic job placement in rhinology are unclear, but h-index during training, and research productivity during fellowship may serve as indicators of an academic career.

Context The failure to collect information on lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity in healthcare and medical education is a part of a systemic problem that limits academic medical institutions’ ability to address LGBTQ health disparities. Objectives To determine whether accurate sexual and gender minority (SGM) demographic data is being consistently collected for all US medical schools during admissions and enrollment, and whether differences exist between collection practices at osteopathic and allopathic schools. Methods Secure, confidential electronic were sent via email in July 2019 to 180 osteopathic (n=42) and allopathic (n=138) medical schools identified through the American Association of Colleges of Osteopathic Medicine Student Guide to Osteopathic Medical Colleges database and the American Association of Medical Colleges Medical School Admissions Requirements database. The nine question survey remained open through October 2019 and queried for; (1) the ability of students to self report SGM status during admissions and enrollment; and (2) availability of SGM specific resources and support services for students. Chi square analysis and the test for equality of proportions were performed. Results Seventy five of 180 (41.7%) programs responded to the survey; 74 provided at least partial data. Of the 75 respondent schools, 55 (73.3%) allowed applicants to self report a gender identity other than male or female, with 49 (87.5%) of those being allopathic schools compared with 6 (31.6%) osteopathic schools. Similarly, 15 (20.0%) allowed applicants to report sexual orientation, with 14 (25.5%) of those being allopathic schools compared with one (5.3%) osteopathic school. Fifty four of 74 (73.0%) programs allowed matriculants to self report a gender identity other than male or female; 11 of 74 (14.7%) allowed matriculants to report sexual orientation. Conclusions Demographics collection practices among American medical education programs that responded to our survey indicated that they undervalued sexual orientation and gender identity, with osteopathic programs being less likely than allopathic programs to report inclusive best practices in several areas. American medical education programs, and their supervising bodies, must update their practices with respect to the collection of sexual orientation and gender identity demographics as part of a holistic effort to address SGM health disparities.

Introduction.Posterior Positional plagiocephaly (PPP) is a cranial deformation seen in infants. The case number increased since 1992, following the supine sleeping advice. Most of the time several factors are combining together, leading to a multi-level lack of mobility of the infant, thus leading to the cranial deformation. Studies show this deformation to be linked with perturbations in various fields.Objective.This study aims to assess the efficacy of osteopathic care on the severity of the PPP.Materials and methods.100 infants were recruited in an osteopathic practice in Lyon (France). All the infants followed the same study protocol; however, the treatment was individualized. Three consultations occurred with a 15 days′ interval over 30 days′ period. Craniometric measurements were realized with Mimos® craniometer on each consultation.Results.The mean severity of the PPP was 10,1 mm at Day 0. At day 30, this average was down to 6 mm. It is a significant (pConclusions.As every infant is unique, every plagiocephaly is different, thus the treatment was not standardised. This study suggest some effectiveness for osteopathic care in the cranial asymmetry of infants with PPP. Other studies should be done, some with a control group, in order to compare our results with spontaneous evolution of plagiocaphaly.

COVID-19 continues to be a major societal disruptor that threatens the wellness and health of millions of people worldwide. We rightfully celebrate the over 20 million survivors in the United States, yet, what constitutes actual recovery, as many face continuing repercussions of their illness? This paper reviews COVID-19, focusing on its sequela of acute respiratory distress syndrome (ARDS) and the accompanying intensive care unit stay, treatment options and its increased morbidity. Outlined is the importance of long-term, comprehensive care for post-infection patients, as well as the numerous barriers to adequate care. We suggest looking to doctors of osteopathic medicine to bridge the gaps in multifactorial care, including psychological and physical dysfunction. Osteopathic medicine is discussed as a potential benefit during this pandemic by reviewing its effectiveness in a previous pandemic. However, additional work must be conducted to improve awareness of needed care and delivery of that care.

Background and purpose This 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 setting The 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. Findings Survey 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%. Summary Results 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.

