Journal of Osteopathic Medicine最新文献

Context: Simulation-based medical education (SBME) is a method for enhancing learner skill prior to initiating care for real patients. Although the use of SBME continues to grow, there is limited data on simulations related to osteopathic medical training. Osteopathic manipulative medicine (OMM) applies hands-on techniques to facilitate healing. We hypothesized that the use of SBME to closely mimic OMM provided to the hospitalized patient would help to increase individual knowledge and comfort with OMM techniques and increase the likelihood of a learner utilizing OMM techniques on patients.

Objectives: This study aimed to determine the effectiveness of the SBME lab to enhance the learning of medical learners of OMM on hospitalized patients, and to determine the favorability of the OMM SBME experience by learners.

Methods: This was a single-institution pilot quality improvement project that utilized a novel simulation to provide OMM to critically ill and hospitalized patients. The simulation was a single instructor-led event lasting 2 h. The OMM experience utilized specialized simulation gowns and hospital beds to mimic the treatment of postsurgical ileus, acute respiratory failure, and congestive heart failure (CHF) exacerbation. Learners alternated between the role of physician (practicing technique) and the patient (wearing the simulation gown). Pre- and postsurveys evaluated learners' knowledge and comfort regarding OMM in hospitalized patients. Graduate medical residents/fellows from five osteopathic-recognized programs and medical students on rotations (n=35) participated in the simulation, and n=32 completed the postsimulation survey. The survey included 15 questions and utilized a 5-point Likert Scale. Results were analyzed with the chi-square test.

Results: The average knowledge pretest score ranged from 2.5 to 3.5 for the 15 questions. Learner knowledge improved for all areas evaluated, with a range of 3.6-4.6 for the postsurvey. The p-value was significant for each question. In addition, lab, simulation, and lecturers were evaluated and were received positively.

Conclusions: This study demonstrates that simulation may be an effective way to increase knowledge and comfort on how to apply OMM in a hospital setting.

Context: Research on the effects of osteopathic manipulative treatment (OMT) on visual functions and conditions is very limited. This study continues the exploration on the application of OMT with the intent of lowering intraocular pressure (IOP).

Objectives: A pilot randomized clinical trial was conducted to assess the impact of one OMT session on patients diagnosed with suspected ocular hypertension (OHT) or glaucoma.

Methods: Patients meeting the inclusion and exclusion criteria were randomized to OMT treatment or no-treatment control groups. Total n=16: treatment=9, control=7. The OMT included osteopathic cranial manipulative medicine (OCMM) along with myofascial release (MFR) and soft-tissue procedures. There were no adverse events reported in either cohort. Each patient was seen in AM and PM sessions for 5 days; the first 2 days established eligibility to be randomized to treatment or control cohorts after the Day 3 AM IOP assessment. Subjects in the control group laid on the treatment table with no OMT performed. Immediately after the intervention, the patient had a second Day 3 IOP assessment, then a PM IOP assessment. On Day 4, the patient received an AM and PM IOP assessment, and on Day 5, at the 1-week follow-up time period the patients again received AM and PM IOP assessments.

Results: In the OMT treatment group, significant IOP reductions were detected posttreatment with differences between the Day 3 initial AM pre-randomization IOP level and the immediate postintervention IOP (p=0.027; -1.361 mmHg), the Day 4 PM (p=0.016; -1.556 mmHg), and the Day 5 PM (p=0.014; 1.382 mmHg).

Conclusions: The application of OMT shows potential benefit in the reduction of IOP in patients with suspected OHT and patients with suspected glaucoma.

Context: Following the transition to a single graduate medical education (GME) accreditation system in 2020, leaders at American Association of Colleges of Osteopathic Medicine (AACOM) were interested in learning more about the research being done about osteopathic medical education leading up to that point in time.

Objectives: The objective of this scoping review was to identify trends in undergraduate and graduate osteopathic medical education and to determine where this information was being disseminated and the institutions who were creating the content.

