Editorial  |   November 2018
Moving Down the Road Less Traveled: The GROUPIE Program at Touro California
Author Notes
  • Financial Disclosures: Dr Clearfield is a consultant for NovoNordisk. 
  • Support: None reported. 
  •  *Address correspondence to Michael Clearfield, DO, Dean, Touro University College of Osteopathic Medicine-CA, 1310 Club Dr, Vallejo CA, 94592-1187. Email:
Article Information
Imaging / Preventive Medicine
Editorial   |   November 2018
Moving Down the Road Less Traveled: The GROUPIE Program at Touro California
The Journal of the American Osteopathic Association, November 2018, Vol. 118, 696-699. doi:
The Journal of the American Osteopathic Association, November 2018, Vol. 118, 696-699. doi:
In my August 2017 editorial1 in The Journal of the American Osteopathic Association (JAOA), I discussed the scarcity of prospective studies demonstrating the distinguishing characteristics of the osteopathic medical profession. The editorial1 briefly reviewed the past 125 years of osteopathic medicine and outlined an abridged path leading to the current status of the profession. In that editorial, 7 measureable outcomes used at the Touro University College of Osteopathic Medicine-CA (TUCOM) were proposed under the GROUPIE acronym: 
G = Global health 
R = Research 
O = Osteopathic manipulative medicine and Obesity 
U = hand-held Ultrasonography 
P = Public health 
I = Interprofessionalism 
E = Empathy 
These outcomes attempt to demonstrate a unique osteopathic approach to health care to enhance patient-physician communication and, ultimately, improve patient adherence and compliance in a high-quality, cost-effective manner. 
The 3 articles that accompanied my editorial in the August 2017 issue of the JAOA focused on research, obesity, and empathy.2-4 These 3 articles were intended to provide a foundation to better define a framework for the unique and distinguishing characteristics of osteopathic medical students and graduates as health care professionals. 
In the current issue of the JAOA, through this editorial and 4 other articles, 3 additional components of GROUPIE (ultrasonography, public health, and interprofessionalism) are highlighted and 1 (obesity) is revisited.5-8 When added to the 3 previously published articles, the content collectively further sets the foundation elucidating a possible direction to consider as the osteopathic medical profession moves into the next 125 years. 
Ultrasonography has been a diagnostic tool for decades, but not until the past decade has it transformed into a portable handheld device for the clinician to use at the point of care. Our college has joined a consortium of medical schools in California (referred to as UMeCali) to introduce ultrasonography longitudinally throughout the medical school curriculum.9 The article by Hendriksz et al5 explores how a staged approach focusing on point-of-care ultrasonography enhances anatomical knowledge and diagnostic skill as an integrative educational unit. The article also details the rationale for the TOUCH program (Targeting OMT [osteopathic manipulative treatment] and Ultrasound Combination in Health), which will help determine whether patient-physician communication is improved with OMT or ultrasonography and whether the combination of these 2 modalities will enhance communication and patient adherence to an even greater extent. 
Public Health
The Institute of Medicine recommends that public health education be incorporated into the medical school curriculum.10 In this issue of the JAOA, Velasco-Mondragon et al6 review the development and success of the dual DO/MPH program, which has grown to be the largest DO/MPH program in the osteopathic medical profession.6 In 2012, TUCOM's affiliation with the 3 local Federally Qualified Healthcare Centers opened the full array of county public health services, which contributed significantly to the public health component of GROUPIE. The strong public health culture further derives much of its strength from its ability to overlap with various other components of GROUPIE, such as the global health program, where 43% of the dual degree DO/MPH students receive their MPH in global public health. 
As part of our public health focus, we are also addressing type 2 diabetes mellitus, which has become a public health pandemic. In their review, Shubrook et al8 show the substantial evidence for prevention and delay of new-onset type 2 diabetes as demonstrated in the National Diabetes Prevention Program (DPP). The evidence has been so strong that Medicare now provides full coverage for the DPP as a benefit for all Medicare beneficiaries who have prediabetes. Further, California Medicaid and private insurers are also covering this program. 
Interprofessional Education
The Commission on Osteopathic College Accreditation requires interprofessional education in its standards for all colleges of osteopathic medicine (COMs).11 An example of the interprofessional focus of the GROUPIE program is the DPP, which includes a full spectrum of health care professionals functioning as a collaborative team.12 To date, the DPP has trained more than 350 certified lifestyle coaches across all disciplines (DO, PA, PharmD, and MPH students and faculty from each college). The coaches then work in interprofessional teams to offer this program to the community as part of service learning. The success of the DPP has allowed TUCOM to become the first medical school in the nation to formally train its student body and register with the Centers for Disease Control and Prevention to become an accredited program. 