Context The Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) is a three level examination used as a pathway to licensure for students in osteopathic medical education programs. COMLEX-USA Level 2 includes a written assessment of Fundamental Clinical Sciences for Osteopathic Medical Practice (Level 2-Cognitive Evaluation [L2-CE]) delivered in a computer based format and separate performance evaluation (Level 2-Performance Evaluation [L2-PE]) administered through live encounters with standardized patients. L2-PE was designed to augment L2-CE. It is expected that the two examinations measure related yet distinct constructs. Objectives To explore the concurrent validity of L2-CE with L2-PE. Methods First attempt test scores were obtained from the National Board of Osteopathic Medical Examiners database for 6,639 candidates who took L2-CE between June 2019 and May 2020 and matched to the students’ L2-PE scores. The sample represented all colleges of osteopathic medicine and 97.5% of candidates who took L2-CE during the complete 2019–2020 test cycle. We calculated disattenuated correlations between the total score for L2-CE, the L2-CE scores for the seven competency domains (CD1 through CD7), and the L2-PE scores for the Humanistic Domain (HM) and Biomedical/Biomechanical Domain (BM). All scores were on continuous scales. Results Pearson correlations ranged from 0.10 to 0.88 and were all statically significant (p Conclusions This study provides evidence supporting the validity of the blueprints for constructing COMLEX-USA Levels 2-CE and 2-PE examinations in concert with the purpose and nature of the examinations.

Perceived discrimination in medical settings remains prevalent within the U.S. health care system. However, the details of these experiences and their associations with perceived quality of care are not well understood. This study evaluates any potential difference in African Americans' systemic health care discrimination and Latinx perceived by African American and Latinx patients and physicians. The New England physician alumni from the University of New England College of Osteopathic Medicine were sent surveys. Two hundred fifty-one practicing physicians' responses to the 2018 study address their beliefs toward African Americans and Latinx' racism within the health care system. High scores indicate more significant perceived discrimination among these groups. Physicians have lower discriminatory belief scores across gender, patient racial distribution and specialty.

Evidence confirms that children and adolescents can experience the whole spectrum of mood disorders and suffer from the significant morbidity and mortality associated with them. Effective treatment often relies on physicians developing advanced communication skills with their patients. Enhanced communication will help decipher the etiology of the patient’s depression and, in addition to serotonin-regulating medications, will optimize treatment. Osteopathic medicine offers an effective treatment model through osteopathic manipulative treatment (OMT) because of the inseparability of physical and mental health. Osteopathic medicine takes a holistic view in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will help treat psychopathologies, such as depression and its accompanying somatic dysfunctions. This paper discusses the epidemiology of depression, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) depression criteria, screening algorithms, current treatment protocols, osteopathic considerations to treating depression, and lastly, OMT and its role in treatment.

Context Strong evidence throughout the literature highlights burnout as a significant and increasing problem among medical students, impacting students’ ability to effectively care for and empathize with patients. Objectives To examine how involvement in extracurricular activities and attendance at burnout lectures can impact burnout among medical students. Methods An anonymous digital survey including the Maslach Burnout Inventory (MBI) was sent to all students (n=765) at Rowan University School of Osteopathic Medicine. The survey included questions regarding the number of burnout/wellness lectures respondents had attended, the number of clubs in which the respondents participated, the number of hours spent in these clubs, and any leadership positions held by the respondents. Results Of the 765 students enrolled, 597 completed the survey. Results indicated that women participated in significantly more clubs than men (t[456]=−4.30; pt[463)=2.98; pβ=0.34; p Conclusions Our results indicate the importance of understanding what drives burnout on the individual level and adapting interventions to suit the needs of individual students, rather than the student body as a whole.

