Osteopathic Family Medicine Residents' Knowledge, Views, & Management of Natural Family Planning
Recent surveysane–v on the use of osteopathic manipulative treatment (OMT) past osteopathic physicians (DOs) in clinical practice take documented a declining use of OMT. This diminished use of OMT by DOs, in turn, has raised concerns that OMT might become a "lost art" in the osteopathic medical profession.6 Because OMT is i of the about distinctive features of osteopathic medicine, the concern is non only for the loss of a central component of osteopathic medical exercise, but as well for the potential loss of the distinctive nature of the osteopathic medical profession.4,six,7
Since 1985, the majority of new DOs have received their residency training in allopathic training programs that have been accredited past the Accreditation Quango for Graduate Medical Teaching (ACGME) rather than those that accept been canonical by the American Osteopathic Association (AOA).8,ix There are ii chief implications of this preparation blueprint for trends in the practise of OMT. These implications tin be stated in the form of hypotheses:
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Hypothesis i: Osteopathic physicians who receive postdoctoral training outside of traditional AOA-approved medical residency programs will be less probable to use OMT.
-
Hypothesis 2: Because more than allopathic graduates are beingness exposed to OMT, by virtue of practicing aslope increasing numbers of osteopathic residents, the interest of allopathic physicians (MDs) in learning OMT and using it in their practices is increasing.
A number of previous studies support our first hypothesis. Aguwa and Liechty3 and Johnson and Kurtz4 institute that DOs who received preparation in residency programs approved by the AOA reported more OMT apply than did DOs who received training in ACGME-accredited programs or programs with dual accreditations. Fryane found that practicing DOs who adult an interest in OMT during their internships also reported using OMT more than oft in their practices, compared with those DOs who were not interested in OMT during their internships. Spaeth and Pheley5 discovered that depression frequency of OMT use by practicing DOs was associated more than closely with insufficient training in OMT during residency than during medical school.
In contrast to these results, Johnson et alii found that DOs' perceptions of insufficient training were not predictive of current utilise of OMT in clinical exercise. Since all of these studies asked practicing DOs to answer to questions about postdoctoral training experiences that had occurred years before, information technology is not articulate that the observed differences in OMT utilize in clinical practise are the result of experiences obtained during postdoctoral grooming. We believe there are at to the lowest degree iii culling explanations for these differences, outlined below.
The first alternative explanation is that differences in OMT use amid practicing DOs reflect decisions or expectations formed before residency preparation. For example, DOs who intend to utilize OMT minimally or not at all in subsequent clinical practice, or for whom other considerations play a more important role in residency choice, may exist more likely to choose ACGME-accredited postdoctoral training programs. One such group consists of those who apply the degree in osteopathic medicine as a "backdoor" into allopathic medicine.10 2 studies10,11 have found that these so-called "allopathic ideologists" (ie, DOs who would have preferred to attend allopathic medical schools) were less probable than other DOs to apply OMT in their current or future practice.ten,11
The second alternative explanation is that differences in utilize of OMT among practicing DOs is a result of posttraining experiences and decisions. Fry1 reported that 2-thirds of the practicing DOs who responded to his group'southward survey indicated that experiences they had after completion of formal preparation influenced the amount of OMT they use. Spaeth and Pheley5 reported that xl% of the DOs in their survey had reduced OMT utilise since starting medical practise. In 2 studies, Johnson et al2 and Johnson and Kurtz4 reported that survey respondents attributed their reduced use of OMT to barriers to OMT use in practice rather than to deficiencies in grooming. Amid these barriers were limited time, poor reimbursement, competing professional interests, and unsuitable physical facilities.
The third alternative explanation is that differences in OMT use amidst practicing DOs reflect the different types of medical specialties called past those residents who are enrolled in AOA-approved programs versus ACGME-accredited programs. For example, if a larger proportion of DOs in AOA-approved residency programs, compared with ACGME-accredited residency programs, specialize in family medicine, the physicians in family medicine would be more likely than the physicians in other specialties to care for their patients with OMT.iv In this example, differences in OMT use between DOs in AOA-approved and ACGME-accredited residency programs might reflect the larger proportion of family medicine physicians in AOA-approved programs.
