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JAOA/AACOM Medical Education  |   April 2018
Resident and Faculty Attitudes Toward Osteopathic-Focused Education
Author Notes
  • From the Accreditation Council for Graduate Medical Education (Dr Hempstead); the Department of Community and Family Medicine at the University of Missouri-Kansas City (UMKC; Drs Rosemergey and Swade); and the Departments of Community and Family Medicine (Dr Foote) and Biomedical and Health Informatics (Dr Williams) at the UMKC School of Medicine. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Laura K. Hempstead, DO, 5323 Pershing Ave #3, Saint Louis, MO 63112-1707. Email: stanandlaurasmith@gmail.com
     
Article Information
Medical Education / Graduate Medical Education
JAOA/AACOM Medical Education   |   April 2018
Resident and Faculty Attitudes Toward Osteopathic-Focused Education
The Journal of the American Osteopathic Association, April 2018, Vol. 118, 253-263. doi:https://doi.org/10.7556/jaoa.2018.050
The Journal of the American Osteopathic Association, April 2018, Vol. 118, 253-263. doi:https://doi.org/10.7556/jaoa.2018.050
Web of Science® Times Cited: 1
Abstract

Context: The transition period for the single accreditation system for graduate medical education under the Accreditation Council for Graduate Medical Education (ACGME) began on July 1, 2015, and will end June 30, 2020. As of February 5, 2018, 82.6% of residency programs accredited by the American Osteopathic Association (AOA) have applied for or achieved ACGME accreditation and 160 programs have applied for or achieved osteopathic recognition.

Objective: To assess baseline attitudes of osteopathic and allopathic faculty and residents in AOA-accredited and dually accredited residency programs regarding the value of osteopathic-focused educational curricula and mentors.

Methods: A survey was emailed to 60 program directors of AOA-accredited programs and dually accredited residency programs, some of which had obtained ACGME osteopathic recognition. The survey was to be completed by residents and faculty. Items were formulated to obtain baseline measurements regarding the level of awareness of osteopathic principles and practice (OPP), attitudes regarding osteopathic culture, and the weighted importance of aspects of the osteopathic curriculum. Principal components analysis with Varimax rotation was used. Comparison analysis was accomplished by either independent t tests for subscale scores or Mann-Whitney U tests for item-level scores.

Results: A total of 327 people responded to the survey (115 faculty members, 211 residents, and 1 no response). Of the 60 program directors contacted, 53 replied with at least 1 program representative. One hundred twenty-nine of all 211 residents (61.7%), including 107 of 134 osteopathic family medicine residents (79.9%), agreed that they intended to use OMT when in practice. The curricular component item with the lowest total survey score, indicating the highest-ranked level of importance, was the ability to work with osteopathic faculty (mean [SD], 1.98 [0.98]). Of the items measuring osteopathic awareness, statements with the strongest level of agreement from all respondents were “I have seen OMT performed on a patient or a peer” and “I am familiar with the basic tenets of OPP.”

Conclusion: Residents in AOA-accredited programs value osteopathic mentors and OMT, and they generally intend to use OMT when in practice. Respondents from programs with osteopathic recognition had more favorable attitudes toward osteopathic culture and curriculum than did respondents from programs without osteopathic recognition.