Mindfulness is a focused approach toward accepting one’s thoughts without judgment or perseveration, with ancient Indo-Sino-Tibetan philosophical origins. Many variations exist; however, they typically include focused attention where one concentrates on a specific sensation such as breathing and open monitoring where one concentrates on consciousness itself. Mindfulness-based interventions (MBIs) are specific, organized, targeted methods to teach mindfulness with specific goals. MBIs have shown benefit in pain patients. MBIs teach the individual the concept of pain coping, encouraging cognitive flexibility and attempting to discourage the fear or alarm reaction of pain, instead focusing on the quality of life and functionality. Mindfulness-based stress reduction (MBSR) showed a 30% significant improvement in pain intensity and pain coping at six months in patients with chronic low back pain, compared to opiates and NSAIDs, which showed no benefit. MBIs have also shown benefit in addiction, as they help the individual relearn to control cravings, habit modification and attempt to restore the natural reward system while improving regulation of emotions. Applications to opiate use disorder are significant as patients learn to enjoy the lifestyle of recovery and learn to believe they can improve. Additionally, other comorbid conditions are known to improve with MBIs and mindfulness-based principles support the holistic principle of mind, spirit and body consistent with osteopathic medicine.

Context In March 2020, the World Health Organization declared the novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Due to the rapid spread, strong contagion, high incidence of lethality in severe cases, and the lack of a pharmaceutical prevention or cure, COVID-19 has posed a serious threat to human life and health. It has also had a tremendous impact on mental health, including fear and worry, difficulty sleeping or concentrating, and increased use of poor coping mechanisms. Osteopathic medical students have had additional concerns regarding the interruption of their studies, closing of clinical rotations, and postponed licensing exams. To date, few reports have focused on osteopathic medical students and their reactions to the outbreak. Objectives To assess resilience, coping, health behaviors, and emotional wellbeing of osteopathic medical students during the onset of the COVID-19 pandemic. Methods In this cross-sectional study, we distributed an anonymous online survey to all medical students enrolled at Nova Southeastern University in May 2020 (n=1,310) via an e-mail invitation using the institution’s student listservs. Our major study variables were based on published reports and anecdotal evidence; we subsequently developed the Emotional Wellbeing in Healthcare Professions Students Questionnaire (EWB-Q). This EWB-Q contained validated scales to assess the contribution of levels of coping strategies used, personal resilience, and health behaviors on the emotional wellbeing of osteopathic medical students. Multiple linear regression and other statistical analyses were conducted using SPSS v0.26. Results Of the 1,310 students invited to participate, 335 (25.5%) surveys were returned. Of those, 133 had more than 33% of the necessary data missing and were removed, resulting in 202 (15.4%) completed questionnaires. The mean age of the participants was 26.7 years. About half (n=92; 45.5%) were in the clinical phase (years 3 and 4) of their medical school training (in rotations). A significant regression equation was found (F[4,171]=17.481, pR 2 =0.290, R 2adjusted=0.274), indicating that levels of coping, personal resilience, and health behaviors (i.e., not sleeping more than usual, not exercising less than usual) accounted for a significant amount of the variance in emotional wellbeing scores in osteopathic medical students. Higher levels of resilience, greater use of coping strategies, not sleeping more than usual, and not exercising less than usual were predictors of emotional wellbeing. Conclusions Cultivating positive mental health should be a high priority for medical educators as they develop and implement curriculum-based initiatives to help medical students bolster their personal resilience and to encourage healthy coping behaviors during times of crisis and beyond. A proactive position that assists with building personal resilience and developing stress management habits is paramount in assisting students who are grappling not only with the challenges of rigorous medical training, but also with the uncertainty and stress that exists during any major global health or socioeconomic crisis.

Context 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. Objectives 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. Methods 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 6 weeks at 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. Results 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. Conclusions 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.