Given the recent down trend in OMT use in clinical practice, equally well as the potential influence of postdoctoral grooming programs on attitudes toward OMT, nosotros undertook a survey of OMT use past, and attitudes of, osteopathic residents in AOA-approved and ACGME-accredited family unit medicine residency programs and residency programs other than family medicine. We besides studied attitudes toward OMT of allopathic residents in ACGME-accredited family medicine residency programs.
Methods
We developed split up ane-page surveys for osteopathic (Figure 1) and allopathic (Figure ii) family medicine residents who were in AOA-approved or ACGME-accredited programs. The survey for DOs was also given to physicians in residency programs other than family medicine. The Institutional Review Board of the University of Oklahoma College of Medicine at Tulsa approved these surveys and all other aspects of the electric current study.
Both surveys asked near physicians' attitudes regarding the effectiveness of OMT and their desire for continuing medical instruction (CME) opportunities focused on OMT. The survey for osteopathic residents also asked almost the extent of their current OMT apply; expectations they might have had before their residencies with regard to OMT employ; expectations for postresidency OMT use; confidence in their OMT preparation and ability; availability of skilled OMT mentors; adequacy of their current facilities for OMT; and support for OMT among colleagues.
The survey for allopathic residents asked about their preresidency familiarity with and exposure to OMT; their involvement in OMT training; the level of their support for inclusion of OMT training into the curricula of allopathic medical schools and residency programs; and the level of their support for AOA certification of allopathic physician proficiency in OMT.
We purchased 439 mailing labels from the AOA for all AOA family medicine residents in Arkansas, Missouri, Oklahoma, and Texas. Near of the AOA trainees in these four contiguous states who returned the surveys graduated from 1 of the four osteopathic medical schools in this region: Kirksville (Mo) College of Osteopathic Medicine of A.T. Yet Academy of Health Sciences, Oklahoma Land University Higher of Osteopathic Medicine in Tulsa, Kansas City (Mo) University of Medicine and Biosciences College of Osteopathic Medicine, or University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine. We too purchased 1424 mailing labels from the ACGME for all ACGME family medicine residents in this same region. We used the labels to mail surveys and postage-paid return envelopes to the resident physicians. A encompass alphabetic character explained the nature of the study and bodacious confidentiality.
Six weeks post-obit the outset mailing, nosotros mailed a second re-create of the survey using an updated mailing listing for both AOA and ACGME residents. Along with the second survey, nosotros sent a encompass letter asking the recipient to complete and return the accompanying class only if he or she had non returned the original survey.
We tabulated response frequencies using SPSS statistical software (version xi.five for Windows; SPSS Inc, Chicago, Ill) and used the χ2 examination procedure to analyze differences in response frequencies betwixt DOs in AOA-canonical and ACGME-accredited programs. All group differences reported in the current study are pregnant at P<.05.
Figure ane.
Survey provided to osteopathic residents on attitudes toward osteopathic manipulative treatment.
Results
Although nosotros had originally intended to survey only family medicine residents, many surveys returned to us were from residents in specialties other than family medicine. Responses from these boosted respondents were tabulated and included for assay and discussion.
Table 1 shows the distribution of DOs and MDs who responded to the survey by program blazon and medical specialty. Of the 439 DOs surveyed, 155 (35.3%) returned completed questionnaires. Nonetheless, results for half dozen DO respondents who indicated OMT every bit their medical specialty were excluded from statistical analyses, resulting in a concluding Do response charge per unit of 33.nine%. Of these DO respondents (due north=149), 54 (36.two%) were in AOA-approved residency programs and 95 (63.viii%) were in ACGME-accredited residency programs.
Table 1
Osteopathic and Allopathic Physicians in AOA-Canonical and ACGME-Accredited Residency Programs past Specialty (Due north=381) *
| | Residents, No. (%) | ||||
|---|---|---|---|---|---|
| Specialty/Residency Program | Osteopathic (northward=149 † ) | Allopathic (northward=232) | Total | ||
| ▪ Family Medicine | |||||
| □ AOA | 28 (42.four) | ... | 28 (7.3) | ||
| □ ACGME | 38 (57.six) | 232 (100) | 270 (70.nine) | ||
| ▪ Other | |||||
| □ AOA | 26 (31.3) | ... | 26 (half dozen.8) | ||
| □ ACGME | 57 (68.7) | ... | 57 (xv.0) | ||
Figure 2.
Survey provided to allopathic residents on attitudes toward osteopathic manipulative treatment.