Methods: Searches were conducted in eight databases: PubMed (National Center for Biotechnology Information [NCBI]), MEDLINE (Ovid), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature ([CINAHL], EBSCO), Education Research Complete (EBSCO) OSTMED.DR, Education Resources Information Center ([ERIC], Ovid), and Scopus (Elsevier). Gray literature sources were also identified. All 10 authors were involved in the search. Search terms were identified by utilizing Medical Subject Headings (MeSH), the Yale MeSH Analyzer, and through consultation with an expert searcher. Sources were excluded if they were not in English, were based outside of the United States, did not fit in the date range of being published between 2010 and 2020, and included information on COVID-19. The research team conducted title/abstract screening based on the inclusion and exclusion criteria.

Results: A total of 8,083 articles were identified and included through searches, ending in a total of 1,203 articles after full-text screening. Most sources for this osteopathic medical education review were journal articles (n=505) and conference proceedings (n=482). A total of 23 trends were identified, with the top three being residency (n=318), curriculum (n=235), and pedagogy (n=178). None of the other 23 primary trends were above 6.9 %.

Conclusions: Osteopathic medical education trends from 2010 to 2020 were primarily focused on residency, curriculum, and pedagogy. This information was disseminated evenly between published journal articles and conference presentations, and osteopathic institutions that have existed longer and have established research track records were more likely to publish and share information in this area.

Context: Medical education in the United States has undergone significant changes, specifically within the osteopathic community. In 2020, a merger occurred between the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME), forming a single accreditation system (SAS) for graduate medical education and residency placement, with the purpose to create consistency within graduate medical education and to provide equal opportunities for applicants pursuing all specialties in medicine. However, osteopathic medical students, especially students applying to competitive residencies including orthopedic surgery, have faced challenges, raising concerns about future implications within this field.

Objectives: The main objective of this study aimed to investigate recent match rate trends in orthopedic surgery within the past 5 years and to forecast match trends for both allopathic and osteopathic students to further analyze the future projection of the orthopedic surgery match.

Methods: This study utilized publicly available data from the National Residency Match Program (NRMP) Main Residency Match data. Data were collected retrospectively from 2020 to 2024 regarding students applying for orthopedic surgery residency. The number of matched Doctor of Osteopathic Medicine (DO) applicants, Doctor of Medicine (MD) applicants, overall applicants, and the proportion of matched applicants being DOs were forecasted over the next 10 years utilizing an Autoregressive Integrated Moving Average (ARIMA) model in SPSS 29.0. This model harvests data from previous instances (number of matched applicants from 2008 to 2024) to develop a close-fit model to predict future values and their respective confidence intervals (CIs). This study incorporated all applicants applying to orthopedic surgery, including international medical graduates (IMGs).

Results: There was an increase in the total applicants applying to orthopedic surgery residency positions for both allopathic and osteopathic students. The largest increase in applicants occurred between the 2021 and 2022 application cycles. There was a statistically significant difference in the total number of applicants overall over the 2020-2024 match cycle. The percentage of DOs to match into an orthopedic surgery residency position decreased from 63.28 % in 2020 to 45.70 % in 2024, and there was a statistically significant decline in the match percentage of DOs in orthopedic surgery residency over the 2020-2024 match cycle. Based on the ARIMA model projection utilizing data from 2008 to 2024, there is expected to be an average increase of 14.1 % in the total number of positions offered by 2034, to 1,045 positions total. There is expected to be a moderate increase in the number of matched DO applicants, from 128 in 2024 to 161 in 2034. Utilizing data from 2016 to 2024, there is expected to be

Context: The healthcare industry faces a critical shortage of qualified physicians. To address this growing concern, medical schools nationwide are increasing their efforts to recruit and train premedical students to fill this gap. Those efforts include adequately preparing premedical students with the competencies and skills to meet the application requirements and gain acceptance to the medical school of their choosing. These requirements include a Medical College Admission Test (MCAT) score at or above the mean of 504, a grade point average (GPA) at or above the mean of 3.61 for the total GPA and 3.53 for the science GPA. The application also requires demonstrating specific core competencies, including patient care, communication, and problem-solving skills evidenced by activities and achievements. Unfortunately, many premedical students are unsure of what activities and experiences fulfill these competencies, the expectations of medical school and clinical practice, and the roles and responsibilities in various settings. Therefore, early exposure and guidance when selecting these experiences and activities are vital in helping premedical students to make informed decisions and select experiences that align with their career goals. While obtaining clinical experiences can be challenging, these requirements may provide invaluable insights into the profession and fulfill competencies required for medical school admission. Furthermore, these experiences familiarize students with clinical and interprofessional settings early in their careers. Because premedical students are better equipped to gain admission to medical school, universities can expand their pool of qualified and adequately prepared candidates matriculating into medical training.