In 2014, the American Osteopathic Association (AOA), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) announced their agreement to pursue a single accreditation system for graduate medical education.1 Transition to this single accreditation system began July 1, 2015, and is expected to be complete by June 30, 2020. Under the single accreditation system, graduates of osteopathic (ie, DO) and allopathic (ie, MD) medical schools will complete postgraduate training in ACGME-accredited programs and will be required to demonstrate achievement of the same accepted milestones and competencies determined by each specialty college. Residency programs may apply for osteopathic recognition (OR), which would allow residency training to focus on the unique principles and practices of the osteopathic medical profession (osteopathic milestones) in addition to the program's specialty milestones.1 As of February 5, 2018, 853 of 1244 AOA-accredited postgraduate training programs (including fellowships and transitional internship year programs) and 712 of 862 AOA-accredited residency programs have applied for or received ACGME accreditation, and 160 programs have applied for or achieved OR.2 Of those 160 programs, 48% of the programs were dually accredited, 16% were ACGME-accredited programs with no prior osteopathic affiliation, and 36% were AOA-accredited programs that achieved ACGME accreditation.2 
A growing body of literature demonstrates that MDs are interested in osteopathic principles and practice (OPP), including osteopathic manipulative treatment (OMT).3-8 In January 2017, Levine9 reported that 17% of applications for OR were from ACGME-accredited programs. Allee et al3 found that 90% of MD residents believed OMT to be effective, and nearly 71% of them indicated interest in learning OMT. A study by Przekop et al4 that examined the implementation of an OMT clinic in an allopathic residency demonstrated that many MD students expressed interest in OPP and a desire for an elective rotation to be made available. Rubeor et al5,10 described similar success implementing an OMT clinic into an allopathic residency setting. Leiber6 examined a 1-month rotation in OMT and concluded that after completion of this elective, MD residents demonstrated competency in a defined set of osteopathic principles and skills. The University of Missouri Kansas City (UMKC) family medicine residency program has replicated this success. Allopathic residents have successfully performed OMT on their continuity clinic patients after completing an OMT elective or participating regularly in the monthly OMT interest group. The interested MD medical students rotate through the UMKC OMT clinic during their first clinical year, and many demonstrate interest in further opportunities to learn OMT as another tool to benefit their patients. 
The current study was designed to assess baseline attitudes of DO and MD faculty and residents in AOA-accredited and dually accredited (ACGME and AOA) residency programs regarding the perceived value of osteopathic-focused educational curricula and mentors through an anonymous survey. We hypothesized that osteopathic-focused education would be ranked more highly by DOs than MDs. 
Methods
Participants
To recruit participants, a blast email was sent from the American College of Osteopathic Family Physicians (ACOFP) to 60 program directors of AOA-accredited or dually accredited family medicine residency programs to forward to their faculty and residents, as well as program directors who were members of the Osteopathic Postdoctoral Training Institute at Kansas City University (referred to as the KCU-GME Consortium). The KCU-GME Consortium consists of 17 programs in multiple specialties, including emergency medicine, internal medicine, general surgery, orthopedic surgery, psychiatry, and dermatology, and 4 family medicine programs. Approval was obtained through the UMKC's Adult Health Sciences Institutional Review Board. The survey was sent through Research Electronic Data Capture (REDCap) on January 17, 2017. Weekly reminders to complete the survey were sent for 4 weeks. The survey closed on February 15, 2017. 
Forty-three program directors responded to the email with interest in participating. These programs represented diverse geographic regions within the continental United States. Program directors were sent a follow-up email asking for the number of faculty and residents to whom the survey was forwarded. Respondents who were MDs were training in AOA-accredited programs or dually accredited programs that had achieved accreditation and OR through the ACGME. 
Survey
A 22-item survey was developed, expanding on 12 items used in a 2012 pilot study11 regarding the attitudes of residents toward osteopathic curricula. The survey was designed to occur early during the transition to a single accreditation system. Items were formulated to obtain baseline measurements regarding physician level of awareness of OPP, attitudes regarding osteopathic culture, and the weighted importance of aspects of the osteopathic curriculum, including OMT. A draft of the survey was sent to 5 faculty members at outside institutions and selected UMKC faculty for initial review and comments, and changes were made accordingly. Demographic information gathered included medical degree (DO, MD), employment type (faculty, resident), sex, the name of the residency program, and whether the program had achieved OR. Three of the 22 survey items were designed to be answered by residents only. Resident-specific items evaluated the resident's intent to use OMT in practice, the degree to which OMT training was a factor in their choice of residency, and satisfaction with the osteopathic curriculum. Respondents were not required to answer all items. Consent was obtained verifying that study participation was voluntary and anonymous, participants were under no obligation to complete all items in the study, and participants could request removal from the study at any time. 
Most survey items were ranked on a 5-point Likert-type scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”). Items regarding frequency of OMT use were ranked according to time frame from 1 to 4 (within the past month, 1-6 months ago, >6 months ago, and no, respectively) The remaining 8 items ranked the importance of osteopathic curricular factors on a 5-point Likert-type scale (1, “extremely important”; 2, “very important”; 3, “somewhat important”; 4, “neutral/unsure”; and 5, “not important”). 
Statistical Analysis
Study data were collected and managed using REDCap tools hosted at UMKC. Statistical analysis of data collected via REDCap was performed using SPSS (IBM) version 23. Principal components analysis was used to explore the underlying structure of the survey and provide preliminary construct validity. Varimax rotation was used in the analysis to improve the interpretation of the factor loading. A 3-factor solution explained 68.3% of the item variance. The factors included awareness of OPP (8 items; Cronbach α=0.924); integration of osteopathic culture into curriculum (7 items; Cronbach α=0.899); and osteopathic curricular components (4 items; Cronbach α=0.803). Subscale scores were computed for each factor by taking a mean score of the items. Three survey items with low factor scores were analyzed separately. Parametric descriptive statistics were computed on subscales, and nonparametric descriptive statistics were computed on item-level scores. 
Comparison of survey scores between programs with and without OR; MDs and DOs; faculty and residents; and men and women were completed using an independent t test for subscale scores or a Mann-Whitney U test for item-level scores. Incomplete surveys were included in the analysis. Listwise deletion was used for item-level analysis. Data imputation was not used, as it was determined that these data were not missing completely at random (0.15). 
Results
A total of 327 faculty and residents responded to the survey. The overall program response rate was 53 of 60 (88.3%). Of the 327 respondents, 97 (29.7%) were MDs and 229 (70.3%) were DOs. Two hundred forty-one respondents (73.7%) were from programs that had achieved OR, and 86 respondents (26.3%) were from programs that had not. Of the 327 respondents, 177 (54.1%) were men and 150 (45.9%) were women; 115 (35.3%) were faculty, 211 (64.7%) were residents, and 1 did not respond. Forty-eight of 327 respondents (14.7%) were from specialties outside of family medicine (ie, dermatology, otorhinolaryngology, internal medicine, general surgery, psychiatry, and orthopedic surgery), and 134 (41.0%) were DO family medicine residents. Of the 327 total respondents, 323 (98.8%) answered all items on the survey and, of the 211 resident respondents, 209 (99.1%) answered all items. The first identified factor in the survey was awareness of OPP (Table 1). Regarding the survey items answered by faculty and residents, 290 of 326 respondents (89.0%) agreed or strongly agreed that they were familiar with the basic tenets of OPP, and 251 of 324 (77.5%) had performed OMT on a patient or peer within the past 6 months. The majority of all 327 respondents ranked maintaining hands-on OMT skills, learning to integrate OMT into an office practice, and learning OMT billing and coding as extremely, very, or somewhat important (276 [84.4], 281 [85.9], and 277 [84.7], respectively). 
Table 1.
Survey Item Responses Grouped by Factors Identified in the Survey
Survey Factors Factor Loading Affirmative Response,a Agree,b or Ranked as Important,c No. (%) Mean (SD)
Awareness of Osteopathic Principles and Practice (OPP) (Cronbach α=0.924)
 I am familiar with the basic tenets of OPP (n=326).d 0.660 290 (89.0) 1.7 (.91)
 I have seen osteopathic manipulative treatment (OMT) performed on a patient or a peer (n=326).e 0.641 314 (96.3) 1.4 (0.76)
 I perform OMT on patients (n=324).e 0.840 251 (77.5) 2.4 (1.69)
 Rank the importance of maintaining hands-on OMT skills (n=237).f 0.836 276 (84.4) 2.0 (1.24)
 Rank the importance of learning to integrate OMT into an office practice setting (n=327).f 0.793 281 (85.9) 2.0 (1.20)
 Rank the importance of learning OMT billing and coding (n=327).f 0.756 277 (84.7) 2.1 (1.20)
 I intend to use OMT when I am in practice (n=209).d,g 0.855 129 (61.7) 2.3 (1.24)
 One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills (n=211).d,g 0.770 110 (52.1) 2.6 (1.31)
Integration of Osteopathic Culture Into Curriculum (Cronbach α=0.899)
 Osteopathic recognition, including the osteopathic curriculum, is one of the strengths of this residency program (n=327).d 0.796 229 (70.0) 2.1 (1.09)
 I have attended didactic sessions during which osteopathic principles and practice have been discussed (n=324).d 0.609 286 (88.3) 1.6 (0.96)
 There are enough opportunities to learn OPP my residency program (n=326).d 0.839 251 (77.0) 1.9 (0.99)
 I am more aware of osteopathic principles and practice, including awareness of OMT, than I was a year ago (n=325).d 0.760 176 (54.2) 2.5 (1.15)
 I am satisfied with faculty support of OMT and osteopathic principles and practice in this residency program (n=325).d 0.799 255 (78.5) 1.9 (0.90)
 The culture at this program is supportive of osteopathic principles and practice (n=325).d 0.759 307 (94.5) 1.5 (0.72)
 I am satisfied with the quality of osteopathic education I receive at this residency program (n=210).d,g 0.871 147 (70.0) 2.2 (0.99)
Osteopathic Curricular Components (Cronbach α=0.803)
 Rank the importance of the ability to work with DO faculty (n=323).f 0.790 297 (92.0) 2.0 (0.98)
 Rank the importance of OMT improves relationships with patients (n=323).f 0.682 282 (87.0) 2.1 (1.04)
 Rank the importance of camaraderie with other DOs (n=326).f 0.857 268 (82.2) 2.3 (1.14)
 Rank the importance of AOA board certification (n=325).f 0.660 217 (66.8) 2.6 (1.41)
Survey Items Analyzed Separately
 Rank the importance of a separate OMT clinic (n=326).d 209 (64.1) 2.2 (1.13)
 Offering an OMT elective is beneficial to resident education (n=327).d 271 (82.9) 1.9 (0.91)
 Rank the importance of OMT benefits our patients (n=327).f 303 (92.7) 1.7 (0.97)

