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Pushing into the Barrier: Investigating the Use of OMM Among 3rd and 4th Year Medical Students
Pirzadeh, N. [1]
Dona, C. G. [1]
Valencia, R. [3]
Anche, G. [3]
Liang, W. M. [1]
Chen, D. [1]
Para, R. [1]
Volokitin, M. [22]

Journal: Journal of Osteopathic Medicine Date: 2025/12, 125(12):Pages: A725–726. doi: Subito , type of study: cross sectional study

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

Keywords:

cross sectional study [863]
medical students [659]
OMT [3779]
osteopathic manipulative treatment [3799]
osteopathic medicine [2055]
USA [1707]
utilization [24]

Abstract:

Context: Osteopathic Manipulative Medicine (OMM) is an integral part of osteopathic medical education, providing students with hands-on training to diagnose and treat somatic dysfunctions. However, despite receiving over 200 hours of OMM instruction in their first two years, many students use it less frequently during their clinical rotations. This decline can be attributed to both external and internal factors. Although studies have shown that practicing Osteopathic Physicians underutilize OMM [1], the causes remain unclear. Some efforts to boost OMM use during clinical years have improved usage [2,3] but more comprehensive data is needed to better understand barriers and opportunities, and ultimately strengthen OMM integration across training [4]. Objective: To understand the frequency of OMM usage by 3rd and 4th-year medical students during clinical rotations, and to identify barriers and facilitators to OMM use in patient care. A secondary objective was to evaluate whether these trends hold across multiple osteopathic institutions. Methods: We conducted an IRB-approved, cross-sectional survey of 3rd and 4th-year medical students from Touro College of Osteopathic Medicine - Harlem (n=53), who completed at least 5 blocks of clinical rotations, to understand the frequency and barriers of OMM application during their rotations in the fall semester. Using a Likert scale of 1 to 5, we measured students’ self-confidence in OMM, perceived barriers, and the influence of positive or negative feedback from medical professionals on their OMM practices over a 5-section, 40-item survey. To expand and validate our findings, the same survey was later distributed to (n=145) 3rd and 4th-year students at 13 osteopathic medical schools across the country as part of a Phase 2 rollout. The survey included a broad range of graduation years (classes of 2025–2028), ensuring representation across clinical phases. Results: In Phase 1, students reported moderate confidence in explaining the benefits of OMM to patients (mean: 3.7), but less confidence in adjusting techniques to individual patient needs or performing them in limited clinical spaces. The most frequently reported barriers were lack of treatment space (mean: 3.9) and limited time with patients (mean: 3.7). Key facilitators included being assigned OMM tasks by attendings (mean: 3.8) and having longer one-on-one time with patients (mean: 3.9). Most students reported few negative perceptions from preceptors or patients; however, there was also a noticeable lack of positive reinforcement. Preclinical training was considered effective in preparing students for diagnosing and explaining OMM to patients. In Phase 2, students across 13 osteopathic medical schools, with PCOM and Rowan-Virtua SOM having the highest representation, revealed similar patterns. OMM use was highest in Family Medicine and Pediatrics rotations, and lowest in OB-GYN, Surgery, and Psychiatry. While a few students reported performing OMM under MDs, most described these opportunities as limited by the preceptor’s unfamiliarity with OMM techniques and discomfort supervising them, highlighting that preceptor training and exposure, more than degree alone, play a critical role in OMM integration during rotations. Conclusion: This multi-institutional study reveals consistent patterns in OMM usage and barriers students face during clinical training. Findings from Phase 1 and Phase 2 identified Family Medicine and Pediatrics as the most common rotations for OMM use, while Surgery, Psychiatry, and OB/GYN were the least conducive. Key facilitators included working in outpatient settings with established OMM services, having supportive DO physicians, and longer patient interaction times. Conversely, major barriers included limited time, inadequate treatment space, and low preceptor familiarity, especially among MDs. Students felt moderately confident in identifying OMM opportunities, but less so in adapting to constraints. While overt negativity was uncommon, indifference from preceptors was frequently noted. Limitations include the self-reported nature of the data, a modest Phase 1 response rate, and limited geographic diversity, as most participating schools were located in the Northeast and may not reflect national trends [5-8]. Findings support the need for improved clinical alignment, DO mentorship, and broader institutional advocacy to sustain OMM’s presence in osteopathic education [9] and highlight the need for faculty development and curricular alignment to promote long-term retention [10].

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