Open Access
Medical Education  |   January 2021
Impact of an osteopathic presence in a large categorical pediatric residency training program
Author Affiliations & Notes
  • Elizabeth W. Barnhardt, DO
    Nationwide Children’s Hospital, Columbus, OH, USA
  • Frances Comer, DO
    Nationwide Children’s Hospital, Columbus, OH, USA
  • Elizabeth Zmuda, DO
    Nationwide Children’s Hospital, Columbus, OH, USA
  • Alexander Rakowsky, MD
    Nationwide Children’s Hospital, Columbus, OH, USA
Article Information
Medical Education / Osteopathic Manipulative Treatment / Pediatrics / Graduate Medical Education
Medical Education   |   January 2021
Impact of an osteopathic presence in a large categorical pediatric residency training program
The Journal of the American Osteopathic Association, January 2021, Vol. 121, 35-42. doi:https://doi.org/10.1515/jom-2019-0317
The Journal of the American Osteopathic Association, January 2021, Vol. 121, 35-42. doi:https://doi.org/10.1515/jom-2019-0317
Abstract

Context: Nationwide Children’s Hospital (NCH) has a large pediatric residency program with 43 residents in the categorical pediatric program and 10 residents in the Internal Medicine-Pediatrics (IM-Peds) program per class. Of the 43 categorical pediatric residents, four are in the osteopathic recognition track (ORT) and continue their osteopathic education throughout residency. There is currently a lack of data examining the effect of an ORT, and specifically a pediatric ORT, on a residency program.

Objective: To evaluate the impact of an ORT osteopathic recognition track on an overall residency program’s perceptions of osteopathic manipulative treatment (OMT) and to evaluate allopathic (MD) resident perception of osteopathic educational sessions.

Methods: An anonymous survey was conducted in June 2017 and distributed to 141 residents (both categorical and IM-Peds) to gather baseline information regarding perceptions and knowledge of OMT. Based on the initial results, a four-part case-based educational series was implemented during the 2018–2019 academic year to teach osteopathic principles to MD residents. A second survey was distributed following each session.

Results: For the initial survey, 59 (41.8%) residents responded. Survey results demonstrated that resident perceptions of OMT as an efficacious treatment option increased after starting their residency at NCH (p=0.04), and 25 of 43 (58.1%) MD residents stated an interest in learning OMT skills. A total of 140 attendees were present at the four educational sessions. One hundred and thirty-eight residents (98.5%) found the educational sessions beneficial and 132 (94.2%) stated they would refer a patient for OMT.

Conclusion: ORT residents make a significant impact on their colleagues’ perceptions and knowledge of OMT. This study suggests that further efforts to highlight the clinical applications of OMT in pediatric patients would be welcomed by residents.