a Includes responses of “yes, within the past month,” “yes, 1-6 months ago,” and “yes, more than 6 months ago.”

b Includes responses of “strongly agree” and “agree.”

c Includes reposes of “extremely important,” “very important,” and “somewhat important.”

d Responses ranked according to time frame from 1 to 4 (yes, within the past month; yes, 1-6 months ago; yes, more than 6 months ago; and no; respectively).

e Responses ranked on a 5-point Likert scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”).

f Responses ranked on a 5-point Likert scale ranging from 1 (“extremely important”) to 5 (“not important”).

g Survey item for residents only.

Abbreviations: DO, osteopathic physician; MD, allopathic physician.

Table 1.
Survey Item Responses Grouped by Factors Identified in the Survey
Survey Factors Factor Loading Affirmative Response,a Agree,b or Ranked as Important,c No. (%) Mean (SD)
Awareness of Osteopathic Principles and Practice (OPP) (Cronbach α=0.924)
 I am familiar with the basic tenets of OPP (n=326).d 0.660 290 (89.0) 1.7 (.91)
 I have seen osteopathic manipulative treatment (OMT) performed on a patient or a peer (n=326).e 0.641 314 (96.3) 1.4 (0.76)
 I perform OMT on patients (n=324).e 0.840 251 (77.5) 2.4 (1.69)
 Rank the importance of maintaining hands-on OMT skills (n=237).f 0.836 276 (84.4) 2.0 (1.24)
 Rank the importance of learning to integrate OMT into an office practice setting (n=327).f 0.793 281 (85.9) 2.0 (1.20)
 Rank the importance of learning OMT billing and coding (n=327).f 0.756 277 (84.7) 2.1 (1.20)
 I intend to use OMT when I am in practice (n=209).d,g 0.855 129 (61.7) 2.3 (1.24)
 One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills (n=211).d,g 0.770 110 (52.1) 2.6 (1.31)
Integration of Osteopathic Culture Into Curriculum (Cronbach α=0.899)
 Osteopathic recognition, including the osteopathic curriculum, is one of the strengths of this residency program (n=327).d 0.796 229 (70.0) 2.1 (1.09)
 I have attended didactic sessions during which osteopathic principles and practice have been discussed (n=324).d 0.609 286 (88.3) 1.6 (0.96)
 There are enough opportunities to learn OPP my residency program (n=326).d 0.839 251 (77.0) 1.9 (0.99)
 I am more aware of osteopathic principles and practice, including awareness of OMT, than I was a year ago (n=325).d 0.760 176 (54.2) 2.5 (1.15)
 I am satisfied with faculty support of OMT and osteopathic principles and practice in this residency program (n=325).d 0.799 255 (78.5) 1.9 (0.90)
 The culture at this program is supportive of osteopathic principles and practice (n=325).d 0.759 307 (94.5) 1.5 (0.72)
 I am satisfied with the quality of osteopathic education I receive at this residency program (n=210).d,g 0.871 147 (70.0) 2.2 (0.99)
Osteopathic Curricular Components (Cronbach α=0.803)
 Rank the importance of the ability to work with DO faculty (n=323).f 0.790 297 (92.0) 2.0 (0.98)
 Rank the importance of OMT improves relationships with patients (n=323).f 0.682 282 (87.0) 2.1 (1.04)
 Rank the importance of camaraderie with other DOs (n=326).f 0.857 268 (82.2) 2.3 (1.14)
 Rank the importance of AOA board certification (n=325).f 0.660 217 (66.8) 2.6 (1.41)
Survey Items Analyzed Separately
 Rank the importance of a separate OMT clinic (n=326).d 209 (64.1) 2.2 (1.13)
 Offering an OMT elective is beneficial to resident education (n=327).d 271 (82.9) 1.9 (0.91)
 Rank the importance of OMT benefits our patients (n=327).f 303 (92.7) 1.7 (0.97)

a Includes responses of “yes, within the past month,” “yes, 1-6 months ago,” and “yes, more than 6 months ago.”

b Includes responses of “strongly agree” and “agree.”

c Includes reposes of “extremely important,” “very important,” and “somewhat important.”

d Responses ranked according to time frame from 1 to 4 (yes, within the past month; yes, 1-6 months ago; yes, more than 6 months ago; and no; respectively).

e Responses ranked on a 5-point Likert scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”).

f Responses ranked on a 5-point Likert scale ranging from 1 (“extremely important”) to 5 (“not important”).

g Survey item for residents only.

Abbreviations: DO, osteopathic physician; MD, allopathic physician.

×
Regarding the survey items that referred to osteopathic culture in the curriculum answered by faculty and residents (Table 1), 229 of 327 respondents (70.0%) agreed or strongly agreed that OR, including the osteopathic curriculum, was one of the strengths of the residency program; 251 of 326 (77.0%) agreed or strongly agreed that there were enough opportunities to learn OPP in their residency program; and 176 of 325 (54.2%) agreed or strongly agreed that they were more aware of OPP, including OMT, than they were a year ago. Most respondents agreed or strongly agreed that they were satisfied with faculty support of OPP and OMT in their residency program (255 of 325 [78.5%]) and that the culture of their residency program is supportive of OPP (307 of 325 [94.5%]). 
Regarding the survey items that were analyzed separately (Table 1), 209 of 326 respondents (64.1%) agreed or strongly agreed that OMT clinic was important, and 271 of 327 (82.9%) agreed or strongly agreed that offering an OMT elective was beneficial to resident education. 
Responses to items answered by residents only (Table 2) revealed that 110 of 211 total residents (52.1%) and 90 of 134 family medicine DO residents (67.2%) agreed or strongly agreed that one of the reasons they chose their residency program was the ability to practice and improve OMT skills. A majority of all residents (129 of 209 [61.7%]) and specifically family medicine DO residents (99 of 134 [73.9%]) agreed or strongly agreed that they intended to use OMT when in practice. They were satisfied with their faculty's support of osteopathic education (147 of 210 [70.0%]). 
Table 2.
Responses to Survey Items for Residents Only (n=211)
Survey Item Resident Respondents DO Family Medicine Respondents
n Ranked as Important,a No. (%) Mean (SD) n Ranked as Important,a No. (%)
One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills. 211 110 (52.1) 2.6 (1.31) 134 90 (67.2)
I intend to use OMT when I am in practice. 209 129 (61.7) 2.3 (1.24) 134 99 (73.9)
I am satisfied with faculty support of osteopathic education. 210 147 (70.0) 2.2 (.99) 134 99 (73.9)

a Includes reposes of “extremely important,” “very important,” and “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