Lx-6 (44.3%) of the Exercise respondents specialized in family medicine. Of these, 28 (42.4%) were in AOA-canonical residency programs and 38 (57.half dozen%) were in ACGME-accredited residency programs. Eighty-three (55.7%) of the DO respondents practiced specialties other than family medicine. Of these, 26 (31.3%) were in AOA-approved programs and 57 (68.7%) were in ACGME-accredited programs.
Of the 1424 MDs surveyed, 233 returned completed questionnaires for a final Doc response charge per unit of sixteen.iv%. All just i respondent were in ACGME-accredited family medicine residency programs. The lone allopathic resident who was in an ACGME-accredited programme other than family medicine is not included in the data gear up presented in this newspaper, and then the total Md sample size is 232.
▪ Osteopathic Residents in Family unit Medicine
Survey results for DOs in family medicine residency programs (n=66) are reported in Table two. Because of nonresponses to certain questions by some survey respondents, the sample size for each question in the survey varied from 27 to 28 (for osteopathic residents in AOA-canonical family unit medicine programs) and from 37 to 38 (for osteopathic residents in ACGME-accredited family unit medicine programs). All group differences are significant at P<.05.
Table 2
Survey of Osteopathic Residents' Attitudes Toward Osteopathic Manipulative Handling by Specialty and Residency Type *
| | Response, No. (%) | ||||||
|---|---|---|---|---|---|---|---|
| Family Medicine (n=66 † ) | Other (n=83 ‡ ) | ||||||
| Question | AOA | ACGME | AOA | ACGME | |||
| 1. To what extent exercise yous use OMT? | |||||||
| □ Daily | 8 (28.6) | iii (vii.9) | i (three.8) | 0 | |||
| □ Weekly | eleven (39.three) | 12 (31.half-dozen) | 7 (26.9) | 4 (7.0) | |||
| □ Monthly | 3 (10.seven) | 7 (18.4) | five (19.2) | vii (12.iii) | |||
| □ Rarely | 4 (14.3) | 13 (34.2) | ten (38.5) | 23 (40.four) | |||
| □ None | 2 (7.i) | 3 (7.9) | 3 (11.5) | 23 (40.four) | |||
| two. Prior to residency, to what extent did y'all plan on using OMT? | |||||||
| □ Frequently | 14 (50.0) | 15 (forty.five) | five (19.two) | 16 (28.1) | |||
| □ Occasionally | 13 (46.4) | 21 (56.8) | xvi (61.5) | 26 (45.6) | |||
| □ Rarely | ane (three.6) | ane (2.7) | 3 (11.5) | 8 (14.0) | |||
| □ Never | 0 | 0 | two (7.7) | 7 (12.three) | |||
| three. To what extent do you program on including OMT in your do afterward residency? | |||||||
| □ Often | 16 (57.ane) | 12 (31.6) | 4 (15.iv) | 3 (5.3) | |||
| □ Occasionally | x (35.vii) | 20 (52.6) | seven (26.nine) | 17 (29.8) | |||
| □ Rarely | 2 (vii.one) | v (13.ii) | eleven (42.three) | 20 (35.1) | |||
| □ Never | 0 | 1 (2.6) | 4 (fifteen.4) | 17 (29.8) | |||
| 4. Do y'all feel confident in your OMT training? | |||||||
| □ Yes | 26 (92.9) | 30 (78.9) | 22 (88.0) | 35 (61.4) | |||
| □ No | 0 | 5 (13.two) | i (4.0) | 11 (19.iii) | |||
| □ Non sure | ii (vii.1) | 3 (7.ix) | 2 (viii.0) | 11 (19.3) | |||
| 5. Practise y'all experience confident in your OMT ability? | |||||||
| □ Yes | 25 (89.iii) | 30 (78.9) | 15 (60.0) | 23 (xl.4) | |||
| □ No | 0 | half-dozen (xv.8) | 6 (24.0) | twenty (35.1) | |||
| □ Not sure | 3 (10.7) | 2 (5.three) | iv (16.0) | fourteen (24.6) | |||
| 6. To what extent do you experience OMT is effective for somatic dysfunction? | |||||||
| □ Very effective | 23 (82.1) | 27 (71.i) | 17 (68.0) | 25 (44.6) | |||
| □ Somewhat effective | 5 (17.9) | 10 (26.3) | 7 (28.0) | xxx (53.6) | |||
| □ Non effective | 0 | ane (ii.6) | one (4.0) | ane (i.8) | |||
| 7. To what extent practice you feel OMT is effective for systemic illness (eg, asthma)? | |||||||
| □ Very effective | 5 (17.9) | iv (10.five) | 1 (3.eight) | iv (7.0) | |||
| □ Somewhat effective | xviii (64.iii) | 24 (63.two) | 19 (73.i) | 31 (54.4) | |||
| □ Not effective | 5 (17.9) | 10 (26.3) | 6 (23.one) | 22 (38.6) | |||