Objectives: This review aims to determine how US premedical osteopathic and allopathic students gain clinical experiences and extracurricular activities that enhance their application and increase their chances of admission into a medical school of their choice.

Methods: The authors conducted a comprehensive search of Education Resources Information Center (ERIC), Scopus, Excerpta Medica dataBASE (EMBASE), and other databases for original peer-reviewed studies of undergraduate, premedical, and medical students in the United States utilizing the deconstruction technique. The authors utilized thematic analysis to unearth overarching themes from the results and outcomes of these studies.

Results: The authors reviewed 14 studies published between 2004 and 2022. The articles addressed two main themes: the types of clinical experiences and extracurricular activities that increase medical school admission and those that meet the critical competencies required for medical school and osteopathic practice. Activities such as shadowing, research, healthcare, and volunteering were identified repeatedly. Self-reporting, researcher bi

Context: With the advent of the Single Accreditation System (SAS) within the Accreditation Council for Graduate Medical Education (ACGME), few programs have achieved Osteopathic Recognition (OR) status to date. OR is an accreditation that graduate medical education (GME) programs can achieve to distinctly acknowledge the additional focus on osteopathic training. There is an effort by national osteopathic organizations to determine barriers for programs to achieve OR and what innovative methods might help overcome them. In identifying its own barriers, a central Ohio hospital created a unique Program Director for Osteopathic Medical Education (PDOME) role to assist its 10 programs in achieving OR.

Objectives: The objectives of this study were to determine the effect that a PDOME role has through measures of the numbers of programs achieving OR and standards met, as well as the perceived 'helpfulness' of the role based on surveys of program leadership.

Methods: Upon initiation of the PDOME in July 2021, the PDOME assessed applications, citations, and curriculums of the 10 hospital programs with varied OR status to help determine curricular goals. Additional osteopathic activities, evaluation tools and faculty development were subsequently offered based on this information and needs assessments of the programs. A survey was sent to all programs at intervals of 12 and 18 months after role inception to be utilized as process improvement. Comparisons were made between surveys, as well as between the total number of programs with continued OR status and the total OR requirements achieved before and after PDOME. A chi-square test (or Fisher's exact test when the 'n' was too small) was utilized for significance, and the p value was set at 0.05.

Results: After the PDOME, there was a significant increase in the number of OR standards met across programs (p<0.001). Although not significant, the number of programs achieving continued OR increased from 4 to 8 (p=0.168). Due to many positive responses in both surveys, there was no significance between surveys in the "helpfulness" of PDOME; however, there was a significant increase in the number of respondents from 13/67 (or 19.4 %) to 32/67 (or 47.8 %) (p<0.001), indicating increased engagement among respondents.

Conclusions: This study suggests that a PDOME role in medical education may be well received and may assist GME programs in achieving OR. Implementation of a similar role elsewhere could help programs overcome barriers and stir growth in OR programs nationwide.

Context: The injuries caused by falls-from-height (FFH) are a significant public health concern. FFH is one of the most common causes of polytrauma. The injuries persist to be significant adverse events and a challenge regarding injury severity assessment to identify patients at high risk upon admission. Understanding the incidence and the factors that predict injury severity can help in developing effective intervention strategies. Artificial intelligence (AI) predictive models are emerging to assist in clinical assessment with challenges.

Objectives: This retrospective study investigated the incidence of FFH injuries utilizing conventional statistics and a predictive AI model to understand the fall-related injury profile and predictive factors.

