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Editorial  |   March 2018
A Focus on Research at the First School of Osteopathic Medicine
Author Notes
  • From the A.T. Still Research Institute at the A.T. Still University in Kirksville, Missouri. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to John T. Heard, PhD, A.T. Still Research Institute, 800 W Jefferson St, Kirksville, MO 63501-1443. Email: jheard@atsu.edu
     
Article Information
Imaging / Medical Education / Osteopathic Manipulative Treatment / Graduate Medical Education / Curriculum
Editorial   |   March 2018
A Focus on Research at the First School of Osteopathic Medicine
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 133-135. doi:10.7556/jaoa.2018.030
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 133-135. doi:10.7556/jaoa.2018.030
The A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM) was the first osteopathic medicine school, established in 1892. As a form of medicine unique to the United States, Dr Still's belief in the inherent ability of the body to heal itself lay the foundation for a discipline that initially provided limited interventions consisting of manipulation and surgery. Over its 125-year history, osteopathic medicine has developed into a fully qualified and recognized area of medicine within its founding country. With its mission to educate students to be leaders in the field of medicine, ATSU-KCOM further places an emphasis on producing physicians who will care for the medically underserved and those living in rural communities. 
Following the tenets of osteopathic medicine, ATSU-KCOM educates students to become physicians who use evidence-based medicine and whole-person care. Students are exposed to the basic elements of evidence-based medicine within the curriculum and continue to use this training throughout their careers. A.T. Still University Kirksville College of Osteopathic Medicine regards its responsibility as not only educating students and preparing them for successful residencies, but also helping them to maintain their own health and well-being during the formative years of medical school and throughout their careers. 
Recognizing the importance of all forms of research within health care, ATSU-KCOM places special emphasis on supporting the development and implementation of uniquely osteopathic-related research. Within the A.T. Still Research Institute, the Center for Research in Osteopathic Manual Medicine, co-chaired by Brian F. Degenhardt, DO, and Eric J. Snider, DO, continues the university's tradition begun by the osteopathic researchers J. Stedman Denslow, DO, and Irvin M. Korr, PhD, to advance the scientific basis for osteopathic manipulative medicine.1 
The areas of research from ATSU-KCOM featured in this edition of The Journal of the American Osteopathic Association as part of its ENGAGE initiative2 cover adverse events after osteopathic manipulative treatment (OMT),3 palpation accuracy using lumbar spine models,4 effects of osteopathic manipulation in the sacrum,5 medical school burnout,6 ultrasonography in the undergraduate curriculum,7 and student readiness for residency via entrustable professional activities.8 The diversity of topics is an indication of the level of scholarly activity that has been occurring at ATSU-KCOM for many years. Spanning the gamut of research in educational activities, wellness, and clinical practice, researchers at ATSU-KCOM continue their long-standing tradition of generating new and provocative outcomes. 
Safe, effective treatment is one of the goals of medicine. In manual medicine, or more specifically OMT, this objective is especially important because these techniques may potentially aggravate symptoms. In the study by Degenhardt et al,3 an attempt was made to determine what adverse events could be directly attributable to OMT performed in the current clinical practice setting. Using a prospective method and data from multiple physicians within the practice-based research network, DO-Touch.NET, the researchers collected data from more than 1800 office visits and found a low incidence of adverse events with no serious adverse events detected. 
For effective OMT, diagnostic palpation requires accurate localization of the structures being examined. In the study by E. Snider et al,4 localization of the lumbar transverse processes and determination of their relative position (asymmetry) was tested. The study attempted to determine how much localization affected the overall accuracy of the diagnostic process. Two groups of students were compared for their ability to determine the position of the right transverse process relative to the position of the left. One group examined models that were marked with a black dot on the cover of the model over the transverse processes landmarks while the other group had models and no markings on their surface, thus requiring the students to localize the transverse processes. The outcomes demonstrate the importance of students accurately localizing landmarks to optimize their palpatory diagnostic skills. 
Although the ultimate responsibility for accurate diagnostic palpation and effective OMT lies in the hands of the individual physician, establishing tools to detect and predict the mechanisms underlying treatments would be a great benefit to the osteopathic medical profession. One cost-effective method to objectively assess various body structures is ultrasonography. K. Snider et al5 used this technology to detect changes in sacral asymmetry before and after OMT. While ultrasonography may ultimately be beneficial in determining structural changes following OMT, the current study was not able to demonstrate improvement in sacral positioning after OMT. 
