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Osteopathic Medical Education and Treatment: Changes in Perspective Through the Lens of Standardized Patients
Thompson, T. R. [1]
Craun, W. D. [1]
Strickland Creech, T. [1]
Parks, J. M. [1]
Nolin, J. R. [3]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A709–711. doi: Subito , type of study: qualitative study

Full text    (https://www.degruyterbrill.com/document/doi/10.1515/jom-2025-2000/html)

Keywords:

osteopathic medicine [2010]
perception [128]
qualitative study [279]
standardized patients [1]
USA [1610]

Abstract:

Context: Standardized patients (SPs) are individuals trained to portray patients in healthcare settings in “realistic and repeatable ways.”1 Encounters with students involve history-taking, physical examination, communicating diagnoses and determining treatment plans. At osteopathic medical schools, SPs also received osteopathic manipulative treatment (OMT) during student encounters. A wealth of research has analyzed the benefits SPs provide for students, but there is a paucity of information exploring how SPs are impacted by the work they perform. Qualitative researchers have considered the experience of being an SP on one’s perspective of healthcare workers,2-4 medical knowledge and communication skills,2-4 emotional well-being,5 and interest in the job.6,7 No studies on the experience of SPs have been performed at an osteopathic medical school, and thus they have never considered the perspectives of SPs on osteopathic physicians or education. Objective: The objective of this study is to obtain qualitative data on the changes in perspective of SPs on osteopathic medical education and physicians. These findings could aid osteopathic medical schools in recruitment, and help osteopathic physicians understand the perspectives that patients have when frequently exposed to osteopathic medical students and physicians. Methods: The authors determined that the interpretative phenomenological analysis (IPA) approach was most suitable to address the objective. The IPA framework allows researchers to develop an understanding of an individual’s experience as well as how they make sense of their experience and choices.8 Ten SPs at the Alabama College of Osteopathic Medicine were invited to one-on-one semi-structured interviews in-person or over Zoom. The SPs represent a variety of career backgrounds and varying years of experience as an SP. Interviews were recorded and transcribed by the authors. Then, two authors annotated each interview blinded to the other to identify key quotes and summarize them and their relevance to the objective of the study. Annotations were formatted in an excel sheet identifying the interviewer, interviewee, annotator, key quote, and annotation. These annotations were printed and sorted together by the authors to identify major themes and then reconsidered two weeks later to ensure accuracy and agreement on identified themes. The authors reflected on themes and their implications before developing the results. Results: Three themes emerged: Appreciation of the physician educational path, positive experiences with osteopathic medicine, and occupational enjoyment. Theme 1: Appreciation of the Physician Educational Path: SPs frequently endorsed their appraisal of the rigors of medical school and the competency of students and their personal physicians. Many were impressed with the ability of medical students to pick up on common symptoms of high mortality disease during mock scenarios. Some noted an increased comfort in their health due to being regularly examined by students. Students were even able to pick up on undiagnosed conditions. “And I was really impressed that he picked up on it almost immediately, that I had a murmur, and mine is kind of hard to hear sometimes, unless you’re really listening”. (LL) “The benefits are you getting a free medical exam, and you’re getting paid to do it.” (RF) “[Students] are a little more in depth. My normal physician has a certain routine.” (RE) SP’s frequently highlighted a respect for the volume of information that students and physicians are expected to master. RF noted “the number of different drugs for the same thing.” “It’s just a mass amount of information that you have to get.” (RE) Others described an overall sense of comfort from students even after just one year of study. “I felt taken care of.” (VY) “He was just so smooth and so well presented.” (UE) Theme 2: Positive Experiences with Osteopathic Medicine: SPs working within an osteopathic medical school are exposed to OMT as a separate treatment modality. They also see the emphasis on patient centered and holistic care emphasized in the osteopathic medical philosophy. We examined how learning medicine through mock encounters with osteopathic medical students affected their perceptions of DOs and other providers. Consistently, SPs reported positive experiences and perceptions towards OMT. Some appreciated the immediate pain reduction it offers as an alternative to medication. One noteworthy experience included an SP whose familiarity with OMT led her to seek out a practitioner who she felt significantly contributed to reducing the burden of her grandson’s IBS. No SPs expressed any negative perceptions towards their experience with OMT. “With my grandson we did. You know the bowel training helped us tremendously. It helped us tremendously.” (LL) “There’s not really any medication to give for it. I mean, you had to get something for the inflammation you do. But my, when I realized hands really work.” (EE) “I had some aches and pains…. and it helped.” (UD) “I prefer noninvasive treatments when possible.” (FO) VY said it succinctly describing her recommendation to friends and family to “find someone who does OMT.” Opinions were positive, neutral, and even confused when asked whether they preferred their primary care provider be a DO. A common experience was the idea of patient centeredness; their DO student experience involved students strongly making them feel like a driver in their healthcare. “I think the DO really looks at the whole picture, you know?” (LL) “I think the DO’s attitude towards health is greatly aligned with my own.” (VY) Describing an equal perception of DOs and MDs, “I have seen both over the years and I have worked with both over the years.” (UD) “What is DO and MD?” (EE) Theme 3: Occupational Enjoyment: Although a seemingly simple statement, overwhelming numbers of interviewees described “having fun” as a key aspect of their time as a standardized patient. Some SP’s expanded on their enjoyment and stated they would recommend others participate in the program as well. “it’s a great experience, and you need to do it if it’s something that would fit for you.” (RE) “I like to act.” (UE) “I have several people from church that have become standardized patients, so I’ve talked it up. yeah and I at least three that I have when I go to…. breakfast [with my friends] sometimes on on Wednesdays there’s at least three of them that have become standardized patients, so yeah I’ve talked it up.” (RF) Conclusion: The experience of being an SP gave the participants newfound respect of the medical school experience. They valued the hard work and came to understand the challenges associated with becoming a physician. SP also gained a better understanding and appreciation for osteopathic medicine and treatment. For many, this resulted in a desire to seek out OMT or physicians that value the osteopathic philosophy. Finally, SPs described their enjoyment of the work and process of helping students in their education. This data is limited by only addressing the experiences of a small portion of SPs at one osteopathic medical school, but, these findings present a new understanding of how work as an SP can influence the lives of SPs themselves. Exposure to an osteopathic medical school environment helps them grow in understanding and appreciation of medical students and the osteopathic profession.

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