Jennifer Holmes, DO; Joseph Brocato, PhD; Jennifer Wesenberg, DO May 4, 2013

 Osteopathic Program Director ◦ University of Minnesota/St Cloud Hospital Family Medicine Residency  Developed the Osteopathic Curriculum at St. Cloud  Developed the OMT Course at the University of Minnesota

 Director of Graduate Medical Education & Faculty Development ◦ Department of Family Medicine and Community Health ◦ University of Minnesota  PhD, Michigan State University  Involved in ◦ Program Administration & Accreditation ◦ Research& Scholarship ◦ Faculty development ◦ Curriculum development ◦ Evaluation

 Third Year Family Medicine Resident ◦ University of Minnesota / St Cloud Hospital Family Medicine Residency  Kirksville College of Osteopathic Medicine, 2010

By the end of the session, participants will be able to:  Describe the gap that residencies face when training osteopathic family medicine residents  List several barriers to providing osteopathic training in allopathic and dually-accredited family medicine residency programs  Describe the the curriculum created at the UMN Department of Family Medicine and Community Health to provide osteopathic training in allopathic and dually-accredited family medicine residency programs.

 Founded in 1970 with over 1,800 residency alumni  Department located on Twin Cities campus, 73 fulltime faculty and 994 non-salaried community faculty  Eight residencies: 3 rural/outstate sites and 5 Twin Cities urban and suburban sites  Two fellowships (Sports Med & HPM)  Approximately 175 residents at any one time

 Three Rural/Small Town Outstate Residencies ◦ Mankato FM ◦ St. Cloud FM ◦ Duluth FM

 Five Metro Minneapolis/St. Paul Urban/Suburban Residency Programs ◦ North Memorial FM ◦ Methodist FM ◦ UMMC/Fairview (Smiley’s FM) ◦ St. John’s FM ◦ St. Joseph FM

 Nearly 200 hours in first 2 years  Teaching Methods ◦ Didactics on general osteopathic philosophy ◦ Lab time to learn techniques  Evaluation ◦ Practical exams ◦ Written tests  Students are competent in techniques prior to completion of 2 nd year  3 rd and 4 th years, experiences varied

 Philosophy refresher  Technique refresher  Application of osteopathic treatment and philosophy ◦ Different patient populations ◦ Different healthcare settings  Billing and coding OMT

Course A

Lecture Evaluation: “A” Course Knowledge Before Mean (SD) Knowledge After Mean (SD) Knowledge Δp Ambulatory Care (Lecture) 2.73 (1.27)3.82 (0.87) Hospital Care (Lecture) 2.55 (1.37)3.64 (1.21) Geriatric/End of Life Care (Lecture) 2.45 (1.44)3.73 (1.01) Documenting/Billing/Coding (Lecture) 2.27 (1.27) 3.82 (0.87) Scale: 1=Poor; 2=Fair; 3=Good; 4=Very Good; 5=Excellent

Hands-On Practice Evaluation: “A” Course Knowledge Before Mean (SD) Knowledge After Mean (SD) Knowledge Δp Ambulatory Care (Hands-on) 2.83 (1.60)4.00 (0.89) Hospital Care (Hands-on)2.50 (1.51)3.67 (0.87) Geriatric/End of Life Care (Hands-on) 3.00 (1.53)4.00 (0.89) Scale: 1=Poor; 2=Fair; 3=Good; 4=Very Good; 5=Excellent

Evaluation of Usefulness of Procedure in Practice: “A” Course 10 Most useful procedures ranked by mean Procedure Usefulness in practice Mean (SD) Suboccipital tension release9.45 (0.82) Sinus efflurage9.27 (1.27) Suboccipital traction9.00 (1.32) Paraspinal inhibition8.56 (1.94) Cervical muscle energy8.40 (2.46) Axillary traction8.36 (1.86) Lymphatic pumps8.27 (1.68) Myofacial release8.18 (2.44) Pectoral traction8.00 (2.36) Thoracic pump7.91 (2.63) Scale: 1(low) to 10 (high)

Lecture Evaluation: “B” Course Knowledge Before Mean (SD) Knowledge After Mean (SD) Knowledge Δp Approach to Athlete Patient (Lecture) 3.00 (1.34)4.18 (0.75) Female OB Patient (Lecture) 3.05 (1.46)4.27 (0.79) Approach to Pediatric Patient (Lecture) 2.55 (1.11) 4.09 (0.83) Documenting/Billing/ Coding (Lecture) 2.50 (1.43)4.30 (0.68) Scale: 1=Poor; 2=Fair; 3=Good; 4=Very Good; 5=Excellent

Hands-On Practice Evaluation: “B” Course Knowledge Before Mean (SD) Knowledge After Mean (SD) Knowledge Δ p Athlete Patient (Hands-on) (1.26) Female/OB Patient (Hands-on) 3.45 (1.63)4.20 (0.83) Pediatric Patient (Hands-on) 2.55 (1.35)3.80 (0.76) Scale: 1=Poor; 2=Fair; 3=Good; 4=Very Good; 5=Excellent

Evaluation of Usefulness of Procedure in Practice: “B” Course 10 Most useful procedures ranked by mean Procedure Usefulness in practice Mean (SD) Pediatric: Torticollis stretching (sidebending and rotation) 9.30 (0.95) Pediatric: Galbreath’s 9.14 (0.95) OB: Sacroiliac Region Muscle Energy Techniques 9.09 (1.38) OB: Muscle Energy of the Lumbar Region 9.00 (1.55) Athlete: Hamstring spread 9.00 (1.00) Pediatric: Auricular drainage 9.00 (1.00) Athlete: Hamstring strain/counterstrain 8.91 (1.22) Athlete: Plantar myofascial neurovascular release 8.90 (0.99) OB: HVLA of the Toraco-Lumbar Region 8.82 (1.99) Athlete: Treating fibular head 8.82 (1.54) Scale: 1 (low) to 10 (high)

Future Application YesLikelyUnlikelyNoNot Suren I plan to include an osteopathic approach in my future practice—“A” Course Participants: YesLikelyUnlikelyNoNot Suren I plan to include an osteopathic approach in my future practice—“B” Course Participants:

 Training gap  Faculty barrier  Time barrier  Space/equipment barrier  Positive resident feedback

 Thanks to Erik Solberg, MA, MEd for Evaluation and Statistical support for this presentation!