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OMT as Wellness in the Family Medicine Residency
Conaway, E. [2]
O'Donnell, A.
Pena, M. [2]
Pepe, J. [1]
Du, Y. [1]

Journal: Journal of Osteopathic Medicine Date: 2019/12, 119(12):Pages: e98-e100. doi: Subito , type of study: clinical trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2019.128/html)

Keywords:

clinical trial [612]
family medicine [25]
medical students [402]
mental health [21]
OMT [2951]
osteopathic manipulative treatment [2973]
osteopathic medicine [1540]
residency [206]
USA [1086]

Abstract:

Statement of Significance: AdventHealth Family Medicine Residency at East Orlando is ACGME accredited with Osteopathic Recognition. As ACGME's Clinical Learning Environment Review (CLER) Pathways to Excellence and Common Program Requirements stress the need for resident wellness and burnout prevention, the residency sought to fulfill this mandate with an osteopathic solution. If regularly receiving OMT could improve resident mental health, then this program could be easily implemented for osteopathic residents of any specialty across the country. There has been some limited research on the effect of OMT on mental health parameters in the general population, but only 1 study to date on its effect in the osteopathic profession itself with first year medical students. Research Methods: Residents in the AdventHealth Family Medicine Residency at East Orlando were eligible to participate. All residents were required to take part in the wellness program, but their participation in the research arm was voluntary. The study was IRB approved by AdventHealth IRB #900172 and was exempted from written informed consent. The Residency has an academic half-day 1 afternoon per week for educational lectures. Seven 1-hour lecture time slots per year spaced throughout the academic year were designated as OMT wellness times. Portable OMT tables were set up and residents were given an hour to exchange a full osteopathic evaluation and treatment with a fellow resident. Faculty board certified in either Neuromusculoskeletal Medicine (NMM), Family Medicine and Osteopathic Manipulation, or both, as well as fourth year Integrated FM/NMM residents were present to assist as needed with evaluation and treatment. Every effort was made to treat any residents who were not present within 2 weeks of the scheduled OMT wellness session. A series of validated National Institutes of Health PROMIS Health Measures were collected quarterly from the residents in an anonymous fashion. These measures assessed: anxiety, depression, fatigue, sleep, emotional support, and alcohol use. Each resident was assigned a randomly generated participant number to allow for the linking of anonymous responses. Data collected began in August 2016 and conclude June 2019. Data Analysis: Data analysis was performed by a professional bio-statistician. Data from the NIH Promise Measures were analyzed for change over time as well as compared with normative values established during their validation. Wilcoxon signed rank test was used to assess the difference between the initial and final values. The study was designed to run for 3 full academic years. In the third year of the project the Graduate Medical Education department for the hospital system rolled out their own required residency wellness program. This was determined to be too large of a con-founder for this study and therefore data from the 3rd year of the study was not included in the analysis. Results: Data was analyzed from 23 residents from the first year of the study and the 16 residents who remained in the residency during the 2nd year of the study. During the first year, participants showed significant improvement in symptoms of anxiety (P=.009), fatigue (P=.043), and depression (P=.008). When residents were compared with normative values at the end of the first year there was positive difference in symptoms of anxiety (=P=.004) and depression (P=.001). Resident fatigue was worse than the normative value but not significantly so, but sleep disturbance was significantly worse than normative value (=P=.010). Residents displayed significantly higher levels of emotional support (=P=.001) and lower levels alcohol consumption than normative values (P=.001). Secondary analysis was performed to assess for effect of age, sex, marital status, or presence of children. Secondary analysis was also performed to investigate any difference between residents who were currently on or had recently complete a more demanding rotation vs rotations with a more routine work load. There was no significant difference in any of the sub group analyses. The second year in the study showed a maintenance of these improvements with no significant worsening. Conclusion: Exchanging OMT treatments may be a viable component to a residency wellness program. It results in improvement in reported symptoms of anxiety, depression, and fatigue, all of which can be signs of burnout. It does not mitigate the sleep disturbance that is inherent in residency programs due to fluctuating schedule and work demands. It has the added anecdotal benefit of allowing residents a low stress environment to practice OMT without the time constraints of a patient care clinic. The program requires minimal time, effort, and equipment to institute and can be used by any specialty. It is also a practical application for osteopathic principles and practice that can help a program meet requirements for osteopathic recognition.

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