Methods: A total of 124 patients who sustained injuries from FFHs were recruited for this retrospective study. These patients fell from a height of 15-30 feet and were admitted into a level II trauma center at the border of US-Mexica region. A chart review was performed to collect demographic information and other factors including Injury Severity Score (ISS), Glasgow Coma Scale (GCS), anatomic injury location, fall type (domestic falls vs. border wall falls), and comorbidities. Multiple variable statistical analyses were analyzed to determine the correlation between variables and injury severity. A machine learning (ML) method, the multilayer perceptron neuron network (MPNN), was utilized to determine the importance of predictive factors leading to in-hospital mortality. The chi-square test or Fisher's exact test and Spearman correlate analysis were utilized for statistical analysis for categorical variables. A p value smaller than 0.05 was considered to be statistically different.

Results: Sixty-four (64/124, 51.6 %) patients sustained injuries from FFHs from a border wall or fence, whereas 60 (48.4 %) sustained injuries from FFHs at a domestic region including falls from roofs or scaffolds. Patients suffering from domestic falls had a higher ISS than border fence falls. The height of the falls was not significantly associated with injury severity, but rather the anatomic locations of injuries were associated with severity. Compared with border falls, domestic falls had more injuries to the head and chest and longer intensive care unit (ICU) stay. The MPNN showed that the factors leading to in-hospital mortality were chest injury followed by head injury and low GCS on admission.

Conclusions: Domestic vs. border FFHs yielded different injury patterns and injury severity. Patients of border falls sustained a lower ISS and more lower-extremity injuries, while domestic falls caused more head or chest injuries and low GCS on admission. MPNN analysis demonstrated that chest and head injuries with low GCS indicated a high risk of mortality from an FFH.

Context: Point-of-care ultrasound (POCUS) has diverse applications across various clinical specialties, serving as an adjunct to clinical findings and as a tool for increasing the quality of patient care. Owing to its multifunctionality, a growing number of medical schools are increasingly incorporating POCUS training into their curriculum, some offering hands-on training during the first 2 years of didactics and others utilizing a longitudinal exposure model integrated into all 4 years of medical school education. Midwestern University Arizona College of Osteopathic Medicine (MWU-AZCOM) adopted a 4-year longitudinal approach to include POCUS education in 2017. There is a small body of published research supporting this educational model, but there is not much data regarding how this approach with ultrasound curriculum translates to real-world changes in POCUS use by graduate student clinicians having received this model of education.

Objectives: The objectives of this study are to determine the frequency of POCUS use by MWU-AZCOM graduates and to assess how a 4-year longitudinal ultrasound curriculum may enhance the abilities of MWU-AZCOM graduates to perform and interpret ultrasound imaging in specific residency programs.

Methods: The study was approved by the MWU Institutional Review Board (#IRBAZ-5169, approval date October 3, 2022). An anonymous novel 12-question survey was conducted utilizing Research Electronic Data Capture (REDCap), a secure online platform, and distributed to MWU-AZCOM 2021 and 2022 graduates via email. Survey questions were aimed at assessing frequency of use, utilization of different imaging modalities, reasons for utilizing POCUS, barriers/enablers to utilizing POCUS, ultrasound training, and confidence in performing scans and interpreting POCUS imaging. All of the 104 surveys returned were included in the study. Statistical software R version 4.3 was utilized to conduct statistical analyses.

Results: Of the 484 surveys distributed, 104 were completed (21.5 % response rate). Responses came from residents working in 14 different specialties, 50 in primary care and 54 in nonprimary care. Of all respondents, 85.6 % currently utilize POCUS in their practice on at least a monthly basis and 77.0 % believe that their POCUS training in medical school enriches their current practice in residency. The top five modalities utilized by residents were procedures (89.9 %), cardiac (88.8 %), pulmonary (82.0 %), Focused Assessment with Sonography for Trauma (FAST, 73.0 %), and vascular (71.9 %). Respondents recognized POCUS as a beneficial diagnostic tool (97.8 %) and reported enhancements in physical examination skills (58.4 %) and professional growth (61.8 %). Facilitators for POCUS adoption included cost-effectiveness (82.0 %), diagnostic differentiation (78.7 %), and safety (79.8 %). Barriers included a lack of trained faculty (27.9 %), absenc

Context: In 2020, the allopathic and osteopathic residency programs were merged into a single residency system, with the Accreditation Council for Graduate Medical Education (ACGME) as the sole accreditor for residencies and fellowships in the United States. As a result of this merger, osteopathic recognition (OR) emerged as a unique approach to promoting osteopathic training and practice. However, there is a lack of data on the effects of OR in residency, specifically university-based residency programs.

