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Student Application of Osteopathic Manipulative Medicine (OMM) During Third-Year Rotations
Ganatra, L. B. [1]
Belisario, C. [1]
Terzella, M. [14]
Gilliar, W. [4]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e114-e116. doi: Subito , type of study: descriptive study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2017.141/html)

Keywords:

clinical rotation [3]
descriptive study [37]
medical students [402]
OMT [2951]
osteopathic manipulative treatment [2973]
osteopathic medicine [1540]
USA [1086]

Abstract:

Background: The osteopathic medical profession has evolved from a form of medical practice using exclusively osteopathic principles and practices (OPP) in the 19th century to a modern system that uses OPP in addition to all conventional methods of diagnosis and treatment. As classroom instruction and laboratory hours have been condensed to include coverage of the vastly expanding base of medical knowledge in the basic and clinical sciences, osteopathic manipulative medicine (OMM) training has shifted to the periphery of osteopathic medical education. Many premedical students now apply to osteopathic schools as an alternative to the MD route, without a sincere interest in osteopathic philosophy or the intention to incorporate OMM into their future practice. The loss of osteopathic focus in DO training is illustrated by a 2001 survey of osteopathic physicians, which reported that more than 50% of respondents used OMM on less than 5% of their patients, and most prescribed medications or surgery as first-line treatment. To maintain distinctiveness in osteopathic medical education, it is critical to implement a distinctive undergraduate curriculum in the first 2 years that will promote continued OMM use throughout clerkships, internships, and residency. An analysis of the OMM techniques used and the clinical context in which OMM is performed by osteopathic medical students during their third- and fourth-year clerkships can serve as a metric of efficacy of the existing osteopathic medical curriculum while offering critical insights into opportunities for curricular improvement and modification. Hypothesis: We hypothesized that third-year medical students at NYITCOM would choose to use OMM techniques most frequently in the adult primary care setting (family medicine) and would prefer to use techniques in which they received the greatest cumulative hours of instruction throughout the first 2 years: myofascial release (MFR), balanced ligamentous tension (BLT), and muscle energy (ME). Methods: This study was approved by NYITCOM Institutional Review Board (BHS-1253). All thirdyear medical students at NYITCOM were required to perform OMM during at least 10 supervised patient encounters throughout their third-year clerkships between August 1, 2016, and May 25, 2017. Each student could complete the encounters during 1 or more clerkships of their choice (internal medicine, family medicine, psychiatry, obstetrics-gynecology, pediatrics, surgery) and could use the technique of their choice on any patient they chose. Each student was required to submit an online log to document each patient encounter. Information collected included time, rotation, patient sex, patient age, chief complaint, regions treated, technique performed, osteopathic treatment model, patient ability to tolerate technique, student-perceived effect of OMT administered, pain level before treatment, pain level after treatment, and contact details and signature of supervising physician. All data were deidentified before analysis, and results were downloaded directly into an Excel spreadsheet. Any logs with incorrect or incomplete data fields were excluded from analysis. All data analyses were performed in the Matlab programming language. Data Analysis: All data were deidentified and uploaded into Matlab from Excel. All fourth-year students and academic medicine scholars were excluded from the analysis. The total logs and total techniques submitted by third-year students were calculated. The number of times each technique was used was calculated, as well as the percentage of time each technique was used. The total logs submitted by students during each clinical rotation were calculated. All data were graphed using the Chart plug-in tool in Matlab. Results: Data were collected and analyzed for 2980 logs and 5904 individual OMM techniques. Each self-reported OMM technique was used at the following frequency and percentage of time: myofascial release (n=1908, 32.3%); balanced ligamentous tension (n=749, 14.2%); muscle energy (n=812, 13.8%); articulatory (n=725, 12.3%); cranial (n=262, 4.4%); counterstrain (n=308, 5.2%); facilitated positional release (n=214, 3.6%); high-velocity, low-amplitude (n=137, 2.5%); Still technique (n=22, 0.38%); lymphatic (n=226, 5.1%); visceral (n=101, 1.7%); PINS (n=3, 0.20%); ganglionic inhibition (n=4, 0.1%); sinus drainage (n=8, 0.1%); thoracic outlet release (n=59, 0.69%); Spencer Technique (n=30, 0.51%); suboccipital release (n=79, 1.0%); paraspinal inhibition (n=24, 0.41%); Galbreath technique (n=14, 0.2%); and sacral rock (n=12, 0.2%). The number of logs submitted by rotation were as follows: family medicine (n=1877, 63%), internal medicine (n=566, 19%), pediatrics (n=178, 6%), surgery (n=119, 4%), and psychiatry (n=30, 1%). Conclusion: The 3 most common techniques used by osteopathic students on third-year clerkships were myofascial release (n=1908, 32.3%), balanced ligamentous tension (n=749, 14.2%), and muscle energy (n=812, 13.8%). These results correlated with the techniques that received the greatest number of hands-on instruction hours during the firstand second years of medical education and was consistent with our hypothesis. The most common rotation during which OMM was performed was family medicine and, also consistent with the hypothesis, OMM was most commonly performed in the adult primary care setting. These results indicate that hands-on instruction in specific techniques likely increases student comfort in independently using these maneuvers. Additional research into the most common techniques used by physicians in primary care settings can provide further insight into techniques that need additional hours of training or in which training is likely not as effective. For example, only 5.2% of the total techniques used were counterstrain techniques, although 20.1% of the total preclinical OMM hours are currently devoted to teaching counterstrain. This disproportionate relationship may indicate that the current methods used to teach counterstrain techniques are not effective, and this portion of the curriculum requires correction.

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