Table 2.
Responses to Survey Items for Residents Only (n=211)
Survey Item Resident Respondents DO Family Medicine Respondents
n Ranked as Important,a No. (%) Mean (SD) n Ranked as Important,a No. (%)
One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills. 211 110 (52.1) 2.6 (1.31) 134 90 (67.2)
I intend to use OMT when I am in practice. 209 129 (61.7) 2.3 (1.24) 134 99 (73.9)
I am satisfied with faculty support of osteopathic education. 210 147 (70.0) 2.2 (.99) 134 99 (73.9)

a Includes reposes of “extremely important,” “very important,” and “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

×
Of the 8 components of osteopathic curricula (Table 3), a large majority of respondents ranked the following as extremely, very, or somewhat important: “OMT benefits our patients,” “the ability to work with DO faculty,” “OMT improves relationships with patients,” “learning to integrate OMT into an office practice setting,” “learning OMT billing and coding,” “maintaining hands-on OMT skills,” and “camaraderie with other DOs.” 
Table 3.
Results of Survey Items Ranking the Importance of Osteopathic Curricular Components
Rank the importance of… Ranked Important,a No. (%) Ranked as Very Important or Extremely Important, No. (%) Mean (SD) Survey Item Score
OMT benefits our patients (n=327). 303 (92.7) 276 (84.4) 1.7 (0.97)
The ability to work with DO faculty (n=323). 297 (92.0) 248 (76.7) 2.0 (0.98)
OMT improves relationships with patients (n=323). 282 (87.0) 238 (73.6) 2.1 (1.04)
Learning to integrate OMT into an office practice setting (n=327). 281 (85.9) 244 (74.6) 2.0 (1.20)
Learning OMT billing and coding (n=327). 277 (84.7) 236 (72.2) 2.1 (1.20)
Maintaining hands-on OMT skills (n=327). 276 (84.4) 246 (75.2) 2.0 (1.24)
Camaraderie with other DOs (n=326). 268 (82.2) 198 (60.8) 2.3 (1.14)
The ability to obtain AOA board certification (n=325). 217 (66.8) 177 (54.5) 2.6 (1.41)

a Includes responses of 1, “extremely important;” 2, “very important;” and 3, “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment

Table 3.
Results of Survey Items Ranking the Importance of Osteopathic Curricular Components
Rank the importance of… Ranked Important,a No. (%) Ranked as Very Important or Extremely Important, No. (%) Mean (SD) Survey Item Score
OMT benefits our patients (n=327). 303 (92.7) 276 (84.4) 1.7 (0.97)
The ability to work with DO faculty (n=323). 297 (92.0) 248 (76.7) 2.0 (0.98)
OMT improves relationships with patients (n=323). 282 (87.0) 238 (73.6) 2.1 (1.04)
Learning to integrate OMT into an office practice setting (n=327). 281 (85.9) 244 (74.6) 2.0 (1.20)
Learning OMT billing and coding (n=327). 277 (84.7) 236 (72.2) 2.1 (1.20)
Maintaining hands-on OMT skills (n=327). 276 (84.4) 246 (75.2) 2.0 (1.24)
Camaraderie with other DOs (n=326). 268 (82.2) 198 (60.8) 2.3 (1.14)
The ability to obtain AOA board certification (n=325). 217 (66.8) 177 (54.5) 2.6 (1.41)

a Includes responses of 1, “extremely important;” 2, “very important;” and 3, “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment

×
Table 4 shows the comparison between the mean (SD) response values of MD and DO respondents, respondents from programs with and without OR, resident and faculty respondents, and male and female respondents. Response values for each survey item ranged from 1 to 5, where 1 represented the highest level of agreement or the highest level of importance, and 5 represented the lowest. When comparing responses between DO and MD respondents on items regarding osteopathic awareness, the mean overall response value was significantly lower for DOs than MDs, indicating a higher level of agreement (P<.001). There was also a significant difference in the mean survey score for DOs and MDs regarding the importance of osteopathic curricular components (P<.01). Overall, the mean survey score for the item regarding the importance of “OMT benefits our patients” as a factor of the curriculum was higher among DOs than in MDs, indicating a higher level of agreement with the statement (P=.024). 
Table 4.
Mean (SD) Survey Response Valuesa Grouped by Respondent Characteristics
Component Osteopathic Recognition Degree Role Sex
Yes (n=241) Mean (SD) No (n=86) Mean (SD) P Value MD (n=97) Mean (SD) DO (n=229) Mean (SD) P Value Faculty (n=115) Mean (SD) Resident (n=211) Mean (SD) P Value Male (n=177) Mean (SD) Female (n=140) Mean (SD) P Value
Awareness of osteopathic principles 2.0 (0.92) 2.0 (0.98) .802 2.8 (0.94) 1.7 (0.73) <.001 2.0 (0.90) 2.0 (0.95) .646 2.1 (0.94) 1.9 (0.91) .060
Osteopathic culture and curriculum 1.9 (0.69) 2.2 (0.83) .003 1.9 (0.64) 2.0 (0.77) .153 1.9 (0.61) 2.0 (0.80) .062 2.0 (0.71) 1.9 (0.77) .448
Osteopathic curricular components 2.2 (0.90) 2.4 (0.94) .159 2.7 (1.02) 2.1 (0.81) <.001 2.3 (0.86) 2.2 (0.94) .829 2.3 (0.89) 2.2 (0.94) .191
Importance of a separate OMT clinic 2.1 (1.05) 2.5 (1.26) .003 2.1 (0.92) 2.3 (1.20) .370 2.3 (1.13) 2.1 (1.12) .148 2.3 (1.21) 2.1 (1.01) .121
Importance of OMT electives 1.8 (0.88) 2.0 (0.98) .025 1.8 (0.79) 1.9 (0.96) .735 1.8 (0.83) 1.9 (0.95) .429 2.0 (1.03) 1.7 (0.73) .124
OMT benefits patients 1.7 (0.94) 1.9 (1.09) .129 1.0 (1.17) 1.6 (0.84) .024 1.7 (0.86) 1.8 (0.83) .997 1.9 (0.98) 1.6 (0.92) .004

a Total response values ranged from 1 to 5, where 1 represented the highest level of agreement or the highest level of importance and 5 represented the lowest.