| eight. Do you lot experience your faculty and fellow residents support OMT? | |||||||
| □ Yes | 19 (67.9) | eighteen (47.4) | xi (45.viii) | 7 (12.5) | |||
| □ Some | 8 (28.6) | 18 (47.4) | 10 (41.7) | 27 (48.two) | |||
| □ No | ane (3.vi) | 2 (v.3) | 3 (12.5) | 22 (39.3) | |||
| 9. Practise you experience your current facilities are adequate for OMT? | |||||||
| □ Yes | twenty (74.1) | 12 (32.4) | xiii (52.0) | 11 (14.3) | |||
| □ No | 7 (25.nine) | 25 (67.six) | 12 (48.0) | 46 (80.seven) | |||
| 10. Practice you have a skilled OMT department faculty mentor bachelor? | |||||||
| □ Yes | twenty (71.iv) | 10 (26.seven) | eleven (44.0) | one (ane.8) | |||
| □ No | 8 (28.six) | 28 (73.seven) | 14 (56.0) | 55 (98.ii) | |||
| eleven. Would you like to have more CME geared towards OMT? | |||||||
| □ Yes | 20 (74.i) | 23 (62.two) | seven (thirty.4) | 27 (50.9) | |||
| □ No | 7 (25.9) | 14 (37.eight) | 16 (69.6) | 26 (49.1) | |||
Osteopathic family medicine residents in AOA-approved programs reported more frequent utilize of OMT than did those in ACGME-accredited programs: 67.9% of DOs in AOA-approved programs and 39.v% of DOs in ACGME-accredited programs reported daily or weekly OMT employ.
Despite these differences in OMT employ during residency, DOs in AOA-approved and ACGME-accredited family medicine residency programs reported that, prior to starting their residency training, they anticipated similar frequencies of OMT use during residency: 96.4% of DOs in AOA-approved programs and 97.3% of DOs in ACGME-accredited programs planned to apply OMT "oftentimes" or "occasionally" during residency. Furthermore, DO respondents in the ii types of programs had similar expectations with regard to their use of OMT after residency: 92.eight% of residents in AOA-approved programs and 84.two% of residents in ACGME-accredited programs planned to employ OMT at least occasionally after residency.
The proportions of DOs in AOA-approved and ACGME-accredited family medicine residency programs did not differ significantly in residents' confidence in their OMT training (92.9% for AOA residents versus 78.9% for ACGME residents) or their OMT ability (89.3% for AOA residents versus 78.9% for ACGME residents). All DOs in AOA-approved family medicine residency programs and well-nigh all DOs in ACGME-approved programs (97.4%) indicated that they believed OMT is an effective treatment modality for somatic dysfunction. With regard to treating systemic illness, however, fewer DOs endorsed OMT's effectiveness, with no meaning departure between those in AOA-approved programs (82.two%) and ACGME-accredited programs (73.vii%).
Almost DOs in AOA-canonical family medicine residency programs (96.v%) and ACGME-accredited family medicine residency programs (94.8%) indicated that their colleagues supported at least some OMT use. Withal, most DOs in ACGME-accredited programs reported that facilities for OMT in their departments were not adequate (67.vi%) and that skilled OMT mentors were not bachelor (73.7%). For DOs in AOA-approved family medicine programs, these percentages were much lower: 25.9% reported inadequate facilities and 28.6% noted unavailable mentors.
Statistically similar majorities of DOs in AOA-approved (74.1%) and ACGME-accredited (62.2%) family medicine residency programs indicated that they desired more continuing medical education (CME) geared toward OMT.
▪ Osteopathic Residents in Other Specialties
Survey results for DOs in residency programs other than family medicine (north=83) are reported in Table ii. Considering of nonresponses to sure questions by some survey respondents, the sample size for each question in the survey varied from 23 to 26 (for osteopathic residents in AOA-canonical programs other than family medicine) and from 53 to 57 (for osteopathic residents in ACGME-accredited programs other than family medicine). All group differences are significant at P<.05.
