The present survey-based study was approved by the New York Institute of Technology (NYIT) Institutional Review Board. The participant pool consisted of students who were either first- or second-year osteopathic medical students at NYIT College of Osteopathic Medicine (NYIT-COM). The inclusion criterion for participants was enrollment as a first- or second-year osteopathic medical student at NYIT-COM. Exclusion criteria included the following: (1) being a third- or fourth-year osteopathic medical student, (2) being a medical student who attends a different academic institution; and (3) being a potential participant who was not currently attending medical school.
In March 2013, all first- and second-year students received an e-mail invitation to a survey created using Survey Monkey (
https://www.surveymonkey.com/). The invitation explained that participation in the survey was voluntary. The participants were given 1 week to complete the survey. A reminder e-mail was sent 2 days before the survey's closing date.
The electronic survey contained 18 multiple-choice questions. The first 2 questions were demographic. The next 6 questions asked whether the participant was exposed to OMT in various clinical settings. The next 4 questions assessed the participant's perception of OMT broken into 4 parts: (1) understanding of OMT, (2) attitude toward OMT, (3) scope of practice of OMT, and (4) intention to use OMT in future clinical practice. The final 6 questions concerned whether the participant believed exposure in the various clinical settings improved his or her overall perception of OMT.
The exposure questions solicited whether participants were exposed to OMT through 6 types of exposures before or during their first 2 years of osteopathic medical school, as follows: (1) receiving OMT before attending medical school, (2) shadowing a physician performing OMT before medical school, (3) participating in the MedPrep program, (4) participating in the NYIT-COM Chapter of the Summer Student American Academy of Osteopathy (SAAO) OMM Preceptorship program, (5) receiving OMT while in medical school, and (6) attending any extracurricular OMT didactics (eg, the Osteopathic Medical Conference & Exposition, American Academy of Osteopathy symposia, cranial workshops). The MedPrep and the SAAO OMM Preceptorship programs are educational opportunities offered at our institution. MedPrep is a medical school preparatory program that, as part of its syllabus, requires students to shadow an osteopathic physician who uses OMT in practice for approximately 2 hours. This program is offered to students before the start of their first year of osteopathic medical school. The SAAO OMM Preceptorship program, which takes place during the summer between the first and second year of osteopathic medical school, provides students with the opportunity to shadow a physician who uses OMT in practice for 4 to 8 hours, as well as attend OMT workshops. An affirmative response to each OMT exposure setting was counted as 1 exposure for the purposes of the present study; therefore, response scores for this portion of the survey could range from 0 to 6.
The survey used the statistically validated 5-point Likert scale for the last 10 questions, with 1 indicating strongly agree and 5 indicating strongly disagree. Specific perception-based responses were measured using the following 4 statements: “I believe I possess a thorough understanding of the principles of OMT” (understanding); “I believe that OMT is a beneficial treatment option for patients” (attitude); “I believe OMT should be used on every patient” (scope); “I plan to use OMT in my future clinical practice” (intention to use). As previously mentioned, the final 6 questions, which also used the Likert scale (with the addition of a sixth option, “I did not have this exposure”), solicited participants' agreement with exposure in the various clinical settings improving their overall perception of OMT.
Survey responses were categorized according to the type of clinical exposure to OMT the participant reported. We analyzed the data using Pearson χ2 tests and Fisher exact tests, which yielded odds ratios and 95% confidence intervals. To describe the data, the frequency and proportion in percentages were calculated. To compare the ordinal levels of perceptions between the 2 groups—those with clinical exposures to OMT and those without such experiences—χ2 tests were performed. To properly evaluate the variables between the 2 groups, the 5 categories from the Likert scale were collapsed into 2. Category 1 encompassed answers of strongly agree and agree and category 2 encompassed answers strongly disagree, disagree, and undecided. Fisher exact tests for 2×2 tables were performed because the number of respondents was less than 5 for certain variables. Odds ratios and their associated 95% confidence intervals were calculated as measures of effect sizes.
To assess the exposure-response relationship between the number of OMT clinical exposures and the positively responded perceptions, we classified survey respondents into 3 groups according to the number of reported OMT clinical exposures (ie, 0 exposures, 1 exposure, and 2 or more exposures) and also according to how many perception questions that were answered with agree or strongly agree. The exposure-response relationship was dichotomized according to the number of OMT clinical exposures (0 exposures vs 1 or more exposures) and according to the frequency of positive responses to perception questions: 2 or fewer vs 3 or more. For statistical significance, α was set at .05.