Problem The COVID-19 pandemic required rapid changes to medical curricula, forcing emergent transition to purely remote learning. At Idaho College of Osteopathic Medicine (ICOM), all in-person sessions were suspended on March 16, 2020. One course affected included the first-year, 4-week Respiratory System course which began on March 9. Methods On the final day of the course, students were sent surveys which assessed how they adjusted academically and personally to the campus shutdown. Results The response rate was 137/159 (86%). Students’ learning adjustments took into account changes to spaces and daily routine, their cohabitants, need for accountability, new learning resources, and anxiety. Most students were concerned about public health, the economy, and health of family and loved ones; fewer were concerned about their professional futures, restrictions on personal freedoms, and own health. Most students adjusted personally by connecting more with family, entertainment and sleep, and studying less. While a large majority of students made changes to connecting with friends and physical activity, students did not adjust uniformly.

Context The Spanish flu pandemic of 1918 was approached with a variety of management techniques available at that time, including osteopathic care in addition to standard medical care. Objective To analyze the osteopathic manipulative treatment (OMT) techniques used for the management of patients affected by the Spanish flu according to four themes: the principles and procedures used, frequency and length of OMT, reported side effects, and advice for patients. Methods A structured review of the literature was performed by hand-searching texts at the Museum of Osteopathic Medicine International Center for Osteopathic History in Kirksville, Missouri, and online via PubMed (National Library of Medicine), ScienceDirect (Elsevier), and Google Scholar (Google, Inc). The literature search was carried out between February and March 2020. Three keywords were selected from the medical subject headings database of the National Library of Medicine: manipulation, osteopathic; influenza pandemic, 1918–1919; epidemics. Articles were then reviewed for relevance by screening for articles published between 1900 and 1940 that contained at least 1 of the following keywords in their title: Spanish influenza, flu, epidemic, grippe, pneumonia, or osteopathic management/treatment. All articles that provided information about OMT and advice met the inclusion criteria. Articles that did not report descriptions of manipulative intervention were excluded. Results Our search yielded 63 articles: 23 from the hand-search and 40 from the electronic search. No electronic source was selected for the review because none met inclusion criteria. A total of 16 articles from the hand-searched set met inclusion criteria and were analyzed according to the four main themes stated in the objective. The range of OMT approaches reported to be administered to patients with Spanish flu suggests that early osteopathic physicians treated patients with this disease using OMT in addition to offering advice on healthy lifestyle behaviors. Conclusion Conclusions from this study are limited by the historical and descriptive nature of the data gathered, which lacked the rigor of modern-day scientific studies. However, this review could lead to future research inquiries on the effectiveness of these approaches. Osteopathic physicians and osteopaths should embrace their historical osteopathic heritage by continuing the work of our predecessors and combining their hands-on experience and osteopathic principles with modern medical treatment and rigorous scientific standards.

ContextOsteopathic manipulative medicine (OMM) has been shown to successfully alleviate some pregnancy-related pain. However, most of the published data focuses on the third trimester and postpartum period or musculoskeletal indications.ObjectiveTo explore OMM use among obstetrical providers and determine the frequency of use by trimester and by clinical indications across multiple types of women’s healthcare practices in Southern and Central Maine.MethodsAn anonymous, 43-item survey, presented in English, was emailed to 172 eligible providers (physicians, nurse practitioners, and certified nurse midwives with obstetrics privileges at one of two main delivery centers in southern and central Maine) via an encrypted database system in January 2018. Follow-up email reminders were sent weekly for three weeks. Questions addressed use of OMM for specific indications, knowledge of OMM, and perceived barriers use of OMM.ResultsThe survey response rate was 73 of 172 (42%); 95% of respondents were physicians (n=69). Due to the low response rate of non-physicians, only data from physicians was included in the study. Data were summarized descriptively as frequencies (n [%]). The highest rates of OMM utilization were during the third trimester (35 [51.5%]) and postpartum (41 [60.3%]) periods, while the lowest rates of utilization were in the intrapartum (eight [11.9%]) and first trimester periods (26 [38.3%]). Osteopathic physicians (n=19) used OMM more frequently in the first, second, and third trimesters, as well as the intrapartum period (10 [52.6%]; 11 [57.9%]; 14 [73.7%]; and six [31.6%], respectively) compared with their allopathic physician (n=50) counterparts (nine [8%]; 15 [30%]; 21 [42%]; and two [4%], respectively). While osteopathic physicians reported higher frequencies of OMM use and referral for non-musculoskeletal indications such as constipation, edema, and nasal congestion (13 [68.4%]; 11 [57.9%]; 10 [52.6%], respectively), musculoskeletal complaints were the most frequently cited indication for OMM use among both osteopathic and allopathic physicians (low back, 67 [97.1%]; pelvis, 65 [94.2%]; coccyx, 50 [72.5%]; and head, 49 [71%]).ConclusionThese results suggest that more education is needed about OMM use in the obstetric population, particularly during early trimesters and the intrapartum period, as well as for visceral and lymphatic complaints of pregnancy.