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

Table 4.
Mean (SD) Survey Response Valuesa Grouped by Respondent Characteristics
Component Osteopathic Recognition Degree Role Sex
Yes (n=241) Mean (SD) No (n=86) Mean (SD) P Value MD (n=97) Mean (SD) DO (n=229) Mean (SD) P Value Faculty (n=115) Mean (SD) Resident (n=211) Mean (SD) P Value Male (n=177) Mean (SD) Female (n=140) Mean (SD) P Value
Awareness of osteopathic principles 2.0 (0.92) 2.0 (0.98) .802 2.8 (0.94) 1.7 (0.73) <.001 2.0 (0.90) 2.0 (0.95) .646 2.1 (0.94) 1.9 (0.91) .060
Osteopathic culture and curriculum 1.9 (0.69) 2.2 (0.83) .003 1.9 (0.64) 2.0 (0.77) .153 1.9 (0.61) 2.0 (0.80) .062 2.0 (0.71) 1.9 (0.77) .448
Osteopathic curricular components 2.2 (0.90) 2.4 (0.94) .159 2.7 (1.02) 2.1 (0.81) <.001 2.3 (0.86) 2.2 (0.94) .829 2.3 (0.89) 2.2 (0.94) .191
Importance of a separate OMT clinic 2.1 (1.05) 2.5 (1.26) .003 2.1 (0.92) 2.3 (1.20) .370 2.3 (1.13) 2.1 (1.12) .148 2.3 (1.21) 2.1 (1.01) .121
Importance of OMT electives 1.8 (0.88) 2.0 (0.98) .025 1.8 (0.79) 1.9 (0.96) .735 1.8 (0.83) 1.9 (0.95) .429 2.0 (1.03) 1.7 (0.73) .124
OMT benefits patients 1.7 (0.94) 1.9 (1.09) .129 1.0 (1.17) 1.6 (0.84) .024 1.7 (0.86) 1.8 (0.83) .997 1.9 (0.98) 1.6 (0.92) .004

a Total response values ranged from 1 to 5, where 1 represented the highest level of agreement or the highest level of importance and 5 represented the lowest.

