The correlations among the 6 components of the OMT Global Rating Tool, viewed at the raw score level, suggested 2 clusters of measured skills: 1 related to pre– and post–OMT technique assessment and 1 related to skill at the actual OMT technique. When structural equation modeling was used to test the hypothesis that the tool comprises a single global OMT skill, the hypothesis was rejected because the model was inconsistent with the observed relationships among student component scores. A model that separated the 2 groups of skills fit the data better and was not rejected on statistical grounds.
These results suggest that skill at OMT as measured by the NBOME’s OMT Global Rating Tool is a set of 2 distinct but moderately correlated skills: performing an osteopathic assessment of a patient and performance of a specific OMT technique. A student who is skilled at preassessment evaluation is generally, though not invariably, skilled at postassessment intervention as well; similarly, a student who is good at selecting the correct treatment modality can usually, though not invariably, do a reasonably good job at performing the treatment as well. The evidence of this model indicates, however, that a good preassessment evaluation does not necessarily lead to appropriate or skilled technique. In addition, a student who is skilled in performing OMT techniques is not necessarily good at completing thorough evaluations beforehand or assessments afterward. As measured by this instrument, assessment and technique appear to be distinct, though correlated, skill sets.
Many curricular models for teaching OMT at osteopathic medical schools exist, and the current study’s findings suggest a disconnect (as demonstrated in the difference in scores) in students’ skills in the diagnosis of somatic dysfunction vs the performance of an OMT technique. Incorporating OMT into the third- and fourth-year curriculum,
7 when students can integrate diagnosis with treatment, might be helpful. Students who have clinical exposure to OMT before entering clinical training are more likely to plan to use OMT in future practice.
8 Perhaps practicing OMT in clinical settings would help to integrate diagnosis and treatment. Additional studies would be helpful.
A limitation of the present study is that some students were not rated on some OMT components, which led to missing data that cannot be considered random. However, encounters with fewer than 6 scores accounted for 0.66% of the sample. A more immediate limitation is that the data analyses were performed on 1 cohort of students. Changes in curriculum, cohort ability level, or the level of student interest in OMT as a foundational skill can all influence the relationship between the latent traits measured by the OMT Global Rating Tool, or the relationship between the indicators and their corresponding latent variables.