Hearing loss is a common complaint with extensive cognitive, physical, emotional, social and financial implications. Many adults are expected to present with varying degrees of hearing loss by the age of 60 to 69 years old that can be classified according to the cause into conductive, sensorineural and mixed. There can be associated symptoms, like tinnitus, vertigo and otalgia and/or abnormal behaviors such as social withdrawal and difficulty with interpersonal communication. Somatic dysfunctions can accompany hearing troubles and range from fluid problems such as fluids accumulation in the middle ear, lymphatic congestion of the head and neck, and structural dysfunctions in the eustachian tube, neck musculature, thoracic spine, ribs and the cranial rhythmic impulse in addition to other neurologic dysfunctions such as sympathetic hyperactivity and viscerosomatic changes. In this review, we provide several suggestions that may assist the osteopathic family physician in identifying the various causes behind the hearing loss, especially life-threatening or quality-of-life limiting causes. We will also provide an effective treatment addressing the cause of the hearing loss presentation and associated somatic dysfunctions, alone or in conjunction with other appropriately trained health care providers, based on the understanding of the five models of osteopathic medicine and how they can apply toward the anatomical and physiological components of adult hearing loss.

The coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on both clinical practices and learning environments. On March 17th, 2020, the American Association of Colleges of Osteopathic Medicine and Commission on Osteopathic College Accreditation issued a statement recommending a “pause” in medical student participation in-person at clinical sites. In response, the Family Medicine Department at the Rowan University School of Osteopathic Medicine recognized the need to evolve the traditional curriculum and quickly transitioned to an online format, incorporating telemedicine into the clerkship. This new model enabled 44 third-year medical students to obtain high-quality, offsite, virtual education and learn new skills.

Objective: The purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Korean communities in New York City. Design: A cross-sectional study was designed in which a culturally appropriate survey in Korean and English versions was administered anonymously to measure community perceptions and knowledge of osteopathic medicine. Setting: Data collection occurred in the municipal delineations for the Bayside neighborhood within the New York, New York borough of Queens. Participants: Community members were selected using convenience sampling from high-density areas to participate. The survey included demographics, education level, health care habits and knowledge of the osteopathic profession. Results: 105 surveys were conducted with 47 males and 58 females, with an average age = 66. Only 14% (n=15) indicated knowledge about osteopathic manipulative medicine (OMM) and 9% (n=9) indicated knowledge of osteopathic physicians (DOs), with the primary language spoken at home (Korean) as the sole statistically significant factor in recognition of OMM and DOs among the study variables. Conclusion: Compared to research on the general U.S. population, a general lack of knowledge of osteopathic medicine exists within New York City's Korean community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all health care resources available during the current shortage of primary care physicians in the U.S.

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.