Objectives: The objective of this study is to investigate the impact of OR on retaining and applying osteopathic principles in a mixed cohort of residents in a single-center setting.

Methods: We conducted a prospective cohort study of allopathic and osteopathic-trained residents at varying years of postgraduate training in family medicine (FM), internal medicine (IM), and combined internal medicine-pediatric residencies at a single site. Participation in both the osteopathic curriculum and study was voluntary. We distributed a presurvey before the residents participated in the curriculum for that year and a follow-up 6 months later as a postsurvey. The surveys measured confidence levels based on a Likert scale and were aligned with the Osteopathic Recognition Milestones Project (ORMP). Statistical analysis with paired t tests and a Wilcoxon signed-rank test was conducted on participants who completed both surveys.

Results: We had 38 % (18/47) of participants complete both surveys. We observed significant improvements in confidence levels related to osteopathic principles (p=0.036). Residents reported statistically significant gains in their ability to conduct a literature review on osteopathic medicine (p=0.0288). Additionally, there was a trend toward significance in confidence levels regarding the patient's perception of touch (p=0.0741) and the osteopathic treatment plan (p=0.0635). Notably, content knowledge was significantly improved (p=0.0313) for all participants. Based on the postsurvey responses, we discovered that participants who not only reported higher confidence overall but also had practiced osteopathic manipulative treatment (OMT) in the last month were more likely to state they would practice osteopathic manipulative medicine (OMM) after residency.

Conclusions: We conducted a prospective cohort study to assess the effects of OR utilizing surveys aligned to the ORMP. We identified knowledge- and confidence-level gains on osteopathic principles and practice (OPP) in a single-center study. Residents in OR are more likely to utilize OMT after residency.

Context: Medical students report high levels of perceived stress and burnout, especially during the preclinical years. The combination of physical stressors from poor posture, poor sleep quality, and mental stressors from the rigorous curriculum stimulates the sympathetic nervous system (SNS) to secrete cortisol. Previous studies have shown that persistent elevated cortisol levels are associated with negative health outcomes.

Objectives: We conducted an Institutional Review Board (IRB)-approved study to determine if regular osteopathic manipulative treatments (OMTs) could impact the stress levels of first-year osteopathic medical students (OMSs) at Touro College of Osteopathic Medicine (TouroCOM) Harlem campus by measuring physiologic stress through changes in weekly salivary cortisol levels, perceived emotional and psychological stress levels, and cognitive function.

Methods: We recruited 10 first-year OMSs who were not currently receiving external OMT outside of weekly coursework; other forms of external stress management, such as yoga or meditation, were not controlled for in this study. Utilizing a random number generator, the 10 student respondents were split into a control group that received no treatment and a treatment group that received 15 min of weekly OMT for 6 weeks. The treatment consisted of condylar decompression, paraspinal inhibition, and supine rib raising, which are techniques that are known to balance the SNS and parasympathetic nervous system (PNS). Cortisol levels were quantified by enzyme-linked immunosorbent assay (ELISA) cortisol immunoassay via salivary samples collected at the beginning of each weekly session, prior to treatment for the treatment group, at the same time of day each week. We also measured participants' weekly subjective perception of stress utilizing the College Student Stress Scale (CSSS) and cognitive function utilizing the Lumosity Performance Index (LPI). We conducted a two-tailed, unpaired t-test as well as a U test for the cortisol levels, given the smaller sample size and potential for a nonnormal distribution.

Results: A lower cortisol level was correlated to a higher optical density (OD), the logarithmic measure of percent transmission of light through a sample; analysis of our data from the ELISA cortisol immunoassay showed an average weekly change in OD (∆OD) for the treatment group of 0.0215 and an average weekly ∆OD of -0.0044 in the control group. The t-test showed p=0.0497, and our U test showed a p=0.0317. Both tests indicated a statistically significant decrease across the weekly salivary cortisol levels in the treatment group utilizing a p<0.05. An additional effect-size analysis supported our finding of a significant decrease in weekly cortisol levels in the treatment group, Cohen's d=1.460. Based on the CSSS responses, there was no significant difference in perceived stress b