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

×
Two-hundred fourteen respondents indicated that their residency program had OR, and 86 replied that their program did not. Respondents from programs with OR had significantly lower mean (SD) scores regarding attitudes toward osteopathic culture and curriculum than respondents from programs without OR, indicating stronger levels of agreement with statements regarding positive attitudes toward osteopathic culture (P=.003). Respondents from programs with OR demonstrated a higher level of agreement with the idea that a separate OMT clinic was important (P=.003) and that an OMT elective was beneficial (P=.025) than did respondents from programs without OR. The mean (SD) survey response value was lower for women than men when indicating the importance of OMT benefiting patients, indicating women found this aspect more important than men did (P=.004). 
Of the items measuring awareness of OPP, those with the lowest mean (SD) survey response value, indicating stronger levels of agreement, were having seen OMT performed on a patient or a peer (1.4 [0.76]) and familiarity with the basic tenets of OPP (1.7 [0.91]). The items measuring curricular integration of osteopathic culture with lowest mean (SD) survey result value, indicating stronger levels of agreement, were, “The culture at this program is supportive of osteopathic principles and practice” (1.5 [0.72]) and “I have attended didactic sessions during which osteopathic principles and practice have been discussed” (1.6 [0.96]). The curricular component item with the lowest mean (SD) survey score, indicating the highest ranked level of importance, was the ability to work with DO faculty (2.0 [0.98]). 
Discussion
Overall, the baseline data of resident and faculty attitudes regarding 22 aspects of osteopathic awareness, culture, and curriculum demonstrated agreement for all items that measured the value of osteopathic education. This finding demonstrates that the residency programs surveyed are successfully integrating OPP into their curricula and that MDs are attending didactic sessions alongside DOs who are enrolled in AOA-accredited programs. This value placed on osteopathic education is consistent with findings from previous studies.3-11 Nearly 30% of respondents were MDs, which confirms an interest in osteopathic education among our MD colleagues in the residency programs surveyed. 
In our study, DOs were significantly more aware of OPP than were MDs, and DOs ranked the importance of osteopathic curricular components more highly than MDs did. This finding is not surprising because DOs receive training in OPP in osteopathic medical school. For the items that measured osteopathic culture and curriculum, no significant difference was found between the attitudes of DOs and MDs. Both DOs and MDs valued a separate OMT clinic and agreed that an OMT elective was beneficial. This agreement with the value of added OMT elective experience corroborates previous studies that found that mixed-staff settings have been shown to promote more favorable attitudes toward OMT.12,13 A surprising finding in the current study is that MDs more strongly agreed with the statement, “OMT benefits patients” than DOs did, which also points to favorable attitudes toward OMT in MDs exposed to osteopathic curricula. 
In 2001, Johnson and Kurtz14 expressed concern that an unintended consequence of osteopathic students and graduates training in an allopathic environment was the decreasing number of practicing DOs who used OMT in their practice. In the UMKC 2016 ACGME postgraduate survey completed by graduates 3 years after their residency training, 4 of the 8 respondents indicated that they performed OMT in their practice. Two of those respondents had matched through the AOA (written communication, 2016). 
The importance of DO mentors and osteopathic training during medical school and residency has been examined,3-5,12,13,15 with the finding that residents and students who are exposed to osteopathic mentors and training in settings that incorporate OPP are more likely to perform OMT in their practice. In the current study, the curricular component item with the highest-ranked level of importance was the ability to work with DO faculty, validating these previous observations. The majority of DO and MD residents surveyed in the current study agreed with the statement, “One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills.” 
Research has shown that osteopathic medical students express a strong interest in receiving mentorship in OPP. A 2015 AACOM survey16 found that 70.6% of third-year osteopathic medical students found OR appealing when considering residency program choices. Several studies17-20 highlight the importance of osteopathic mentors along the continuum of osteopathic medical education, including the third and fourth years of medical school, when students are exposed to the hospital setting, and during residency. Ching and Burke17 observed that “students still require role models of physician behavior to understand what it means to be an osteopathic physician.” Osteopathic medical students often struggle to find enough opportunities to hone their OPP skills in the third and fourth years of medical training.4,8,17,18 Teng et al18 wrote that students “mature into osteopathic physicians” primarily during graduate medical education, highlighting the importance of continued exposure to OPP skills during residency training. 
The transition to the single accreditation system is at a pivotal point for the osteopathic medical profession to institute osteopathic curricula and provide role models for osteopathic medical students and residents along the educational continuum. Students are most likely to select residency programs based on geographic location.21 Therefore, as the number of osteopathic medical schools increases and encompasses more geographic areas,22 it is important that medical schools ensure that the affiliated hospitals provide adequate osteopathic mentors. Residency programs accredited by the ACGME often lack the appropriate faculty, curricula, and resources to enhance OPP skills,5 highlighting the need to encourage osteopathic educators in allopathic residencies to prioritize the importance of becoming an osteopathic mentor. Allee et al3 found that 39.5% of surveyed DOs in ACGME-accredited family medicine residency programs reported frequent use of OMT, compared with 67.9% of DOs in AOA-accredited family medicine residency programs. They found that this difference resulted primarily from osteopathic mentorship experienced during residency training.3 Because the majority of DOs are primary care physicians,9,22 the importance of osteopathic mentors in primary care specialties is vital. Ensuring that residents are exposed to DO attending physicians and a curriculum that incorporates OPP is increasingly important as the single accreditation system transition progresses. 
The results of the current study shed some light on the aspects of an osteopathic curriculum that residents and faculty considered most important, including the ability to work with DO faculty, maintaining hands-on OMT skills, learning to integrate OMT into an office practice setting, the importance of improved relationships with patients who receive OMT, and the importance of learning OMT billing and coding. 
Respondents from programs with OR more strongly agreed that a separate OMT clinic was important and that an OMT elective was beneficial than did respondents from programs without OR. Pursuing OR is desirable to the osteopathic medical profession as we seek to promote osteopathic mentorship of students and residents. Osteopathic education is desirable to osteopathic medical students training in a mixed or allopathic setting.23,24 In the current study, respondents from programs with OR had more strongly favorable attitudes toward osteopathic culture and curriculum than programs without OR. Favorable attitudes toward osteopathic training may have the potential to produce stronger osteopathic mentorship to both DO and MD residents training in an institution with OR. Levine9 calls for residency programs to commit to providing distinct osteopathic training by applying for OR, remarking that “it is up to all of us to make sure that osteopathic medicine is embedded in the fabric of the US medical education system.” 
The current study is limited by the inclusion of AOA-accredited and dually accredited residency programs only. Baseline attitudes of programs without osteopathic curricula were not obtained; therefore, the results may not be generalizable to other types of programs. The predominance of respondents from family medicine residency programs further limits the generalizability of the study. Another limitation is inherent survey bias, as we recruited program directors who expressed interest in participating in a survey. The data we obtained are baseline, and validation of the survey tool was not pursued beyond Varimax analysis for construct validity and initial expert review for content. The number of MD resident responses and the number of responses from specialties outside of family medicine were not sufficiently powered for deeper statistical analysis. Future studies that include residency programs without formal osteopathic curricula, as well as studies that include residency programs from internal medicine, pediatrics, and other specialties are needed. The use of multiple response scale types on the survey items may have introduced confusion or bias. 
Conclusion
The results of this study indicate that both DO and MD residents place a high value on the ability to work with osteopathic mentors. The ability to learn and hone OMT skills is valuable to both DO and MD residents. Faculty and residents agree that OMT benefits patients. The majority of residents intend to use OMT when they are in practice, and DOs continue to value obtaining AOA board certification. Our findings show that osteopathic mentorship is needed and desired as the osteopathic medical profession assimilates into the single accreditation system and that programs with OR create a stronger osteopathic culture than those without OR. Graduate medical education leaders who pursue OR can potentially promote osteopathic culture for future osteopathic and allopathic physicians and leaders. 
Author Contributions
All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. 
References
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Table 1.
Survey Item Responses Grouped by Factors Identified in the Survey
Survey Factors Factor Loading Affirmative Response,a Agree,b or Ranked as Important,c No. (%) Mean (SD)
Awareness of Osteopathic Principles and Practice (OPP) (Cronbach α=0.924)
 I am familiar with the basic tenets of OPP (n=326).d 0.660 290 (89.0) 1.7 (.91)
 I have seen osteopathic manipulative treatment (OMT) performed on a patient or a peer (n=326).e 0.641 314 (96.3) 1.4 (0.76)
 I perform OMT on patients (n=324).e 0.840 251 (77.5) 2.4 (1.69)
 Rank the importance of maintaining hands-on OMT skills (n=237).f 0.836 276 (84.4) 2.0 (1.24)
 Rank the importance of learning to integrate OMT into an office practice setting (n=327).f 0.793 281 (85.9) 2.0 (1.20)
 Rank the importance of learning OMT billing and coding (n=327).f 0.756 277 (84.7) 2.1 (1.20)
 I intend to use OMT when I am in practice (n=209).d,g 0.855 129 (61.7) 2.3 (1.24)
 One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills (n=211).d,g 0.770 110 (52.1) 2.6 (1.31)
Integration of Osteopathic Culture Into Curriculum (Cronbach α=0.899)
 Osteopathic recognition, including the osteopathic curriculum, is one of the strengths of this residency program (n=327).d 0.796 229 (70.0) 2.1 (1.09)
 I have attended didactic sessions during which osteopathic principles and practice have been discussed (n=324).d 0.609 286 (88.3) 1.6 (0.96)
 There are enough opportunities to learn OPP my residency program (n=326).d 0.839 251 (77.0) 1.9 (0.99)
 I am more aware of osteopathic principles and practice, including awareness of OMT, than I was a year ago (n=325).d 0.760 176 (54.2) 2.5 (1.15)
 I am satisfied with faculty support of OMT and osteopathic principles and practice in this residency program (n=325).d 0.799 255 (78.5) 1.9 (0.90)
 The culture at this program is supportive of osteopathic principles and practice (n=325).d 0.759 307 (94.5) 1.5 (0.72)
 I am satisfied with the quality of osteopathic education I receive at this residency program (n=210).d,g 0.871 147 (70.0) 2.2 (0.99)
Osteopathic Curricular Components (Cronbach α=0.803)
 Rank the importance of the ability to work with DO faculty (n=323).f 0.790 297 (92.0) 2.0 (0.98)
 Rank the importance of OMT improves relationships with patients (n=323).f 0.682 282 (87.0) 2.1 (1.04)
 Rank the importance of camaraderie with other DOs (n=326).f 0.857 268 (82.2) 2.3 (1.14)
 Rank the importance of AOA board certification (n=325).f 0.660 217 (66.8) 2.6 (1.41)
Survey Items Analyzed Separately
 Rank the importance of a separate OMT clinic (n=326).d 209 (64.1) 2.2 (1.13)
 Offering an OMT elective is beneficial to resident education (n=327).d 271 (82.9) 1.9 (0.91)
 Rank the importance of OMT benefits our patients (n=327).f 303 (92.7) 1.7 (0.97)

a Includes responses of “yes, within the past month,” “yes, 1-6 months ago,” and “yes, more than 6 months ago.”

