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Osteopathic Medical Student Experiences with Assessing Red-Reflex in Different Skin Tones
Shah, P. [3]
Curran, S. [1]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A57-A58. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

cross sectional study [783]
diagnosis [371]
medical students [596]
osteopathic medicine [1955]
palpation [213]
red-reflex [1]
skin tones [1]
USA [1531]

Abstract:

Context: The criteria for diagnosing somatic dysfunction, an altered functional component of the body’s framework, are taught early in Osteopathic Medical Schools. Guidelines for performing osteopathic manipulative techniques (OMT) require at least two of four T.A.R.T. criteria: Tissue texture changes (including red-reflex), Asymmetry, Restriction of motion, and Tenderness. Diagnosis of somatic dysfunction typically begins with patient visualization followed by palpation. With somatic dysfunction present, a red-reflex often appears immediately after palpation. Red-reflex is the body’s natural reddening response to palpation, typically indicating somatic dysfunction. However, skin tone differences can make this difficult to identify consistently. In some cases, diagnoses may be missed due to an unclear red-reflex. As our patient base increasingly reflects the diversity of the general population, it’s essential to undergo training that provides both empathy and expertise for each patient. This approach underscores our commitment to inclusivity and recognition of individual patient differences, strengthening their perception of being valued and respected. Objective: To describe how skin tone affects the appearance of red reflex in different skin tones. To discuss how osteopathic medical students experience challenges in diagnosing somatic dysfunction in different skin tones. To discuss ways osteopathic medical education can highlight these differences early on in osteopathic manipulative medicine courses. Methods: In this study, (IRB #2023-13 Exempt Status), 220 first and second year medical students from Kansas College of Osteopathic Medical School were surveyed in a six-question questionnaire about their experiences practicing palpation skills on different skin tones in Osteopathic Manipulative Medicine (OMM) courses. Students must have been currently enrolled at the Kansas College of Osteopathic Medicine OMM courses; surveys were sent to those individuals. Any data that had duplicated answers between items 4 and 6, apart from Neutrals, were thrown out. They were asked whether they had ever encountered an instance where it was difficult to visualize the red-reflex due to the skin tone differences in fellow classmates. This includes any factors that may have affected their response: whether they had practiced palpating on various skin tones and if they felt they had access to various skin tones. In addition, students were asked to give their perspectives on how to further enhance education by identifying the differences seen in red-reflex in different skin tones. The ability to recognize red-reflex in individuals with various skin tones is crucial for precise diagnosis and treatment of somatic dysfunction. Results: This study showed that students felt comfortable with their palpation skills and agreed that there is enough diversity to practice on. However, only 27% of first year students disagreed to the statement that they struggled to diagnose red-reflex on different skin tones and 27% of first year students believed that they felt educated on the differences in appearance of red-reflex in different skin tones. For second year students, 29% disagreed that they struggled to diagnose red-reflex on different skin tones and 45% of the students believed that they felt educated on the differences in appearance of red-reflex in different skin tones. Many students discussed presentations of patients with different skin tones by increasing the diversity in the demonstration photos used in lectures. Others mentioned encouraging students to seek out practice with different skin tones to make them more well-rounded future physicians. Many students who identified gaps in OMM education emphasized the importance of early exposure, particularly when learning about somatic dysfunctions in first-year OMM courses. They stressed that early introduction to these concepts is crucial for comprehensive understanding. Conclusion: Palpation is taught very early at every osteopathic medical schools and is an essential component to learning the layer-by-layer technique in diagnosing somatic dysfunction. This data showed that not only does skin tone affect the appearance of the erythema friction rub (red-reflex), but it is an area of improvement needed in the education of diagnosis in osteopathic medical education. Essential textbooks such as Foundations of Osteopathic Medicine(1) and Atlas of Osteopathic Techniques(2) have zero or one photo demonstrating red reflex on a very fair skin tone. With changes in the patient population group, we will encounter as future osteopathic physicians, it is important to take note of the variability in skin tone, allow ourselves to be comfortable with these changes to be the best osteopathic physicians in the future.

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