Letters to the Editor  |   June 2006
In a Vacuum or In a S(l)ide Show: OPP in Osteopathic CME Programming
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    Nirvana Clinic Jacksonville, Fla
Article Information
Medical Education
Letters to the Editor   |   June 2006
In a Vacuum or In a S(l)ide Show: OPP in Osteopathic CME Programming
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 361-362. doi:10.7556/jaoa.2006.106.6.361
The Journal of the American Osteopathic Association, June 2006, Vol. 106, 361-362. doi:10.7556/jaoa.2006.106.6.361
To the Editor: Although I second the observations of Robert A. Cain, DO, in his May 2005 letter to the editor (“Promoting active engagement with osteopathic principles and practice in interns and residents. 2005;105:236–237), I'd like to take his position several steps farther. I would argue that not only is there almost no integration of osteopathic principles and practice (OPP) through most of our hospitals' postgraduate medical education training, there has been almost no integration of OPP in our profession's continuing medical education (CME) programming—and there hasn't been for years. 
I studied at Philadelphia College of Osteopathic Medicine (PCOM), Pa, under the legendary Angus G. Cathie, DO, and I can't recall our other osteopathic educators making more than a few minor attempts at incorporating OPP into their courses, either clinical or in the basic sciences. It was almost as if osteopathic manipulative treatment (OMT) existed in a vacuum. 
At PCOM, we were constantly told that our training was “different” because we were taught to “think differently” from allopathic physicians, but I don't believe this is really true. Any medical school worth its salt will emphasize the importance of treating the whole patient. 
Ultimately, osteopathic distinctiveness is supposed to involve—in at least some way—the importance of the musculoskeletal system in the maintenance and restoration of health. 
From what I've seen in our hospitals, though, OMT is usually reserved for courtesies to fellow staff members. Throughout my clinical rotations and during my internship, I saw OMT provided to only three patients. One of these three patients was an osteopathic surgeon who was hospitalized for pneumonia. The internist had previously shown about as much interest in OMT as Morris K. Fishbein, MD, the former editor of the now-defunct Medical World News, but the surgeon was a “ten-finger man.” I think the internist felt obligated. 
I believe the osteopathic medical profession's CME programs provide a more recent and more vivid illustration of the problem, however. 
In 35 years of attending CME programs, I have heard exactly one osteopathic CME lecture that emphasized the use of OMT to treat patients with headaches. The speaker, a neurologist, stated that he had always been skeptical about the use and efficacy of OMT, viewing it, more or less, like sex. “You do it because it feels good,” he said. He later added anecdotally that, in his clinical experience, he found OMT to be extremely helpful to his patients. At the end of the lecture, he summarized his presentation and said, “And don't forget about your OMT!” 
Interestingly, I also attended a Pri-Med Institute program (accredited by the Accreditation Council for Continuing Education) about 4 years ago, and lecturers cited manipulation as a valid headache treatment. 
Otherwise, the profession's CME programs seem to consist of endless slide shows by clinicians who present the results of multitudes of studies, but never mention where in patients' musculoskeletal systems a clinician might expect to see a manifestation of the disease process under discussion. 
The lecturers shouldn't feel too bad though, because it was never done at PCOM either. As with my medical school and internship experiences, when osteopathic tables are available for CME events, they are most often placed off stage somewhere, used as a side show, or kept mainly to treat other osteopathic physicians and their family members. 
I've always had a strong belief in the validity of the osteopathic concept and the efficacy of OMT, but I've had to figure out for myself how to apply it. Whether a musculoskeletal problem is the primary problem or a secondary manifestation of a disease process, it offers a portal for treatment that we ignore at our—or, actually, at our patient's—peril. Throughout my entire career, I never heard it put quite that way. That is what's missing in our entire educational process. 
Although I use OMT to treat patients with a host of complaints, I most commonly use OMT to treat patients with asthma, emphysema, upper respiratory infections, hypertension, dysmenorrhea, and influenza or other viral infections. I go out of my way to incorporate OMT in my treatment regimens. I even use crude cranials for patients with colds and sinusitis, but most of these methods are derived. 
Although I haven't tried to provide OMT to my patients with gastrointestinal problems, I'm not ruling out the possibility that it could be effective. Where are our osteopathic gastroenterologists to tell us about how OMT works for them? Unfortunately, I don't think they are providing lectures for our CME programs. 
As our osteopathic hospital system collapses, if we are to preserve any remnants of osteopathic distinctiveness, we'd better start addressing such deficits in our knowledge and training. 
The American Osteopathic Association has strict requirements for the qualifications of presenters at osteopathic CME events, insisting on a minimum number of osteopathic speakers at such conferences (ie, the “50% requirement”),1 but it might help if they also tried to include some osteopathic tie-ins within the lectures themselves. 
At least the public knows what the chiropractors are. It would be nice if they also knew what DOs are. Unfortunately, for that lack of knowledge, we have only ourselves to blame. 
 Editor's note: Morton Morris, DO, JD, Chairman of the American Osteopathic Association's Council on Continuing Medical Education, will be presenting the Andrew Taylor Still Memorial Address on Saturday, July 15, 2006, at the association's annual meeting of the Board of Trustees. In his speech, Dr Morris will address the issues noted by Dr Beaman among others with regard to osteopathic principles and practice in AOA-accredited CME programming.
Rodgers DJ. Osteopathic continuing medical education. J Am Osteopath Assoc. 2006;106:85–95. Available at: Accessed April 13, 2006.