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Letters to the Editor  |   January 2010
The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate
Marlow B. Hernandez, OMS III
Author Affiliations
  • Marlow B. Hernandez, OMS III
    Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida
Article Information
Medical Education
Letters to the Editor   |   January 2010
The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate
The Journal of the American Osteopathic Association, January 2010, Vol. 110, 45-46. doi:10.7556/jaoa.2010.110.1.45
The Journal of the American Osteopathic Association, January 2010, Vol. 110, 45-46. doi:10.7556/jaoa.2010.110.1.45
To the Editor:  
The July medical education article by Benjamin R. Bates, PhD, and colleagues titled “The DO Difference: An Analysis of Causal Relationships Affecting the Degree-Change Debate” (J Am Osteopath Assoc. 2009;109:359-369) was well written but also misleading. 
The true/false items used in this survey-based study of osteopathic medical students to measure students' “knowledge of OPP [osteopathic principles and practice]” do not measure OPP knowledge. Rather, these items, which did not appear in the study, measure knowledge of certain facts about the osteopathic medical profession. 
After reading the article, I contacted the authors, who provided me with a copy of the true/false questions that were used to assess osteopathic medical students' knowledge of OPP, as follows: 
  1. Both DOs and MDs complete four years of basic medical education.
  2. After medical school, both DOs and MDs obtain graduate medical education through internships and residencies.
  3. Graduate medical education prepares DOs and MDs to practice a specialty.
  4. Both DOs and MDs can choose to practice in any specialty area of medicine, such as pediatrics, family practice, psychiatry, surgery, or obstetrics.
  5. MD students are required to take the USMLE [United States Medical Licensing Examination] exam, while DO students are required to take the COMLEX [Comprehensive Osteo pathic Medical Licensing Examination-USA] exam.
  6. Both MDs and DOs must pass the same state licensing examination to practice medicine.
  7. Both MDs and DOs are trained to conduct surgery.
  8. Both MDs and DOs can receive osteopathic manipulative training during graduate medical education.
  9. DOs receive more training in the musculoskeletal system than MDs.
  10. DOs practice a “whole person” approach to medicine. Instead of just treating specific symptoms or illnesses, they regard your body as an integrated whole.
  11. There has been recent discussion among osteopathic medical students, osteopathic physicians, the AOA [American Osteopathic Association], AACOM [American Association of Colleges of Osteopathic Medicine], and other interested parties about the possibility of changing the designation of the DO degree by adding the letter “M” to represent “Medicine.”
These items were verified by JAOA editorial staff. 
Had Bates and colleagues used these survey items to evaluate osteopathic medical students' knowledge of certain facts about the DO profession instead of students' OPP knowledge, the authors' article would have some scientific validity. However, based on these survey items, how can the authors make the conclusion that the students' opinions regarding changes in the DO degree name and formal designation are related to their knowledge of OPP? 
Moreover, even if the tools used by Bates et al to measure students' OPP knowledge were validated, the conclusions drawn from the survey cannot be generalized to the wider osteopathic medical student population because of the small sample size (N=214) and the sample population's composition (ie, limited to a single osteopathic medical school). 
Given the importance of improving the public's perception of, and research quality in, osteopathic medicine, I would like to urge caution and skepticism on the part of both investigators and editors when publishing studies in our most important periodical—JAOA—The Journal of the American Osteopathic Association.