Objective Work-related injuries constitute a significant proportion of osteopaths' practice. This study was designed to determine the practitioner and practice characteristics of osteopaths who treat people with work-related injuries and to identify the impact of workers’ compensation scheme status on the use of osteopathic medicine. Methods A cross-sectional survey was distributed to a nationally-representative sample of 992 Australian osteopaths. Multivariate logistic regression modelling was performed to identify the practitioner and practice characteristics of osteopaths that were statistically significantly associated with the treatment of work-related injuries. Results A total of 847 osteopaths (86%) at least sometimes treated people with work-related injuries within the previous 12-months. One hundred and three participating osteopaths indicated they often treated people with work-related injuries who were covered by a workers' compensation scheme and 341 participating osteopaths indicated they often treated people with work-related injuries who were not covered by a workers’ compensation scheme. Osteopaths who often treated work-related injuries were also more likely to often treat people with sports-related injuries, often treat people with traffic-related injuries, and/or often discuss medications with patients. Conclusions A large proportion of Australian osteopaths treat people with work-related injuries. Further examination of osteopathic medicine use for work-related injuries is warranted.

Background Evidence-based practice (EBP) is integral to the provision of ethical, safe and high-quality health care. While osteopathy is an established and registered health profession in many countries, it is a developing, unregistered health profession in Sweden. This study explored the perceptions, skills, use, barriers and enablers of EBP among Swedish osteopaths. Methods Osteopath members of the Swedish Osteopathic Association were invited by email to participate in an anonymous online survey - a Swedish-translated and pilot-tested version of the Evidence-Based Practice Attitude and Utilisation Survey. Data collection was conducted between January and March 2019. Results Thirty-one per cent (78/249) of invited osteopaths responded to the survey. Respondents were largely supportive of EBP and most agreed or strongly agreed that EBP assisted clinical decision-making (84.7%), improved quality of patient care (83.3%), and was necessary in the practice of osteopathy (80.8%). Respondents typically reported moderate to moderate-high levels of EBP skills, whereas their level of engagement in EBP activities was variable and infrequent. The main reported barrier for EBP uptake was lack of clinical evidence in osteopathy. Workplace access to the internet and free online databases, and the ability to download full-text journal articles, were considered very useful enablers of EBP. Conclusions The responding Swedish osteopaths appeared largely supportive of EBP, reported moderate to moderate-high levels of EBP skills but participated infrequently in EBP activities. Studies of interventions aimed at enhancing the skills and clinical use of EBP in osteopathy are warranted.

Background Recent debates inside the osteopathic community have underlined the need to revise and to implement osteopathic traditional clinical concepts in relation to the process of clinical reasoning. Nevertheless, clinical reasoning has to be based on models and evidence to enhance the quality and to maximise the effectiveness of the therapeutic act. Among models, the five osteopathic models (OMs) are supposed to guide osteopathic clinical reasoning. However, there is a lack of studies on how OMs characterise clinical practice. Objectives The primary purpose of this study was to explore Italian osteopaths’ attitudes and beliefs toward the five OMs and their application in clinical reasoning and practice. Methods 19 Italian professional osteopaths with clinical and educational experience formed the purposive sample of this qualitative study. Data were collected through recorded semi-structured interviews, transcribed verbatim and coded by using elements of a constructivist grounded theory approach. Results Three main themes were identified: 1) Ambiguity of the professional identity; 2) OMs: an enigma of clinical reasoning, 3) Osteopathic knowledge paths: evolutionary on-going trajectories. Conclusion The results of the present study suggest a heterogenic theoretical and practical conceptualisation of OMs within the Italian osteopathic field, identifying a gap between knowledge and tradition. This study may contribute to reducing this gap promoting a framework to clarify current understanding of the OMs in order to guide the profession towards the definition of an updated osteopathic paradigm.

