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Medical Student Use of Osteopathic Manipulative Medicine (OMM) in Outpatient and Inpatient Clinical Rotations
Granat, L. M. [1]
Docherty, J. [10]
Yao, S. C. [54]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e171-e173. doi: Subito , type of study: descriptive study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

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

Abstract:

Introduction: During the first 2 years of osteopathic medical school, students learn osteopathic manipulative medicine (OMM) in the classroom and laboratory setting. They practice skills on their fellow students, most of whom are in good health, or on standardized patients, who typically present with complaints that mirror those of patients in a standard outpatient setting. Third and fourth-year clinical rotations serve as an opportunity for students to practice the aforementioned skills on real patients, with a variety of chief complaints and pre-existing conditions, in a multitude of different settings. A prior study found that despite receiving little to no OMM training in inpatient settings, third and fourth-year students were able to decrease patients’ pain via OMM treatments in hospitals and outpatient clinics. Hypothesis: We predict that student-performed OMM is safe and effective in clinical rotations in both inpatient and outpatient settings. We also hypothesize that third- and fourth-year students will be more comfortable performing OMM techniques in an outpatient setting based on their training in medical school. Therefore, we predict that techniques performed in an outpatient setting will lead to greater decreases in patient-reported pain, as compared with those performed in an inpatient setting. Statement of Significance: OMM is a cornerstone of osteopathic medical education. The findings of the current study may help to shape future educational structure and to encourage OMM use during clinical rotations. Methods: This study was approved by NYIT's Institutional Review Board. Third and fourth-year students at NYITCOM are required to submit logs of patient encounters during which they use OMM on rotations at local hospitals and outpatient clinics. Information collected on OMM encounter logs includes: class, rotation, OMM technique(s) used, and a pre- and posttreatment patient-reported pain scale out of 10. Logs from the family medicine and ambulatory medicine rotations were classified as “outpatient.” Logs from internal medicine and surgery were classified as “inpatient.” Logs from psychiatry, pediatrics, OB-GYN, electives, sub-internships, and radiology were excluded from this analysis, as these rotations have both inpatient and outpatient components and the logs did not capture the specific setting of OMM treatment. Change in pain was calculated as the difference between the pretreatment pain scale and the posttreatment pain scale. Data Analysis: Data were analyzed using IBM SPSS with χ2 tests for categorical comparisons and t tests for the scalar data. Results: 9168 logs were completed between June 7, 2016, and June 13, 2018. A total of 6126 logs were included in this analysis, 72.6% of which were classified as outpatient (n=4448) and 27.4% of which were classified as inpatient (n=1678). Significantly more patients tolerated treatments than not (99% vs 1%, P<.001). There was no significant difference between the types of techniques used by students on outpatient and inpatient rotations (P<.05). There was a statistically significant difference between pretreatment pain scores and posttreatment pain scores (P<.01). Treatments conducted in an inpatient setting led to significantly larger changes in pain than those conducted in an outpatient setting (4.37, SD 2.26 vs 3.01, SD 1.75, P<.01). Discussion: The findings show that student-performed OMM is generally safe and well tolerated. The results above indicate that the techniques used in an inpatient setting lead to greater decreases in patient-reported pain than those used in an outpatient setting. This can potentially be due to inpatient care providing situations where OMM can be more effective. Overall, the results of this study indicate that our teaching methods and OMM are generalizable and effective among various disciplines. Future curricular planning should seek to broaden the scope of the chief complaints that are used to teach techniques, as to guide students in being equally effective in both outpatient and inpatient settings. Limitations of this study include the accuracy of student logs, a potential bias because students more comfortable performing OMM would be more likely to do so in an inpatient setting, and a lack of reporting of ineffective treatment or treatments performed past the required number of OMM logs.

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