Compared with DOs in family unit medicine residency programs, Exercise respondents in other residency programs reported less frequent daily or weekly electric current OMT apply (51.v% in family medicine programs versus fourteen.5% in other specialties); less frequent preresidency expectations for using OMT at least occasionally during residency (96.ix% in family medicine programs versus 75.9% in other specialties); and less frequent current expectations for using OMT at least occasionally after residency (87.9% in family medicine programs versus 37.3% in other specialties).
More DOs in family unit medicine residency programs than in programs in other specialties indicated conviction in their OMT training (84.8% in family unit medicine programs versus 69.five% in other specialties) and OMT ability (83.iii% in family medicine programs versus 46.3% in other specialties). Nonetheless, DOs in family medicine residency programs did non differ significantly from DOs in other specialties in their behavior virtually the effectiveness of OMT for treating somatic dysfunction (98.v% in family medicine programs versus 97.5% in other specialties) or systemic affliction (77.three% in family medicine programs versus 66.3% in other specialties).
More DOs in family medicine residency programs than in programs in other specialties reported that their fellow residents supported the use of at least some OMT (95.5% in family medicine programs versus 68.8% in other specialties). In addition, more DOs in family medicine programs than in programs in other specialties reported adequate facilities in their departments for OMT (l% in family medicine programs versus 29.3% in other specialties); the availability of skilled mentors for OMT (45.5% in family medicine programs versus fourteen.viii% in other specialties); and a desire for more CME on OMT (67.2% in family medicine programs versus 44.7% in other programs).
Osteopathic physicians in AOA-canonical residency programs other than family medicine reported more frequent daily or weekly OMT use than did those in ACGME-accredited programs other than family medicine (30.vii% AOA versus 7.0% ACGME). Despite this deviation in current use, DOs in AOA-approved and ACGME-accredited not-family medicine programs reported statistically similar preresidency expectations for at to the lowest degree occasional OMT utilise during residency (80.7% AOA versus 73.vii% ACGME) and similar current expectations for at least occasional OMT use later on residency (42.3% AOA versus 35.1% ACGME).
The survey indicated that DOs in AOA-approved residency programs other than family medicine were more likely than their counterparts in ACGME-accredited programs to have confidence in the OMT training they had received (88% AOA versus 61.iv% ACGME). However, the survey showed no statistical divergence in the opinions between DOs in AOA-approved and ACGME-accredited non-family medicine programs regarding their ability to perform OMT (60% AOA versus forty.4% ACGME).
Nearly all (96% AOA and 98.2% ACGME) residents in non-family unit medicine programs indicated their behavior that OMT is at least a somewhat constructive handling modality for somatic dysfunction. In improver, no significant difference was found between DOs in the AOA-approved non-family medicine programs (76.ix%) and ACGME-accredited non-family medicine programs (61.4%) regarding beliefs that OMT is effective for treating patients with systemic illness.
A greater percentage of DOs in AOA-approved residency programs other than family medicine (87.five%) than in respective ACGME-accredited programs (60.7%) indicated that their colleagues supported the use of OMT. Many DOs in ACGME-accredited non-family medicine programs reported that their departments' facilities for OMT were not adequate (80.seven%) and that skilled OMT mentors were not bachelor (98.2%). For DOs in AOA-approved not-family medicine programs, these percentages were much lower: 48.0% noted inadequate facilities and 56.0% noted unavailable mentors.
The proportions of DOs in AOA-approved and ACGME-accredited not-family medicine residency programs did not differ significantly in residents' attitudes toward incorporating OMT in CME. In the AOA-approved programs, 30.4% of the DOs indicated that they wanted more than CME geared toward OMT, and in the ACGME-accredited programs, 50.9% of the DOs indicated the same.
▪ Allopathic Residents in Family Medicine
Survey results for allopathic residents in ACGME-accredited programs are reported in Table 3. Considering of nonresponses to sure questions by some survey respondents, the sample size for each question in the survey varied from 219 to 232. All group differences are significant at P<.05.