As an outgrowth of the success of the DPP, a new interprofessional outreach program called MOBEC (Mobile Diabetes Education Center) extends the DPP and other diabetes-related programs to the far-reaches of Solano County to address risk and lifestyle choices to a largely disenfranchised community.6 Since its launch in April 2017, MOBEC served more than 3000 people in Solano County. The goals of MOBEC are to raise awareness of people's diabetes status and to offer education and access to programming in the community. In the article by Velasco-Mondragon et al,6 the inclusion of interprofessional education into the GROUPIE program is demonstrated to be part of a more comprehensive approach to focus on the quadruple aim of population health, patient experience, per capita cost, and provider work-life balance as espoused by the National Center for Interprofessional Practice and Education.13 
GROUPIE Update on Obesity
One new article7 included in this issue of the JAOA extends and enhances previously published GROUPIE-focused articles on obesity, specifically FOODS (Fundamentals for an Osteopathic Obesity Designed Study).2 The FOODS article2 demonstrated that a comprehensive obesity curriculum improved knowledge related to obesity while concomitantly improving inherent bias against obesity.2 In the article “Cardiovascular Disease as a Result of the Interactions Between Obesity, Climate Change, and Inflammation: The COCCI Syndemic,”7 my colleagues and I focus on a specific component of the FOODS curriculum detailing the environmental implications of the obesity epidemic. The syndemic model implicates 2 or more diseases or contributors to disease, in this case, obesity and climate change, clustering within a myriad of societal factors and creating greater adverse interactions than typically expected.14 The next phase of FOODS will explore the effectiveness of transporting this comprehensive curriculum to other institutions and residency programs to determine whether changes in knowledge and attitude will ultimately result in better patient outcomes. 
Osteopathic Distinction
In my previous editorial,1 I noted that from 1978 to 2016, fewer than 15 original articles presenting evidence-based outcomes demonstrating distinguishing characteristics, uniqueness, and/or distinctiveness of the osteopathic medical profession were published in the JAOA. In reviewing similar original research articles published in 2017, there were 6 that met these criteria.2,3,15-18 Of these 6 articles, 2 were brief communications from Italian researchers,15,17 1 focused on the Comprehensive Osteopathic Medical Licensing Examination-USA,16 and 2 were part of the original GROUPIE articles.2,3 I had posited that if each COM proposed even 1 unique measureable prospective outcome representing an overall public good, the number of distinctive osteopathic articles would grow substantially. As a result, the cumulative influx of manuscripts detailing the overall public good from the osteopathic medical profession could then collectively further refine and delineate an evidence base to help direct a strategic path to start the next 125 years of osteopathic medicine. To requote a 2009 statement from Chen and Mullan:19

The structure of today's osteopathic medical schools may be hard to distinguish from that of their allopathic counterparts, but the output of osteopathic medical schools remains clearly distinctive, and the nation's healthcare system benefits as a result.

Although 9 years have passed since that statement was published, the need for our COMs and the osteopathic medical profession to remain clearly distinctive still resonates and may be more relevant than ever. 