b Includes responses of “strongly agree” and “agree.”

c Includes reposes of “extremely important,” “very important,” and “somewhat important.”

d Responses ranked according to time frame from 1 to 4 (yes, within the past month; yes, 1-6 months ago; yes, more than 6 months ago; and no; respectively).

e Responses ranked on a 5-point Likert scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”).

f Responses ranked on a 5-point Likert scale ranging from 1 (“extremely important”) to 5 (“not important”).

g Survey item for residents only.

Abbreviations: DO, osteopathic physician; MD, allopathic physician.

Table 1.
Survey Item Responses Grouped by Factors Identified in the Survey
Survey Factors Factor Loading Affirmative Response,a Agree,b or Ranked as Important,c No. (%) Mean (SD)
Awareness of Osteopathic Principles and Practice (OPP) (Cronbach α=0.924)
 I am familiar with the basic tenets of OPP (n=326).d 0.660 290 (89.0) 1.7 (.91)
 I have seen osteopathic manipulative treatment (OMT) performed on a patient or a peer (n=326).e 0.641 314 (96.3) 1.4 (0.76)
 I perform OMT on patients (n=324).e 0.840 251 (77.5) 2.4 (1.69)
 Rank the importance of maintaining hands-on OMT skills (n=237).f 0.836 276 (84.4) 2.0 (1.24)
 Rank the importance of learning to integrate OMT into an office practice setting (n=327).f 0.793 281 (85.9) 2.0 (1.20)
 Rank the importance of learning OMT billing and coding (n=327).f 0.756 277 (84.7) 2.1 (1.20)
 I intend to use OMT when I am in practice (n=209).d,g 0.855 129 (61.7) 2.3 (1.24)
 One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills (n=211).d,g 0.770 110 (52.1) 2.6 (1.31)
Integration of Osteopathic Culture Into Curriculum (Cronbach α=0.899)
 Osteopathic recognition, including the osteopathic curriculum, is one of the strengths of this residency program (n=327).d 0.796 229 (70.0) 2.1 (1.09)
 I have attended didactic sessions during which osteopathic principles and practice have been discussed (n=324).d 0.609 286 (88.3) 1.6 (0.96)
 There are enough opportunities to learn OPP my residency program (n=326).d 0.839 251 (77.0) 1.9 (0.99)
 I am more aware of osteopathic principles and practice, including awareness of OMT, than I was a year ago (n=325).d 0.760 176 (54.2) 2.5 (1.15)
 I am satisfied with faculty support of OMT and osteopathic principles and practice in this residency program (n=325).d 0.799 255 (78.5) 1.9 (0.90)
 The culture at this program is supportive of osteopathic principles and practice (n=325).d 0.759 307 (94.5) 1.5 (0.72)
 I am satisfied with the quality of osteopathic education I receive at this residency program (n=210).d,g 0.871 147 (70.0) 2.2 (0.99)
Osteopathic Curricular Components (Cronbach α=0.803)
 Rank the importance of the ability to work with DO faculty (n=323).f 0.790 297 (92.0) 2.0 (0.98)
 Rank the importance of OMT improves relationships with patients (n=323).f 0.682 282 (87.0) 2.1 (1.04)
 Rank the importance of camaraderie with other DOs (n=326).f 0.857 268 (82.2) 2.3 (1.14)
 Rank the importance of AOA board certification (n=325).f 0.660 217 (66.8) 2.6 (1.41)
Survey Items Analyzed Separately
 Rank the importance of a separate OMT clinic (n=326).d 209 (64.1) 2.2 (1.13)
 Offering an OMT elective is beneficial to resident education (n=327).d 271 (82.9) 1.9 (0.91)
 Rank the importance of OMT benefits our patients (n=327).f 303 (92.7) 1.7 (0.97)

a Includes responses of “yes, within the past month,” “yes, 1-6 months ago,” and “yes, more than 6 months ago.”

b Includes responses of “strongly agree” and “agree.”

c Includes reposes of “extremely important,” “very important,” and “somewhat important.”

d Responses ranked according to time frame from 1 to 4 (yes, within the past month; yes, 1-6 months ago; yes, more than 6 months ago; and no; respectively).

e Responses ranked on a 5-point Likert scale ranging from 1 (“strongly agree”) to 5 (“strongly disagree”).

f Responses ranked on a 5-point Likert scale ranging from 1 (“extremely important”) to 5 (“not important”).

g Survey item for residents only.

Abbreviations: DO, osteopathic physician; MD, allopathic physician.

×
Table 2.
Responses to Survey Items for Residents Only (n=211)
Survey Item Resident Respondents DO Family Medicine Respondents
n Ranked as Important,a No. (%) Mean (SD) n Ranked as Important,a No. (%)
One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills. 211 110 (52.1) 2.6 (1.31) 134 90 (67.2)
I intend to use OMT when I am in practice. 209 129 (61.7) 2.3 (1.24) 134 99 (73.9)
I am satisfied with faculty support of osteopathic education. 210 147 (70.0) 2.2 (.99) 134 99 (73.9)

a Includes reposes of “extremely important,” “very important,” and “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

Table 2.
Responses to Survey Items for Residents Only (n=211)
Survey Item Resident Respondents DO Family Medicine Respondents
n Ranked as Important,a No. (%) Mean (SD) n Ranked as Important,a No. (%)
One of the reasons I chose this residency program is the ability to practice OMT and improve my OMT skills. 211 110 (52.1) 2.6 (1.31) 134 90 (67.2)
I intend to use OMT when I am in practice. 209 129 (61.7) 2.3 (1.24) 134 99 (73.9)
I am satisfied with faculty support of osteopathic education. 210 147 (70.0) 2.2 (.99) 134 99 (73.9)

a Includes reposes of “extremely important,” “very important,” and “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

