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Bridging the Gap: A Tri-campus Survey on Student Confidence in Applying OMT in Neurological Conditions
Nallanukala, G. S. [1]
Noto-Bell, L. [5]
Nallanukala, V. [1]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A716–718. doi: Subito , type of study: cross sectional study

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

Keywords:

confidence [9]
cross sectional study [826]
medical students [644]
neurological disorders [3]
OMT [3746]
osteopathic manipulative treatment [3766]
osteopathic medicine [2016]
USA [1630]

Abstract:

Context: Although 96% of physicians who use OMT first encountered its benefits during preclinical training, many students lack structured exposure to neurologically focused techniques. 1 Osteopathic manipulative treatment (OMT) significantly influences the autonomic nervous system, supporting its therapeutic relevance in neurologic conditions such as headache, concussion, and cranial nerve dysfunction. 2 Systematic reviews and pilot studies show reduced headache frequency 3,4 and improved concussion recovery via ANS regulation. 5 Case reports highlight functional improvement in Bell’s palsy 6 and symptom resolution in concussion. 7 While these findings are encouraging, most available data remains small-scale or anecdotal, limiting broader clinical integration. 3 At the same time, despite increased neurosurgical interest in evidence-based OMT 8 and the high prevalence of neurologic complaints in clinical care, training in neurologically focused OMT remains limited, compounded by few required neurology clerkships at osteopathic schools. 9 Moreover, early OMM exposure has been linked to greater confidence in clinical application. 10 In light of these trends, bridging this educational gap may better equip future physicians to apply OMT in neurologic care and support its broader integration into clinical practice. Objective: To evaluate how educational exposure, perceived training barriers, and clinical experience influence osteopathic students’ confidence in applying OMT in neurological conditions, and to guide curriculum and faculty development that support consistent OMT use in practice. Methods: An anonymous cross-sectional survey was distributed by Student Affairs email in late Spring 2025 to osteopathic medical students (OMS I-IV) across PCOM’s three campuses. The 14-item questionnaire used multiple-choice, 5-point Likert scales, and open-ended items to assess demographics, OMT exposure, confidence in applying OMT in neurological conditions, and perceived barriers. The confidence scale mirrored prior survey work (e.g., Shapiro et al., JAOA 2017) to align with established constructs; items were reviewed by an OMM faculty mentor and piloted with three students for face validity. Of approximately 800 eligible students, 180 submitted complete surveys (22.5% response rate); a small gift card raffle was offered to encourage participation. Also, incomplete or missing confidence rating responses were excluded. Descriptive statistics and one-way ANOVA were used to examine differences in confidence by training year and cranial instruction status. IRB exemption was granted by PCOM (45 CFR 46.104(2), Protocol #: H25030X). The osteopathic significance lies in highlighting actionable training gaps and opportunities for structured educational interventions. Results support curriculum and faculty strategies to increase student confidence and promote consistent, high-quality OMT use for neurologic care across osteopathic practice. Results: Student confidence in applying OMT in neurological conditions increased progressively by training year: OMS I (M = 2.11, SD = 1.17), OMS II (M= 2.64, SD = 0.99), OMS III (M = 2.89, SD = 1.15), and OMS IV (M = 3.12, SD = 1.12). Skewness shifted from +0.54 (OMS II) to -0.32 (OMS IV), suggesting a more normal distribution in advanced students. A one-way ANOVA revealed a significant effect of training year on confidence (F (3, 178) = 8.55, p < 0.001, η2= 0.13). Post hoc Tukey tests indicated that OMS IV confidence was significantly higher than OMS I (p < 0.001) and OMS II (p = 0.02); differences between OMS III and IV showed a non-significant trend. Barriers reflected this progression: Lack of confidence (n = 115) peaked in OMS IV (n = 39) and OMS III (n = 29). Lack of training (n = 80) was most common in OMS I (n = 36). Time constraints rose from 11 reports in OMS I to 30 in OMS IV. Systemic barriers like limited faculty support (n = 48) and patient reluctance (n = 51) appeared more frequently in upper years, highlighting a shift from internal knowledge gaps to practical and institutional challenges. Students with formal cranial OMT instruction (n = 135) reported significantly higher confidence (M = 2.99, SD = 1.11) than those without (n = 32, M = 1.63, SD = 0.91) or unsure (n = 11, M = 1.91, SD = 0.94); (F (2, 175) = 23.90), p < 0.001, η2 = 0.21. Post hoc Tukey HSD showed confidence was significantly higher in instructed students than both other groups (p < 0.001 vs. no; p < 0.01 vs. unsure). No significant difference was found between ‘Not Sure” and “No” groups. Skewness dropped from +1.40 (uninstructed) to -0.17 (instructed), indicating more consistent confidence among trained students. A Pearson correlation showed a moderate positive association between training year (coded 1-4) and confidence score (r = 0.47, p < 0.001). Finally, 74% of students (n = 131) expressed interest in additional OMT training in neurological conditions, underscoring the demand for earlier, structured neuromusculoskeletal education. Conclusion: This study demonstrated a clear progression in student confidence for applying OMT in neurologic conditions, influenced by both training year and targeted cranial instruction. Reported barriers reveal a shift from foundational skill gaps to clinical and systemic limitations as students advance. Limitations include a moderate response rate and potential self-reporting bias. These findings underscore the need for earlier, structured neurology-focused OMM education supported by consistent clinical modeling and faculty development. Implementing dedicated workshops and mentorship pathways may strengthen skill retention and better prepare future osteopathic physicians to provide high-quality OMT in neurological conditions, contributing to improved patient access and consistent use of osteopathic neuromusculoskeletal care in diverse clinical settings.

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