Tabular array 3
Survey of Allopathic Residents' Attitudes Toward Osteopathic Manipulative Handling (northward=232) *
| Question | Response, No. (%) † |
|---|---|
| one. How familiar were you with OMT before medical schoolhouse? | |
| □ Very familiar | 9 (three.9) |
| □ Somewhat familiar | 65 (28.0) |
| □ Unfamiliar | 158 (68.1) |
| ii. To what extent were you exposed to OMT during medical schoolhouse? | |
| □ Lectures | 10 (4.4) |
| □ Demonstrations | 10 (4.4) |
| □ Reading | 8 (3.5) |
| □ Personal experience | 30 (xiii.1) |
| □ None | 171 (74.vii) |
| 3. To what extent were you exposed to OMT during residency? | |
| □ Lectures | 26 (eleven.2) |
| □ Demonstrations | 21 (ix.0) |
| □ CME | two (0.nine) |
| □ Fellow resident | 87 (37.5) |
| □ Personal feel | ten (4.3) |
| □ None | 86 (37.i) |
| four. To what extent do y'all feel OMT is constructive for somatic dysfunction? | |
| □ Very constructive | 36 (xvi.four) |
| □ Somewhat effective | 161 (73.2) |
| □ Not effective | 23 (ten.5) |
| five. To what extent practice you feel OMT is effective for systemic illness (eg, asthma)? | |
| □ Very effective | 2 (0.9) |
| □ Somewhat constructive | 32 (fourteen.6) |
| □ Non effective | 185 (84.5) |
| six. To what extent are you interested in learning how to perform OMT? | |
| □ Very interested | 47 (twenty.3) |
| □ Somewhat interested | 117 (fifty.6) |
| □ Not interested | 67 (29.0) |
| 7. Should OMT exist incorporated into allopathic medical school curricula? | |
| □ Strongly support | xx (eight.7) |
| □ Support | 78 (33.9) |
| □ Neutral | 100 (43.5) |
| □ Oppose | 32 (13.9) |
| 8. Should OMT be incorporated into allopathic residency program curricula? | |
| □ Strongly support | 22 (9.half dozen) |
| □ Back up | 78 (34.ane) |
| □ Neutral | 98 (42.8) |
| □ Oppose | 31 (thirteen.9) |
| nine. Would you be interested in more than OMT CME geared towards teaching MDs? | |
| □ Very interested | 64 (27.7) |
| □ Somewhat interested | 120 (51.9) |
| □ Non interested | 47 (20.3) |
| 10. Do you experience the AOA should provide certification recognition of MDs who take tested adept in the use of OMT? | |
| □ Strongly support | 53 (23.0) |
| □ Back up | 104 (45.2) |
| □ Neutral | 61 (26.5) |
| □ Oppose | 12 (5.2) |
Nigh of the Md respondents reported that they were unfamiliar with OMT prior to attending medical school (68.1%) and had received no exposure to OMT during medical school (74.7%). Past contrast, nigh of the MDs (62.nine%) noted that they had been exposed to OMT during their residencies. The near frequent avenues of exposure during residency were a boyfriend, osteopathic resident (37.5%) and lectures on the employ of this treatment modality (11.2%).
As with the Practise respondents, most of the Doctor respondents (89.half dozen%) indicated that they believed OMT is at to the lowest degree somewhat effective in treating somatic dysfunction, while far fewer of the MDs (fifteen.5%) supported the effectiveness of OMT for treating patients with systemic disease.
Most of the Doctor respondents expressed interest in learning to perform OMT (20.3% very interested, l.6% somewhat interested). In addition, 42.6% of the MD respondents supported incorporation of OMT training into the allopathic medical schoolhouse curricula, with simply 13.9% opposed. The MDs indicated support in similar proportions (43.vii%) for incorporation of OMT grooming into allopathic residency training programs. Approximately eighty% percentage of the participating MDs indicated their interest in receiving OMT training as role of CME. Finally, 68.2% of MD respondents expressed their support for AOA certification of MDs who demonstrate proficiency in the use of OMT. Such certification was opposed by 5.2% of the MDs.
In combining responses to the beginning iii questions of the Md questionnaire (Table 3), we found that 50 (21.6%) of the MD residents indicated no exposure to OMT at any time—before medical school (question 1), during medical school (question two), or during residency (question three). The remaining 182 MD residents indicated exposure to OMT during at least i of these three time frames. In analyses comparison these two groups, allopathic medical residents with some exposure to OMT were more probable than those with no exposure to endorse the effectiveness of OMT in treating somatic dysfunction (93.3% some exposure versus 76.ii% no exposure) and more likely to bespeak interest in learning OMT (75.7% some exposure versus 54% no exposure). They were besides more probable to back up incorporation of OMT training into allopathic medical school curricula (48.6% some exposure versus 20.4% no exposure) and allopathic residency programs (48.9% some exposure versus 24.5% no exposure).
