Manual Musculoskeletal Medicine Elective for Allopathic Residents Sarah Cole, DO, FAAFP Mercy Family Medicine St. Louis Lecture Discussion

Disclosures I have no disclosures to report.

Mercy Family Medicine

Osteopathic Curriculum for DOs Competency assessment for PGY1s Knowledge Skills 9 45-minute workshops embedded as an 18-month curriculum in block didactics Direct observation in continuity clinic

The MDs wanted in! 85% of primary care MD residents believe OMT is helpful in the management of musculoskeletal disease 80% of MD residents are interested in learning more Allee et al JAOA Dec 2005

And it’s feasible… Introducing osteopathic medical education in an allopathic residency. Rubeor et al. JAOA 2008 Allopathic family medicine residents can learn OMT in a 1-month elective Lieber J. Fam Med 2005

Objective Create a focused curriculum for senior family medicine residents to develop competency in limited OMT commonly utilized in family medicine

Techniques Commonly used by FPs Taught to DOs Taught to MDs Soft tissue HVLA Muscle energy Articulatory Myofascial release Counterstrain -Johnson and Kurz JAOA 2003 Ligamentous release Facilitated positional release cervical, thoracic, lumbar spine and pelvis Counterstrain, limited cervical, thoracic and lumbar spine thoracic spine

Curricular Content Knowledge Skills Didactic sessions to review osteopathic principles & theory (3) Hands-on workshops to practice osteopathic examination, diagnosis & treatment (6) Observership of chiropractors and physical therapists (6) Weekly Osteopathic Manipulation clinic (4)

Assessment Knowledge Skills Cognitive exam consisting of 25, multiple-choice, AOBFP-style questions Standardized patient encounter with demonstration of OMT Case presentation from continuity clinic Pre/post rotation self-assessment of confidence

Results All achieved minimum passing score of 80% on cognitive exam All reported improved confidence in ability to apply manual techniques for musculoskeletal diagnoses

On a scale of 1-5, how confident are you in your ability to apply manual techniques for musculoskeletal disease?

Resources Required OMT tables Knowledgeable faculty (DO or MD with OMT training) Time (clinic, didactic & faculty)

Limitations Hard to identify which MDs are qualified to perform OMT in continuity clinic No prior assessment of DOs’ confidence at any training level for comparison purposes No graduate survey data on utilization once in practice No mandate to maintain CME

References Allee MA, Pollak MH, Malnar KF. Survey of osteopathic and allopathic residents’ attitudes toward osteopathic manipulative treatment. JAOA 2005; 105(12): 551-561. Lieber JD. Allopathic family medicine residents can learn osteopathic manipulation techniques in a 1-month elective. Fam Med 2005; 37(7): 693-695. Johnson SM, Kurz ME. Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. JAOA 2003; 103(5): 219-224. Rubeor A, Nothnagle M, Taylor JS. Introducing osteopathic medical education in an allopathic residency. JAOA 2008; 108(8): 404-408.

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