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

2. Disclosures
I have no disclosures to report.

3. Mercy Family Medicine

4. 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

5. 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

6. 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

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

8. 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

9. 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)

10. 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

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

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

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

14. 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

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

16. Questions?

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