Letters to the Editor  |   May 2011
One Osteopathic Physician's Path Through an ACGME-Accredited Residency
Author Affiliations
  • David C. Patchett, DO
    Assistant Clinical Professor, Department of Osteopathic Manipulative Medicine, Midwestern University/Arizona College of Osteopathic Medicine, Glendale
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   May 2011
One Osteopathic Physician's Path Through an ACGME-Accredited Residency
The Journal of the American Osteopathic Association, May 2011, Vol. 111, 349-350. doi:
The Journal of the American Osteopathic Association, May 2011, Vol. 111, 349-350. doi:
To the Editor:  
As a new faculty member in the Department of Osteopathic Manipulative Medicine at Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM), I am often asked this question: How did you maintain your osteopathic philosophy and your osteopathic manipulative skills at an allopathic (ie, American College of Graduate Medical Education-accredited) residency? As many graduates of osteopathic medical schools will attend allopathic residencies, I would like to use the present letter to answer that question and to help these individuals find their path. 
The answer to how I maintained my osteopathic skills and osteopathic philosophy is simple: I wanted to. I developed an appreciation of osteopathic principles and practice (OPP) early on. At the beginning of my first year in osteopathic medical school, I purchased a treatment table—a purchase that I highly recommend because it opens up the opportunity to practice one's osteopathic manipulative treatment (OMT) skills. I began treating my friends with OMT, as well as my wife through her first pregnancy. My treatments, even with my limited abilities, seemed to help my “patients” quite a lot. The beneficial results started me on my path and I never looked back. 
I had several additional early experiences that solidified my commitment to osteopathic medicine, a couple of which I will mention here. 
The first of these experiences came during my first year of osteopathic medical school, when my daughter was born with torticollis and a suckling dysfunction after a traumatic delivery. She looked in only 1 direction, and her latch was very poor. After only 2 OMT sessions with Jane Carreiro, DO, my daughter's condition improved substantially. It was amazing to see this change right in front of my eyes! At that point, I knew that osteopathic medicine could make a big difference for patients and their families. 
After my first 2 years of osteopathic medical school, I started my clinical years and was fortunate to work with a director of graduate medical education in Watertown, New York, who demonstrated a true passion for osteopathic medicine. He supervised us (medical students and residents) while we treated patients who had various musculoskeletal problems at an OMT clinic 1 to 2 evenings a month. It was a great experience to put osteopathic principles into practice, and it gave me the foundation I needed for my residency. 
For graduates of colleges of osteopathic medicine who wish to perform OMT in an allopathic residency, I offer the following suggestions, which I found helpful during my own residency. 
First, if at all possible, choose a residency program in which there is at least 1 osteopathic physician on faculty. If your residency program does not have a procedural competency form for OMT, create one. Next, get signed off on your competency to perform OMT. Once you have been signed off, you can perform OMT procedures independently, and you can start treating patients and fellow residents. 
During my first year of residency, my opportunities to perform OMT were somewhat limited. However, I kept looking for more opportunities. As a second-year resident, I was able to treat more of my patients with OMT, and I began getting referrals from other residents. The patients were happy, and the other residents learned about the benefits of OMT. 
At the end of my second year of residency, I used 1 of my elective months to do a rotation in the Department of Osteopathic Manipulative Medicine at MWU/AZCOM. I learned a tremendous amount in this rotation, and it gave me a whole new skill set. I also began to read much more literature about osteopathic medicine. 
During my third year as a resident, the osteopathic portion of my residency practice blossomed, and I began getting referrals from multiple residents, faculty members, and patients. I looked for opportunities to integrate osteopathic medicine into the treatment of my patients. Of course, I did not perform OMT on all my patients, but I incorporated it into my practice whenever possible. 
There is a common misconception among some osteopathic physicians that DOs who perform OMT tend to neglect more traditional medical practices. That is simply not true. I always performed thorough histories and physical examinations and ordered the appropriate workups for my patients. However, I found that OPP helped me narrow down my differential diagnoses. These days, the physical examination has become something of a lost art, having been replaced by technology. Performing a thorough physical examination based on OPP made the diagnosis more times than I could say. 
In summary, to maintain one's osteopathic philosophy and skills while participating in an allopathic residency program, I suggest the following 6 steps: 
  1. Develop a solid foundation in OPP.
  2. Choose a residency that has osteopathic faculty members, and get signed off on your ability to perform OMT.
  3. Start using OMT to treat patients within your comfort level.
  4. Use at least 1 elective month to do a rotation in OMT.
  5. Read literature on osteopathic medicine so you know how to use it in diagnosis and treatment.
  6. Be patient with yourself as you develop your OMT skills.
I have learned more in the past 6 months of doing primarily osteopathic manipulation in my practice than in all my previous years of education and training. Moreover, I still learn daily from my patients, who are the real teachers.