The primary purpose of the present study was to investigate antecedents to the desire among osteopathic medical students to retain vs change the DO degree designation. These desires were operationalized in two ways: the intention to vote for or against the degree change and the intention to participate in the debate surrounding this change.
Using the TPB, we posited that attitudes, subjective norms, and perceived behavioral control would predict student intentions and that OPP knowledge would be negatively associated with attitudes and subjective norms and positively associated with perceived behavioral control.
Although our models are not consistent with the overall predictions of the TPB, we believe that our findings are of use to advocates of the DO difference within the profession. In particular, our models reveal that advocates who urge teaching the DO difference as part of students' professional development are likely correct when they posit that OPP education will help maintain the DO difference as a difference that matters.
4,16,17,20,42
Our models further indicate that, as a student becomes more aware of the similarities and differences between osteopathic vs allopathic medical philosophies, principles, and practices, the less likely that individual is to hold attitudes that support a degree change. In addition, as osteopathic medical students know more about the distinctiveness of the osteopathic medical profession, the less likely they are to believe that there is a social norm within the osteopathic medical community favoring a degree change.
Thus, a powerful strategy for advocates who wish to maintain the DO difference lies in the cultivation of attitudes and subjective norms favorable to OPP among osteopathic medical students.
In addition to didactic education regarding the DO difference, our models suggest a second potentially fruitful strategy. Although not predicted by our hypotheses, there is a strong linkage between attitudes and subjective norms regarding the degree-change debate. Moreover, attitudes and subjective norms opposing a change in the degree designation are influenced by greater knowledge of OPP. Given these connections, OPP advocates are encouraged to mentor students so that they might see and experience the DO difference; merely informing them about this difference is not enough.
3,6,7,21,47
Therefore, subjective norms cultivated through the consistent demonstration of uniquely osteopathic procedures as well as open discussion of OPP are likely the best ways to maintain the DO difference in clinical practice as well as on the more symbolic level of the DO degree designation debate.
In terms of the outcome variables, cultivating attitudes and subjective norms against a degree change appears most likely to guard against conflation of the DO and MD degrees when it comes to voting intentions. The same is not true with regard to intention to participate in the degree-change debate, however. Intention to vote is strongly and directly influenced by one's attitudes toward a degree change, attitude is tightly coupled with subjective norms, and attitudes and subjective norms are clearly influenced by level of knowledge. Therefore, if an osteopathic medical student becomes aware of the differences between osteopathic and allopathic medicine, she or he will likely vote against a degree change.
When it comes to intention to participate in the debate over a degree change, however, public advocacy is not predicted by these variables. The relationships among knowledge, attitudes, and subjective norms operate in much the same way as seen in intention to vote, though intention to debate is predicted only by perceived behavioral control—a variable not influenced by knowledge, attitudes, or subjective norms. That is, individuals who have little knowledge of the DO difference are as likely to participate in debates over a potential degree change as those who are well informed. Because active participation in public advocacy efforts is linked only to individual behavioral differences, advocates of maintaining the DO difference should encourage like-minded individuals to “recognize their behavioral control.” In other words, collegial encouragement and thoughtful, creative suggestions for advocacy efforts would likely be warmly received among vocal proponents of the DO difference.
One limitation of the present study is that the sample was limited to students at one college of osteopathic medicine in the Midwestern United States. A sample of osteopathic medical students from across the country is recommended for future research. A larger sample of this kind would provide a more comprehensive summary of student attitudes, intentions, beliefs, and opinions regarding the degree-change debate. Regional summaries may also be of interest by way of comparison.
Although the models and recommendations we present in the current study may not provide new arguments or strategies in the degree-change debate, they do provide empirical support for a variety of strategies currently in use to support and promote the DO difference.
When it comes to public education efforts with regard to osteopathic medicine, advocates of the DO difference have long emphasized the role of physicians as educators. One part of what Gevitz
43 has named “osteopathic invisibility syndrome” is insufficient public knowledge of osteopathic medicine. Aguwa and Leichty
4 agreed, noting the profession's “meager efforts in promoting and advancing its distinctiveness” to the general public.
Our models suggest that the osteopathic invisibility syndrome may also affect osteopathic medical students. Renewed efforts to promote and advance the profession's distinctiveness to osteopathic medical students are clearly warranted. Greater knowledge of OPP is the best way to assist our students in recognizing and valuing the DO difference. Further promotion of the DO difference within the profession will likely establish subjective norms and attitudes that further clarify this difference and, ultimately, lead to a desire to preserve it.