Allopathic medical residents with some exposure to OMT were more probable than those with no exposure to support the incorporation of OMT into CME (83.5% some exposure versus 65.three% no exposure) and more likely to support AOA certification of Medico proficiency in OMT (71.8% some exposure versus 55.i% no exposure). However, they were not statistically more probable to endorse the effectiveness of OMT for treating patients with systemic illness (17.i% some exposure versus ix.ane% no exposure).
Comment
The results of this survey support our starting time hypothesis, that osteopathic physicians who receive postdoctoral training exterior of traditional osteopathic programs will be less likely to use OMT. This decision extends the findings of previous studies3,4 by showing that the lower frequency of OMT utilize past practicing DOs who received their residency preparation in ACGME-accredited programs is mirrored by differences in OMT use during residency training.
The survey results also advise that the less frequent use of OMT during ACGME-accredited residency programs results from experiences or influences during residency training— rather than from decisions or expectations formed earlier residency training. This suggestion, in plow, implies that the less frequent use of OMT by the ACGME residents may be related to ecology barriers to OMT use. For case, ACGME residents were more likely than AOA residents to report inadequate facilities for OMT and lack of skilled OMT mentors. This interpretation is consequent with the findings of Johnson et al,two who reported that most of the practicing DOs who responded to their survey believed in the efficacy of OMT and agreed that they were well prepared by their training to diagnose and treat structural bug.
As previously noted, these results argue against the idea that ACGME trainees may become disinclined toward using OMT before residency training begins. Such disinclination might be evidenced by preresidency expectations of ACGME trainees—compared with those of AOA trainees—for less frequent OMT use, by less confidence of ACGME trainees in their OMT skills, or by less belief amidst ACGME trainees in OMT'southward effectiveness. This written report, however, found no such differences between the attitudes of AOA and ACGME trainees. Residents in both AOA-approved and ACGME-accredited programs indicated high preresidency expectations for OMT utilize during residency. Statistically like proportions of AOA and ACGME trainees expressed confidence in their OMT training and ability. Virtually all AOA and ACGME residents endorsed OMT every bit an effective treatment modality for somatic dysfunction. Furthermore, there was no significant deviation in AOA and ACGME residents' attitudes regarding the effectiveness of OMT for treating patients with systemic illness.
These findings are not consistent with speculations regarding the role of "allopathic ideologists" in reducing OMT use.nine,xi Such individuals are sometimes seen by other DOs as not valuing OMT. One might expect that, having attained their credentials every bit physicians, these individuals would take the opportunity to enroll in ACGME-accredited postdoctoral programs, thereby coming closer to fulfilling their presumed desire to be MDs. If this had indeed been the case, we would have expected to find that ACGME trainees were less probable than AOA trainees to endorse OMT every bit an effective treatment and that ACGME trainees predictable less OMT use during residency training. Neither of these expectations is supported by the survey results, nonetheless.
Despite the reported divergence in OMT apply during residency grooming, residents in AOA-approved and ACGME-accredited programs reported statistically similar expectations for OMT utilise subsequently residency training. This is an interesting finding that requires farther confirmation and elaboration, however, because information technology is not consistent with the results of other studies,3,four which constitute less frequent OMT use by Exercise graduates of ACGME-accredited residency programs. In attempting to reconcile these conflicting results, it might be important to distinguish between those individuals who completed both a residency and an internship—that is, first year of allopathic residency—nether ACGME auspices and those who completed an AOA internship followed by an ACGME residency.
Information technology might also be important for futurity studies, when comparing OMT apply amongst graduates of AOA-approved and ACGME-accredited residency programs, to consider reductions in OMT apply that may occur over the course of DOs' careers. Spaeth and Pheley5 reported that 40% of the DOs who responded to their 2001 survey admitted to less current employ of OMT, compared with OMT apply before in their practice years.
Perhaps the like inclinations of AOA and ACGME postdoctoral trainees regarding projected utilise of OMT during practice are overshadowed past other considerations that come into play during the early on years of a doc'due south do. For example, the time limitations and other barriers to OMT utilize noted past Johnson et al2 and Johnson and Kurtzfour may explain much of the real-earth departure between residents' expectations and DOs' clinical practice.
