Integrating Allopathic and Osteopathic Family Medicine Residency Training University of Pittsburgh, Dept. of Family Medicine Faculty Development Fellowship UPMC St. Margaret Pittsburgh, PA Jackie Weaver-Agostoni, DO, Faculty Development Fellow Stephen Ritz, DO, Director of Osteopathic Medical Education Stephen Wilson, MD, MPH, Resident and Fellowship Faculty

Osteopathic Principles 1. The Body is a Unit 2. Structure and function are reciprocally inter- related 3. The body possesses self-regulatory mechanisms 4. The body has the inherent capacity to defend and repair itself 5. When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue

Osteopathic Principles (cont.) 6. The movement of body fluids is essential to the maintenance of health 7. The nerves play a crucial part in controlling the fluids of the body 8. There are somatic components to disease that are not only manifestations of disease but also are factors that contribute to maintenance of the disease state

Integration Challenges 1. Didactics 2. Osteopathic Manipulative Treatment (OMT) 3. Precepting 4. Faculty “Buy-in” 5. Fulfilling all requirements for AOA and RRC

Didactics  Lecture Attendees If combined, topics of interest to both MDs and DOs Integrating OMT practice Faculty included  Frequency  Instructors Which faculty

Osteopathic Manipulative Treatment  Clinic vs. Integrated  Block vs. Longitudinal  Frequency  In-patient  Patient base  Time constraints

Precepting  Which physicians  Billing  Number of preceptors  Issues re: MDs precepting OMT

Faculty Buy-In  Skepticism  Promotion of osteopathic principles  Encourage OMT  EBM issues

Existing Models of Integration Hospital #1  Didactics monthly lectures required for all DO interns and FP residents divided by body areas part hands-on OMT for the MD once a year “OMT on the hospitalized patient” early in training  OMT Once/week with available DO Referrals and self- referred  Precepting Bill for OMT only if DO attending present  Evaluation OMM performance checklist Min 2x/yr

Hospital # 2  Didactics Lecture workshop 10 sessions/yr First few months = basics Final months = special topics  Evaluation State exam Observational  OMT Workshop FHC

Hospital #3  Didactics Monthly OMM lecture/ workshop Grand rounds  OMT monthly workshop weekly OMT clinic (referral based) FHC (variable experience)  Assessment State practical Observational Modified Chart Stimulated Recall (MCSR- under development) core skill sheet completion (under development)

Hospital # 4  Didactics 40 hrs over 3 yrs – Integrated w/ core rotational blocks 8 hr workshops w/ practical during selected core blocks  OMT workshops FHC clinic OMT clinic (elective)  EVALUATION OSCE at end of core blocks

Hospital #5  Didactics Lecture 1/mo. Includes hands-on DOs required, MDs welcome Faculty welcome Begin with basic review Subsequent topic chosen by residents  OMT Separate clinic only ½ day each week Referral-based (lecture dedicated to this education)  Precepting Mostly DOs (few MDs with extra training)  Evaluation Observation in clinic Documentation

Key AOA program Requirements: 1. Program Director must: Be full time Be AOBFP / ACOFP certified Have Min 3 yrs practice experience Maintain AOA (and AODME if DME also) membership 2. Residents – Minimum of 6 residents /3 yr 3. All residents must be AOA / ACOFP members

Key AOA program Requirements: 4. Must affiliate with OPTI ( Osteopathic post doctoral training institution) 5. All residents must participate in the AOA clinical assessment program 6. Institution must participate in the AOA intern match program 7. All graduating residents must participate in the AOBFP, and maintain an 85% pass rate

AOA vs. ACGME Family Medicine training requirements - differences Rotation AOA ACGME Differences 1.Peds 18 wks 16 wks 6 wks PGY1 AOA + 2 wks 2. Continuity ½ d per wk yr 1 pt visits visits vs hrs Clinic 3 x ½ d avg yrs 2/3 312 x ½ d yrs 2/3 3. OB/Gyn 16 wks /3 yrs 8 wks OB AOA -no min # 4 wks yr hrs gyn deliveries. 4. Surgery 5 mo / 3 yrs 2mo and subspecialties subspecialties included AOA

AOA vs. ACGME continued Rotation AOA ACGME Difference 5. Emergency 3 mo 2 mo AOA 2 + mo Medicine 1 mo yr 1 6. Internal med 6 mo /3 yrs 8 mo AOA 2 mo yr 1 1 mo ICU 6 mo inpt 2 mo yr 1 1 mo ICU 7. Electives Min 5 mo Min 3mo AOA 2 + mo Max 7 mo Max 6 mo Min 1 mo yr1 Min 2 mo each yrs 2/3 8. Sports Med Not specified required in MS curriculum

AOA -Osteopathic curriculum requirements: 9. Osteopathic principles/practice (OPP): - must be taught longitudinally - all pt. care settings - most will be taught in continuity clinic - must be documented in the medical record - document application of OMT in a variety of conditions, (not just musculoskeletal problems) - No specific didactic/ practical curriculum requirements

AOA Resources  AOA = DO-online.org  ACOFP =acofp.org - resident training

Special Thanks To:  UPMC St. Margaret  UPMC McKeesport  Western Pennsylvania Hospital  Mercy Hospital, Pittsburgh, PA  UHHS- Case Western