×
Table 3.
Results of Survey Items Ranking the Importance of Osteopathic Curricular Components
Rank the importance of… Ranked Important,a No. (%) Ranked as Very Important or Extremely Important, No. (%) Mean (SD) Survey Item Score
OMT benefits our patients (n=327). 303 (92.7) 276 (84.4) 1.7 (0.97)
The ability to work with DO faculty (n=323). 297 (92.0) 248 (76.7) 2.0 (0.98)
OMT improves relationships with patients (n=323). 282 (87.0) 238 (73.6) 2.1 (1.04)
Learning to integrate OMT into an office practice setting (n=327). 281 (85.9) 244 (74.6) 2.0 (1.20)
Learning OMT billing and coding (n=327). 277 (84.7) 236 (72.2) 2.1 (1.20)
Maintaining hands-on OMT skills (n=327). 276 (84.4) 246 (75.2) 2.0 (1.24)
Camaraderie with other DOs (n=326). 268 (82.2) 198 (60.8) 2.3 (1.14)
The ability to obtain AOA board certification (n=325). 217 (66.8) 177 (54.5) 2.6 (1.41)

a Includes responses of 1, “extremely important;” 2, “very important;” and 3, “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment

Table 3.
Results of Survey Items Ranking the Importance of Osteopathic Curricular Components
Rank the importance of… Ranked Important,a No. (%) Ranked as Very Important or Extremely Important, No. (%) Mean (SD) Survey Item Score
OMT benefits our patients (n=327). 303 (92.7) 276 (84.4) 1.7 (0.97)
The ability to work with DO faculty (n=323). 297 (92.0) 248 (76.7) 2.0 (0.98)
OMT improves relationships with patients (n=323). 282 (87.0) 238 (73.6) 2.1 (1.04)
Learning to integrate OMT into an office practice setting (n=327). 281 (85.9) 244 (74.6) 2.0 (1.20)
Learning OMT billing and coding (n=327). 277 (84.7) 236 (72.2) 2.1 (1.20)
Maintaining hands-on OMT skills (n=327). 276 (84.4) 246 (75.2) 2.0 (1.24)
Camaraderie with other DOs (n=326). 268 (82.2) 198 (60.8) 2.3 (1.14)
The ability to obtain AOA board certification (n=325). 217 (66.8) 177 (54.5) 2.6 (1.41)

a Includes responses of 1, “extremely important;” 2, “very important;” and 3, “somewhat important.”

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment

×
Table 4.
Mean (SD) Survey Response Valuesa Grouped by Respondent Characteristics
Component Osteopathic Recognition Degree Role Sex
Yes (n=241) Mean (SD) No (n=86) Mean (SD) P Value MD (n=97) Mean (SD) DO (n=229) Mean (SD) P Value Faculty (n=115) Mean (SD) Resident (n=211) Mean (SD) P Value Male (n=177) Mean (SD) Female (n=140) Mean (SD) P Value
Awareness of osteopathic principles 2.0 (0.92) 2.0 (0.98) .802 2.8 (0.94) 1.7 (0.73) <.001 2.0 (0.90) 2.0 (0.95) .646 2.1 (0.94) 1.9 (0.91) .060
Osteopathic culture and curriculum 1.9 (0.69) 2.2 (0.83) .003 1.9 (0.64) 2.0 (0.77) .153 1.9 (0.61) 2.0 (0.80) .062 2.0 (0.71) 1.9 (0.77) .448
Osteopathic curricular components 2.2 (0.90) 2.4 (0.94) .159 2.7 (1.02) 2.1 (0.81) <.001 2.3 (0.86) 2.2 (0.94) .829 2.3 (0.89) 2.2 (0.94) .191
Importance of a separate OMT clinic 2.1 (1.05) 2.5 (1.26) .003 2.1 (0.92) 2.3 (1.20) .370 2.3 (1.13) 2.1 (1.12) .148 2.3 (1.21) 2.1 (1.01) .121
Importance of OMT electives 1.8 (0.88) 2.0 (0.98) .025 1.8 (0.79) 1.9 (0.96) .735 1.8 (0.83) 1.9 (0.95) .429 2.0 (1.03) 1.7 (0.73) .124
OMT benefits patients 1.7 (0.94) 1.9 (1.09) .129 1.0 (1.17) 1.6 (0.84) .024 1.7 (0.86) 1.8 (0.83) .997 1.9 (0.98) 1.6 (0.92) .004

a Total response values ranged from 1 to 5, where 1 represented the highest level of agreement or the highest level of importance and 5 represented the lowest.

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

Table 4.
Mean (SD) Survey Response Valuesa Grouped by Respondent Characteristics
Component Osteopathic Recognition Degree Role Sex
Yes (n=241) Mean (SD) No (n=86) Mean (SD) P Value MD (n=97) Mean (SD) DO (n=229) Mean (SD) P Value Faculty (n=115) Mean (SD) Resident (n=211) Mean (SD) P Value Male (n=177) Mean (SD) Female (n=140) Mean (SD) P Value
Awareness of osteopathic principles 2.0 (0.92) 2.0 (0.98) .802 2.8 (0.94) 1.7 (0.73) <.001 2.0 (0.90) 2.0 (0.95) .646 2.1 (0.94) 1.9 (0.91) .060
Osteopathic culture and curriculum 1.9 (0.69) 2.2 (0.83) .003 1.9 (0.64) 2.0 (0.77) .153 1.9 (0.61) 2.0 (0.80) .062 2.0 (0.71) 1.9 (0.77) .448
Osteopathic curricular components 2.2 (0.90) 2.4 (0.94) .159 2.7 (1.02) 2.1 (0.81) <.001 2.3 (0.86) 2.2 (0.94) .829 2.3 (0.89) 2.2 (0.94) .191
Importance of a separate OMT clinic 2.1 (1.05) 2.5 (1.26) .003 2.1 (0.92) 2.3 (1.20) .370 2.3 (1.13) 2.1 (1.12) .148 2.3 (1.21) 2.1 (1.01) .121
Importance of OMT electives 1.8 (0.88) 2.0 (0.98) .025 1.8 (0.79) 1.9 (0.96) .735 1.8 (0.83) 1.9 (0.95) .429 2.0 (1.03) 1.7 (0.73) .124
OMT benefits patients 1.7 (0.94) 1.9 (1.09) .129 1.0 (1.17) 1.6 (0.84) .024 1.7 (0.86) 1.8 (0.83) .997 1.9 (0.98) 1.6 (0.92) .004

a Total response values ranged from 1 to 5, where 1 represented the highest level of agreement or the highest level of importance and 5 represented the lowest.

Abbreviations: DO, osteopathic physician; MD, allopathic physician; OMT, osteopathic manipulative treatment.

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