Letters to the Editor  |   March 2011
AOA Not Enforcing OMM Educational Standards
Author Affiliations
  • Thomas Michael McCombs, DO
    Bay Area Osteopathic Inc, American Canyon, California
Article Information
Gastroenterology / Medical Education / Graduate Medical Education
Letters to the Editor   |   March 2011
AOA Not Enforcing OMM Educational Standards
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 176-177. doi:10.7556/jaoa.2011.111.3.176
The Journal of the American Osteopathic Association, March 2011, Vol. 111, 176-177. doi:10.7556/jaoa.2011.111.3.176
To the Editor:  
After I left academia, I kept in touch with a former student who is now on her third-year clinical rotations as a student osteopathic physician. During her surgical rotation, her team cared for a patient with postoperative ileus. She asked the surgical resident if osteopathic manipulative medicine (OMM) could be applied to the patient. The resident told her that the patient should not be “twisted and popped” because the patient was too sick for OMM. My student replied that she was trained by her college of osteopathic medicine (COM) faculty to administer OMM specifically designed for this patient's problem, consisting only of a gentle technique. Postoperative ileus has shown positive clinical response to OMM.1,2 The resident merely changed the subject, and the rounds moved on. 
This was not an allopathic hospital or an allopathic resident. This was an osteopathic surgical resident who was training at an osteopathic hospital in Michigan. The resident had graduated from a COM accredited by our own Commission on Osteopathic College Accreditation (COCA). He is training in a surgical program at a hospital accredited by the American Osteopathic Association (AOA). 
Our profession's accreditation standards require clinical OMM training in both the COM and hospital setting. Yet the absence of clinical OMM training is nearly profession-wide. Educational standards for OMM are clearly not being followed, and yet the accreditation of these colleges and hospitals remains active and repeatedly gets renewed. 
Having seen COCA operate during my 9 years in osteopathic academia, I know how this problem continues. I have never seen COCA accreditors ask for any evidence of OMM training. I have seen accreditors accept reports of osteopathic clinical training but never ask for the curricula, sign-in sheets, clinical logbooks, or chart notes that would document it. Without requirements to produce solid evidence of training, institutions are free to report ambitious plans and programs that never have to mature or operate. Using such plans as a basis for accreditation, and without routine follow-up to ensure that these plans ever operate, institutions may abandon actual programs in favor of “looking like we are about to start.” 
I have reviewed 2 clinical OMM distance-learning programs (from COMs in the Midwest) that were clearly designed for accreditors instead of for students. The authors of these programs obviously had no recent hospital experience and did not seriously intend for students participating in the programs to run to the wards and apply what they had learned. I have also observed OMM rounds at an AOA-accredited hospital conducted only 2 afternoons a week and staffed only with students led by an intern. Osteopathic manipulative treatment was delivered as quickly as possible to 1 or 2 patients, and the team then returned home without a backward glance. 
Our accreditors seem to ask for no more than token compliance to OMM educational standards from the colleges and hospitals that they inspect. “Something is better than nothing.”... “Look like you are trying.” These words are the real standards to which our “unique and distinctive profession” holds itself. 
The Commission on Osteopathic College Accreditation has published new standards, effective as of July 2010.3 These standards state the following3: 

The COM should have in place learning programs in OMM/OPP [osteopathic principles and practice] for students during their third and fourth years that include both didactic content (may be delivered by distance education technology) and hands-on opportunities under faculty/preceptor supervision which include osteopathic physicians. The assessment process through all four years should be appropriate for both cognitive and psychomotor learning.

Our profession has its own standards about its own standards, especially with regard to OMM education. I have no confidence that these new standards will be any better enforced than the old ones. 
Many leaders in our profession do not use OMM in their own practices or for their own families, in part because they do not know how to do so. They do not know how to use OMM because their COMs and hospitals did not teach them clinical OMM, despite multiple requirements to provide such training. I suspect that the surgical resident mentioned at the beginning of this letter has had no clinical experiences with OMM. He could not use OMM to restart his patient's stalled peristalsis. He could not even give the idea serious consideration. None of his mentors will have used OMM. Yet, deep in the file cabinet in the residency director's office, there likely lurks the “OMM Plan” for integration of OPP in their program. This document will be dusted off just before the accreditation team visits, and then it will be returned to storage until needed again. 
Our profession pays wonderful lip service to the ideas behind OMM, while it conducts “ghost” clinical OMM programs in its own COMs and hospitals. Our profession establishes OMM educational standards for those COMs and hospitals, but it applies the standards with the understanding that any token attempt to look busy will keep the AOA happy. 
This is (another) dangerous time for osteopathic medicine. We are our own enemy, passively undermining ourselves. If an outside agency prohibited our students and residents from applying OMM, we might arouse ourselves to advocate for our rights to teach and practice osteopathic medicine. Patients in osteopathic hospitals go untreated, while osteopathic physicians go untrained. The osteopathic medical profession has a lax attitude about educating future members in our own distinctive care. 
If the AOA were truly enforcing its own educational standards, surgical residents would be treating patients with OMM, and osteopathic medical students would not have to ask about the role of OMM in their patients' care. 
Crow WT, Gorodinsky L. Does osteopathic manipulative treatment (OMT) improve outcomes in patients who develop postoperative ileus: a retrospective chart review. Int J Osteopath Med. 2009;12(1):32-37.
American Association of Colleges of Osteopathic Medicine. Clinical Osteopathically Integrated Learning Scenarios. Chevy Chase, MD: Educational Council on Osteopathic Principles, American Association of Colleges of Osteopathic Medicine;2001 : 87-94.
Commission on Osteopathic College Accreditation. Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures. Chicago, IL: American Osteopathic Association; 2010.