Context While recent streamlining of the graduate medical education process signals an important change from the traditional dichotomy between doctors of osteopathic medicine (DOs) and US-trained doctors of medicine (USMDs), this new uniformity does not continue into the process for licensure, including state medical licensing verification of training (VOT) forms for DOs, MDs, and foreign medical graduates (FMGs). Wide variability remains. Objective To document the differences in the performance metrics program that directors are required to disclose to state medical licensing boards for DOs and FMGs compared with USMDs. Methods VOT forms were collected from all osteopathic and allopathic licensing boards for all US states, Washington DC, and US territories. The authors then reviewed VOT forms for questions pertaining to trainee performance only in states where VOT forms differed for DOs, USMDs, and FMGs. Licensing board questions were categorized as relating to disciplinary action, documents placed on file, resident actions, and nondisciplinary actions by the program. Results Fifty-six states and territories were included in the study (50 US states; Washington, DC; and 5 US territories). Most states and territories (46; 82.1%) used the same VOT form for DOs and USMDs. All states and territories except New York used the same form for FMGs and USMDs (55; 98.2%). Of the 14 states with an osteopathic board, Nevada used Federation Credentials Verification Service (FCVS) for DOs only, and 8 states used a unique osteopathic VOT form. Of these 8 osteopathic boards, 3 VOT forms did not ask any questions regarding resident performance during training. Of the remaining 5 forms, all asked about disciplinary actions. Ten states and 1 territory (US Virgin Islands) required the FCVS for both USMDs and FMGs, but not for DOs, while New York required FCVS only for FMGs. Nevada required FCVS only for DOs. Conclusion Although VOT requirements for FMGs and USMDs were mostly the same within states, performance metric question sets varied greatly from state to state and within states for osteopathic vs allopathic licensing boards. Implementation of a standardized VOT form for all applicants that includes academic performance metrics may help ensure that medical licensure is granted to all physicians who demonstrate academic competency during training, regardless of their degree.

Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that affects about one in 40 American adults and one in 100 American children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the patient must have the presence of obsessions, compulsions or both. OCD can be covert in presentation and therefore requires physician vigilance with the diagnosis. The efficacy of the physician’s interviewing style is extremely important in OCD treatment because typically, long delays in diagnosis often occur and the shame associated with the disorder may inhibit discussion of the symptoms and treatment plans. In addition to serotonin-regulating medications, deciphering the etiology of the patient’s obsessions or compulsions is important. Thus, cognitive behavioral therapy supplemented with SSRIs is the true first-line therapy for OCD because it provides a synergistic approach of life discussions, habit training and medication. Because of the inseparability of physical and mental health, osteopathic medicine offers an effective model for treatment through osteopathic manipulative treatment (OMT). In the holistic view of OMT, somatic, visceral and psychological dysfunctions are united. Thus, physicians who incorporate OMT into their practice can aid in the treatment of psychopathology, such as OCD. In this article, we will discuss the epidemiology of OCD, the DSM-5 criteria for OCD, the current OCD treatments, the osteopathic approach and how it pertains to OCD treatment, and lastly, OMT and its possible role in treating OCD. Due to a lack of research on osteopathic manipulative medicine (OMM) treatments in OCD, we will also propose a possible study design for further investigation.

Context In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism. Objectives To assess strengths and weaknesses of residents’ interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT). Methods From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language. Results The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: “greeted me in a way that made me feel comfortable” (#1), “talked in terms I could understand” (#8), “encouraged me to ask questions” (#10), “involved me in decisions as much as I wanted” (#11), “showed care and concern” (#13), and “spent the right amount of time with me” (#14). Conclusions Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.