Being a physician requires the ability to handle stress in a positive manner and resilience to the many struggles involved in the daily practice of medicine. During medical school, students have the opportunity to develop the skills needed to withstand the many stressors of medical practice. Professors, administrators, and researchers have a critical role to play in this development. In the article by Johnson et al,6 the authors describe the analysis and refinement of an assessment instrument that would be helpful in identifying students who are having difficulties in handling the many potential stressors that exist during medical school. Through a process of factor analysis, the researchers delineated a series of subscales in this hassle assessment instrument to help students and support staff identify those areas in life that are creating the greatest stress for the student. Such information should help in identifying resources and coping mechanisms to empower students to manage stress and promote balance and wellness in their lives. 
The work of Sandefur and Kondrashova7 discusses the possible implications of introducing ultrasonography into the undergraduate curriculum. The authors investigated the use of ultrasonography as a mechanism for supporting the development of self-awareness and increased health status in undergraduate medical students. Students used ultrasonography on themselves and their friends outside of class, which led to increased self-awareness of their health status. The results of this study support the integration of ultrasonography into the undergraduate medical curriculum. 
Graduates from medical school are expected to possess a certain level of sophistication when performing a history and physical examination. In addition to performing this task accurately and efficiently, they are expected to provide an insightful differential diagnosis based on the data collected, a task outlined in the entrustable professional activities. One of the novel methods for assessing this readiness is through large-group physician-mentored patient rounds. Physicians model the appropriate behavior and then monitor students as they interact with patients. In the study by Chamberlain et al,8 students were assessed on their ability to perform a patient history and, after observing a physical examination and ordering diagnostic tests, to formulate a differential diagnosis. The results of the study indicate that physician-mentored patient rounds are a useful way to assess some of the entrustable professional activities in preclinical medical students. 
In summary, research and scholarly activity at ATSU-KCOM is an ongoing endeavor continuing the long tradition of investigating medicine from an osteopathic, or holistic, point of view. A.T. Still University Kirksville College of Osteopathic Medicine continues to expand the horizons of research relevant throughout the careers of osteopathic physicians as they provide high-quality health care throughout the United States. 
References
The history of research at A.T. Still University. A.T. Still University website. https://www.atsu.edu/research/magazine/pdfs/historyofresearchatatsu.pdf. Accessed January 19, 2018.
Orenstein R. ENGAGE Initiative: showcasing osteopathic scholarly activity. J Am Osteopath Assoc. 2016;116(5):276-277. doi: 10.7556/jaoa.2016.054 [CrossRef] [PubMed]
Degenhardt BF, Johnson JC, Brooks WJ, Norman L. Characterizing adverse events reported immediately after osteopathic manipulative treatment. J Am Osteopath Assoc. 2018;118(3):141-149. doi: 10.7556/jaoa.2018.033
Snider EJ, Pamperin K, Pazdernik V, Degenhardt BF. Influence of transverse process landmark localization on palpation accuracy of lumbar spine models. J Am Osteopath Assoc. 2018;118(3):151-158. doi: 10.7556/jaoa.2018.034
Snider KT, Redman CL, Edwards C, Kondrashova T, Bahtia S. Ultrasonographic evaluation of the effect of osteopathic manipulative treatment on sacral base asymmetry. J Am Osteopath Assoc. 2018;118(3):159-169. doi: 10.7556/jaoa.2018.035
Johnson JC, Degenhardt BF, Smith CK, Wolf TM, Peterson F. Tool for predicting medical school burnout from sustained stress levels: factor analysis of the Medical Education Hassles Scale-R. J Am Osteopath Assoc. 2018;118(3):170-180. doi: 10.7556 /jaoa.2018.036
Sandefur K, Kondrashova T. Increasing self-awareness of medical students through the use of ultrasonography. J Am Osteopath Assoc. 2018;118(3):190-198. doi: 10.7556 /jaoa.2018.038
Chamberlain NR, Sexton PS, Hardee MR, Baer RW. Physician-mentored patient rounds to observe and assess entrustable professional activities 1 and 2 in preclinical osteopathic medical students. J Am Osteopath Assoc. 2018;118(3):199-206. doi: 10.7556/jaoa.2018.039