The results of the electric current written report do not support the idea that differences in OMT use between DOs trained in AOA-canonical residency programs and ACGME-accredited residency programs reflect a dissimilar distribution of family medicine and specialty medicine trainees in the AOA-approved and ACGME-accredited programs. Residents trained in ACGME-accredited programs in both family and specialty medicine reported less frequent OMT use than their colleagues in AOA-approved family and specialty medicine programs.
The low return rate of the survey among MDs limits business firm conclusions most our second hypothesis, that more allopathic graduates are being exposed to OMT past virtue of practicing alongside increasing numbers of osteopathic residents, and that the involvement of MDs in learning OMT and using it in their practices is increasing. Nevertheless, to our knowledge, this is the outset study to quantify a change in attitude of allopathic medical residents toward a more than positive view of osteopathic medicine. Considering the historical rivalry between the AOA and the American Medical Clan,seven it is remarkable that so many new MDs are willing to endorse the effectiveness of OMT for treating somatic dysfunction and that these MDs express interest in learning to treat patients with OMT.
Although the current report cannot directly accost problems of causation, it seems reasonable to assume that preparation alongside osteopathic medical residents is an important contributor to this positive attitude toward OMT among MDs. This estimation is supported past 2 related findings of the study. First, MD respondents with exposure to OMT were more likely than those without exposure to OMT to endorse OMT effectiveness and to desire OMT training. Second, boyfriend residents who were DOs were the Md residents' master source of exposure to OMT.
Therefore, this study suggests that, absent the official hostility toward osteopathic medicine previously emanating from the allopathic medical institution,vii exposure to OMT through boyfriend trainees tends to increase acceptance by MDs of OMT as a treatment choice for some medical conditions.
The widespread acceptance among new MDs of OMT equally a handling for some disorders may be seen by some DOs as a welcome and long overdue sign of acceptance of the osteopathic medical profession's unique contribution to medical practice. All the same, the desire of MDs for OMT training is likely to be controversial within the osteopathic medical profession. Many DOs might fear that the training of MDs to perform OMT could contribute to the osteopathic medical profession's loss of distinctiveness and promote further "defections" to the allopathic medical profession. After all, osteopathic and allopathic medical training is already so similar that graduates of both professions can receive postdoctoral training in the same programs.half-dozen,12
If significant numbers of MDs begin to care for their patients with OMT, what differences will remain to distinguish DOs from MDs? Why should prospective medical students choose the minority profession (ie, osteopathic medicine) if they can larn the same skills through the majority profession (ie, allopathic medicine)? While some authorities accept suggested that osteopathic medicine is distinct from allopathic medicine in its focus on the whole bodyvii,12 or on primary care,6 these are merely differences in caste. Up to now, OMT has been the most unique practice of DOs.
Preserving OMT for apply only past DOs may assist to maintain a clear stardom between DOs and MDs. Withal, Mills13 suggests that the official acceptance of MDs who desire to larn OMT would actually strengthen the osteopathic medical profession. She notes that information technology is entirely reasonable for physicians of any stripe to want to use the all-time bachelor treatment for their patients and that, if some MDs have come to believe that OMT is the best available treatment, it is unreasonable to deny it to them and their patients. Ironically, every bit the osteopathic medical profession searches for ways to increment the utilise of OMT among its own members—who are using manipulation with decreasing frequency1–5—the largest puddle of potential new adherents may come from a group of physicians who have spurned its use in the past—MDs.7
As is the case with many surveys, the possibility that respondents in the current study are not representative of the populations of resident DOs and MDs cannot exist disregarded. The main concern with regard to potential sampling bias in this report is the survey return rate. Although the return rate for DOs, 33.9%, was like to that for DOs in other, well-regarded studies, including Johnson and Kurtz4 (33%) and Spaeth and Pheley5 (38%), the lower return rate for MDs, xvi.4%, is of greater concern. In improver, if MDs with a favorable attitude toward OMT were more probable to respond to this survey than were those with unfavorable or neutral attitudes toward OMT, the electric current study may overestimate the percentage of MDs with favorable attitudes toward OMT. Further inquiry is needed to institute more reliable quantitative estimates regarding these possibilities.
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Source: https://www.degruyter.com/document/doi/10.7556/jaoa.2005.105.12.551/html?lang=en
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