Context Competency-based medical education, developmental milestones for residency training, and the single graduate medical education (GME) accreditation system have emerged over the last decade, necessitating new ways to adequately prepare graduates to meet new standards in proficiency, including the 13 Core Entrustable Professional Activities (EPA) for Entering Residency. The American Association of Colleges of Osteopathic Medicine (AACOM) Entrustable Professional Activities (EPA) steering committee has implemented an information-gathering process to provide suggestions for supporting a variety of EPA-related implementation efforts at colleges of osteopathic medicine (COMs) across the country. Objective To review the status of EPA implementation at COMs nationally. Methods An explanatory mixed-methods design was used to guide information gathering and synthesis of a 41-question survey and interview feedback; the overarching premise of this design was to use qualitative data to build upon initial quantitative findings. This survey was delivered electronically through a link emailed to liaisons at each main, branch, and satellite campus of the 47 schools within the AACOM institutional database. After survey administration, follow-up structured interviews were conducted according to an 18-question script with a purposive sample of 16 institutions with EPA implementation levels ranging from “moderate implementation with reporting” to “full implementation with reporting.” Post-interview, the interview notes were analyzed and results were aggregated for comparison with the original survey findings. Results Of the 47 schools surveyed, 42 responded (89.4%). To maintain uniformity in data coding and analysis, 36 of 47 (76.6%) of COMs with independently submitted survey responses were retained in the review. The majority of those respondents (23 of 36; 64%) indicated that their institution was above “somewhat knowledgeable” toward “expert” regarding knowledge of EPAs, but 23 (64%) also indicated “no confidence” or “somewhat confident” regarding EPA implementation. Postinterview results showed that the majority of schools were equally distributed across the “foundational implementation” (10; 28%), “slight implementation” (11; 31%), and “moderate implementation” (11, 31%) categories, with a few schools indicating “no implementation” (2; 5%) or “progressive implementation” (2; 5%). Conclusion The results of this review indicate that most osteopathic medical schools are at the early stages of EPA implementation, with emphasis varying by program year in terms of the specific EPAs addressed. Many schools appear engaged in curricular change efforts that will support the advancement of EPA use within their institutions. Faculty development was identified as a continued critical need for a majority of institutions.

Background: The benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness among the population. The osteopathy is a practice of manual therapy which is guided by a holistic perspective of human being, the cranial osteopathy affirms that the respective bones of the cranium represent mobility. Objective: To investigate the effect of the cranial osteopathy techniques on the benign paroxysmal positional vertigo. Methods: The current study included 20 female subjects, each one of them with benign paroxysmal positional vertigo, distributed in two groups, an intervention group and a control group (placebo); in order to detect the BPPV, was applied the Dix-Hallpike test before and after the interventions. Three techniques of cranial osteopathy were used on the structures related to vestibule and to the temporal bones: mobilization of temporal bones, tensioning of cerebellar tentorium and mobilization of eyeball. All statistical analyzes were performed using the GraphPad Prism 6.0 software (GraphPad Software, CA).Results: Among the intervention group, 7 of 10 individuals were negative to the Dix-Hallpike test, whilst individuals of the control group remained positive to the test. In the statistical analysis verified that the intervention with osteopathic techniques had a significant effect in compared to the control group, with a value p=0.0261. Conclusion: The cranial osteopathy appears to be able of produce effects on the vestibular activity, whereas were able to reduce, in a significant means, the symptoms concerning to BPPV.

Background Lower back pain is a leading cause of disability and a common condition seen by osteopaths. Evidence and advice for the safest lifting posture vary, as do healthcare practitioners' attitudes and beliefs towards back pain. Objectives The aim of this study was to understand osteopaths' beliefs about safe lifting postures in relation to their attitudes towards back pain, and to compare these findings with published data from physiotherapists and manual handling advisors. Design Cross-sectional study. Method Between October and November 2018 a cross-sectional electronic survey was used to invite a sample of UK osteopaths to select images that best represent their perception of safe lifting posture (straight or rounded back), and to complete the Back Pain Attitudes Questionnaire (Back-PAQ). Data was analysed to assess lifting posture selection and relationship to back pain attitudes. Results 46 (85.2%) out of 54 osteopaths selected straight back posture as the safest, these participants had significantly more negative attitudes to back pain injury (i.e. higher Back-PAQ scores), than the 8 osteopaths who selected a rounded back posture (p = 0.007). Data from 266 physiotherapists and 132 manual handling advisors revealed an overall agreement about straight back lifting posture, and differences in Back-PAQ attitude between the professions. Conclusion Despite a lack of evidence and inconsistent recommendations, osteopaths in this study believed that straight back lifting posture is the safest and were associated with more negative back pain beliefs. Practitioners' attitudes and beliefs are known to influence their patients' attitudes and recovery behaviour. Further research is recommended to identify reasons for different beliefs, and their impact on advice-giving and patient outcomes.