As I mentioned in my previous JAOA editorial,1 TUCOM appreciates The Journal's Engage Initiative, which allows COMs to showcase their scholarly activity.20 In this issue of the JAOA, TUCOM shares additional articles related to the GROUPIE program, which is but one example of the ways in which the osteopathic medical profession, along with osteopathic medical students, our graduates, and COMs, can distinguish itself. As we move forward from the osteopathic medical profession's 125th anniversary, our profession may be buoyed by an excerpt from Robert Frost's poem “The Road Not Taken”21:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

Clearfield M. A path to osteopathic distinction: the Touro California GROUPIE Program [editorial]. J Am Osteopath Assoc. 2017;117(8):488-494. doi: 10.7556/jaoa.2017.098 [CrossRef] [PubMed]
Gayer G, Weiss J, Clearfield M. Fundamentals for an Osteopathic Obesity Designed Study: the effects of education on osteopathic medical students’ attitudes regarding obesity. J Am Osteopath Assoc. 2017;117(8):495-502. doi: 10.7556/jaoa.2017.099 [CrossRef] [PubMed]
Davis GE, Hartwig WC, McTighe AJ. Clinical preceptors perceptions of empathy: the Empathy in Osteopathic Training and Education (EMOTE) study. J Am Osteopath Assoc. 2017;11(8):503-509. doi: 10.7556/jaoa.2017.100 [CrossRef]
Schwarz JM, Clearfield M, Mulligan K. Conversion of sugar to fat: is hepatic de novo lipogenesis leading to metabolic syndrome and associated chronic diseases. J Am Osteopath Assoc. 2017;11(8): 520-527. doi: 10.7556/jaoa.2017.102 [CrossRef]
Hendriksz T, Markman Z, Pera A. An Education in Osteopathic Ultrasonography (AEIOU) program: one institution's approach to advancing an ultrasonography curriculum. J Am Osteopath Assoc. 2018;118(11):746-752. doi: 10.7556/jaoa.2018.160
Velasco-Mondragon HE, Menini T, West C, Clearfield M. Public health and interprofessional education as critical components in the evolution of osteopathic medical education. J Am Osteopath Assoc. 2018;118(11):753-763, e96-e100. doi: 10.7556/jaoa.2018.161
Clearfield M, Davis G, Weis J, Gayer G, Shubrook JH. Cardiovascular disease as a result of the interactions between obesity, climate change, and inflammation: the COCCI Syndemic. J Am Osteopath Assoc. 2018;118(11):719-729. doi: 10.7556/jaoa.2018.157
Shubrook JH, Chen W, Lim A. Evidence for the prevention of type 2 diabetes mellitus. J Am Osteopath Assoc. 2018;118(11):730-737. doi: 10.7556/jaoa.2018.158
Chiem AT, Soucy Z, Dinh VA, et al. Integration of ultrasound in undergraduate medical education at the California medical schools: a discussion of common challenges and strategies from the UMeCali experience. J Ultrasound Med. 2016;35(2):221-233. doi: 10.7863/ultra.15.05006 [CrossRef] [PubMed]
Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century. The Future of the Publics Health in the 21st Century. Washington, DC: National Academies Press; 2002.
Commission on Osteopathic College Accreditation. Accreditation of Colleges of Osteopathic Medicine: COM Continuing Accreditation Standards. Chicago, IL: American Osteopathic Association; 2017. Accessed September 7, 2018.
Neamah HH, Sebert Kuhlmann AK, Tabak RG. Effectiveness of program modification strategies of the Diabetes Prevention Program: a systematic review. Diabetes Educ. 2016;42(2):153-165. doi: 10.1177/0145721716630386 [CrossRef] [PubMed]
Cox M, Blouin AS, Cuff P, Paniagua M, Phillips S, Vlasses PH. The role of accreditation in achieving the quadruple aim for health. NAM Perspectives. Washington, DC: National Academy of Medicine; 2017. Accessed December 15, 2017.
Singer M, Bulled N, Ostrach B, Mendnhall E. Syndemics and the biosocial conception of health. Lancet. 2017;389(10072):941-950. doi: 10.1016/S0140-6736(17)30003-X [CrossRef] [PubMed]
Curcio JE, Grana MJ, England S, et al. Use of the Spencer technique on collegiate baseball players: effect on physical performance and self-report measures. J Am Osteopath Assoc. 2017;117(3):166-175. doi: 10.7556/jaoa.2017.031 [CrossRef] [PubMed]
Gimpel JR, Horber D, Sandella JM, Kneble JA, Thornburg JE. Evidence-based redesign of the COMLEX-USA series. J Am Osteopath Assoc. 2017;117(4):253-261. doi: 10.7556/jaoa.2017.043 [CrossRef] [PubMed]
D'lppolito M, Tramontano M, Buzzi MG. Effects of osteopathic therapy on pain and mood disorders in patients with high-frequency migraines. J Am Osteopath Assoc. 2017;117(6):365-369. doi: 10.7556/jaoa.2017.074 [CrossRef] [PubMed]
Fornari M, Carnevali L, Sgoifo A. Single osteopathic manipulative therapy session dampens acute autonomic and neuroendocrine response to mental stress in healthy male participants. J Am Osteopath Assoc. 2017;117(9):559-567. doi: 10.7556/jaoa.2017.110 [CrossRef] [PubMed]
Chen C, Mullan F. The separate osteopathic medical education pathway: uniquely addressing national needs. Acad Med. 2009;84(6):695. [CrossRef] [PubMed]
Orenstein R. ENGAGE initiative: showcasing osteopathic scholarly activity [editorial]. J Am Osteopath Assoc. 2016;116(5):276-277.
Frost R. The road not taken. Mountain Interval. Verses 18-20.