Bates BR, Mazer JP, Ledbetter AM, Norander S. The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate. J Am Osteopath Assoc 2009;109(7):359–369. doi: 10.7556/jaoa.2009.109.7.359.
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Context: The academic credential awarded to osteopathic physicians is the doctor of osteopathy or doctor of osteopathic medicine (DO) degree. Public recognition of the degree has been disappointingly low, however, leading some members of the profession to argue for a change in the degree's name and formal designation.
Objectives: To investigate antecedents to the desire among osteopathic medical students to change vs retain the DO degree designation and maintain “the DO difference.”
Methods: A self-administered cross-sectional 38-item electronic survey was distributed to 480 students at an osteopathic medical school in the Midwestern United States. The instrument included knowledge-based items about osteopathic principles and practice (OPP) as well as items designed to assess attitudes, subjective norms, perceived behavioral control, and intention to support a proposed degree change.
Results: An overall response rate of 45% was achieved (n=214). Structural equation modeling revealed that low levels of OPP knowledge were associated with positive attitudes and subjective norms favoring a degree change with the reverse true for opposing students. Knowledge did not influence perceived behavioral control. Attitudes were the best predictor of intention to vote with 85% variance predicted in our models; perceived behavioral control was the best predictor of intention to debate with approximately 38% variance observed.
Conclusions: As a result of diminished use of palpation and osteopathic manipulative treatment—two historic markers of professional identity among osteopathic physicians—the DO degree designation as an indicator of difference has received increasing scrutiny. Improved student awareness of OPP is essential to maintaining the DO difference in clinical practice and with regard to the DO degree designation.
For most of its history, the AOA derived a great deal of internal cohesion and social solidarity among its membership from the menacing actions of the once-powerful AMA [American Medical Association].14
We must not allow our distinct image to fade and disappear. If we do...the public will pose an uncomfortable question: “Why two professions?”
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