The Accreditation Council for Graduate Medical Education (ACGME) has listed multiple benefits of a single accreditation process, such as providing education in osteopathic principles and practices to all osteopathic (DO) and allopathic (MD) medical school graduates and preserving and protecting osteopathic medical education. 1 Many DOs have a strong desire to maintain their uniquely osteopathic skills, and the designation of osteopathic recognition track (ORT) residency programs assists with this endeavor. 2 To date, 232 residency programs, including historically osteopathic programs and historically nonosteopathic programs, have been granted ACGME approval of an ORT. 3 Currently, there are two ACGME-approved pediatric ORT residency programs, which include the ORT program at Nationwide Children’s Hospital (NCH). 4  
NCH is a large, free-standing tertiary care center with more than 1.4 million patient encounters annually. The pediatric residency program at NCH typically has 53 residents per class, 10 of whom are in the Internal Medicine-Pediatrics (IM-peds) program. Four of the 53 residents are in the ORT. From 2008 to 2017, these four residents were in a stand-alone American Osteopathic Association (AOA)/ACGME-accredited program; in 2017, it was converted to the first ACGME-approved pediatric ORT. 5 Under this designation, the overall structure of osteopathic training remained similar. The ORT residents continued to complete all ACGME-required rotations and participate in residency-wide didactic sessions, such as lectures, simulations, and educational retreats similar to the categorical and IM-Peds residents 6 except for approximately two unique rotations annually and several ORT-specific training components during each rotation. To provide a few examples of some of the curricular changes, residents in the ORT complete their adolescent medicine rotation in their intern year, whereas the categorical residents complete this rotation during their third year of training. Additionally, ORT residents participate in a rural medicine rotation and an osteopathic manipulative medicine rotation during their second year of residency. Aside from the four residents in the ORT, there are typically three to five additional DO graduates who follow the traditional curriculum of the categorical program. 
Previous studies 7, 8, 9 have attempted to assess the attitudes of allopathic residents about OMT. A 2005 study 7 assessed the attitudes about OMT of 232 MD residents in ACGME-accredited family medicine training programs; 207 (89.6%) indicated that they believed OMT was at least somewhat effective for the treatment of somatic dysfunction, but only 36 (15.5%) supported the effectiveness of OMT for treating patients with systemic illness. Of the 232 MD residents surveyed, most respondents were interested in learning to perform OMT themselves (47 [20.3%] very interested; 117 [50.6%] somewhat interested). Additionally, 99 (42.6%) MD respondents supported the incorporation of OMT training into the allopathic medical school curricula. 
Other training programs have previously cited increased interest in using OMT by MD trainees. In a survey study of 470 residents in Physical Medicine and Rehabilitation training programs, 8 363 (77.2%) believed that manual medicine should be a part of their residency programs and 386 (82.1%) wanted more training in manual medicine. A 2018 study 9 evaluated the attitudes of 327 residents and faculty from dually accredited or AOA-affiliated programs toward osteopathic-focused education during the transition period for the single accreditation system. 9 Of 211 residents, 110 (52.1%) of the total 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. The opportunity for MD residents to learn more about OMT also seemed to be an influencing factor in residency program choice. 
Our study aimed to evaluate the effect of a pediatric ORT on the perceptions and knowledge of OMT among their MD and non-ORT DO residents in a large categorical pediatric and IM-peds residency program at NCH. There is currently a lack of data examining the effect of an ORT, and specifically a pediatric ORT, on its overall residency program. We describe survey results from MD residents and an educational series developed from the survey results. 
Methods
This study included an initial survey and evaluations from each educational session, which were not deemed human subject research by the NCH institutional review board and did not require approval. 
Initial survey
An anonymous survey was created using Survey Monkey (SVMK, Inc.) and sent to all 141 residents at NCH (12 ORT residents, 40 IM-Peds, five categorical DO residents, and 84 MD categorical residents) in June 2017 with three reminder emails each sent two to three weeks apart. The survey was designed by associate residency program directors (A.R., E.Z.) who had completed a training course at either the Pediatric Academic Societies Annual Conference or the Association of Pediatric Program Directors Conference before developing the survey. The questions were not based upon previously published surveys and included both multiple choice and free-text responses. The full survey is included in Appendix 1. At the time of the initial survey, the dually-accredited program was transitioning into the ORT. The survey included separate sections for MD residents (Section 2), DO residents in the ORT (Section 3), and DO residents in the categorical training program (Section 4). The MD residents were asked 11 questions (two preliminary questions and nine questions in Section 2 of Appendix 1) that were primarily focused on resident perceptions of OMT before coming to NCH and at the time of the survey. These items queried overall knowledge, thoughts about the efficacy of OMT, OMT referral patterns, and interest in learning more about OMT. Of the 11 questions, 10 were multiple choice, and one was free text. The non-ORT DO residents were asked eight questions (two preliminary questions and six questions in Section 3 of Appendix 1) about the importance of continuing their osteopathic education during residency and how the presence of a dually-accredited program/ORT affected their desire to learn and use OMT. Seven of the eight questions were multiple choice format, and one question allowed free text. The residents in the dually-accredited program/ORT were asked nine questions (one preliminary question and eight questions in Section 4 of Appendix 1) regarding their perceptions of the program’s support of their osteopathic skill development and whether they had adequate opportunity to educate their MD and non-dual DO peers on the value of osteopathic medicine. Two of the questions were free text format, and seven questions gave multiple choice answers. The survey was completed in June 2017 to ensure that all residents had at least a minimum of one academic year with their dually-accredited/ORT colleagues. 
Educational sessions
Since the survey demonstrated a general desire from the MD residents to learn more about OMT, several ORT residents, in conjunction with the ORT associate program directors, developed four educational sessions held during the 2018 to 2019 academic year. These sessions were incorporated into the standing noon report (clinical case discussion) series and conducted by ORT residents in their third year of training. They incorporated OMT into the diagnosis and treatment plan for each case and occasionally provided a live demonstration of osteopathic techniques. The tenets of osteopathic medicine provided a framework for the instruction of MD and non-ORT DO residents. 10 The cases addressed common pediatric problems such as constipation, torticollis and plagiocephaly, mechanical low back pain, and musculoskeletal chest pain that may benefit from the addition of OMT to traditional medical management. Each case also included a review of the basic tenets of osteopathic medicine and the referral process to our OMT clinic. This information was incorporated into a template presentation that could be used for future lectures by ORT residents. An anonymous, 10-question paper survey was distributed after each session. These surveys were developed by an ORT resident leading the initiative (E.B.) and included nine multiple choice questions and one question allowing for a free text response (Appendix 2). The questions were similar to those on the initial survey, concerning referrals to osteopathic-specific care and their impressions of these osteopathic-focused lectures. Residents, medical students, and faculty attended the noon report; thus, surveys were obtained from all three groups and all data was included in the results. There was no formal count made of residents, students, and faculty in attendance at each session, nor was there record of those present for multiple sessions. The researchers did not provide a survey to ORT residents, as they were excluded from completing it. 
Results
Initial survey results
A total of 59 of 141 (41.8%) residents responded to the initial survey. Of these, 44 (74.5%) were MD residents, 10 (16.9%) were DO residents in the dually accredited program, and 5 (8.5%) were DO residents in the categorical program. A total of 44 of 124 (35.4%) MD residents completed the survey. The survey was completed by five (100%) of the DO residents in the categorical program and 10 (80%) of the residents in the dually accredited program. Results for the 44 MD residents who completed the survey are included in Tables 1 and 2. 
Table 1:
Assessing MD residents’ understanding of OMT (n=44).a,b
Response optionsc Before residency Currently
Strong/OK understanding 10 16
Not familiar/never heard of 33 27
aUnderstanding of OMT was assessed by the question, “What was your level of understanding about OMM or other unique aspects of osteopathic care?” bp=0.16. cOf the four options, “Strong” and “OK understanding” were combined as one response, and “Not familiar” and “Never heard of” were combined as the second. MD, allopathic physician; OMT, osteopathic manipulative treatment.
Table 1:
Assessing MD residents’ understanding of OMT (n=44).a,b
Response optionsc Before residency Currently
Strong/OK understanding 10 16
Not familiar/never heard of 33 27
aUnderstanding of OMT was assessed by the question, “What was your level of understanding about OMM or other unique aspects of osteopathic care?” bp=0.16. cOf the four options, “Strong” and “OK understanding” were combined as one response, and “Not familiar” and “Never heard of” were combined as the second. MD, allopathic physician; OMT, osteopathic manipulative treatment.
×
Table 2:
Assessing MD residents’ thoughts about the efficacy of OMT (n=44).a,b
Response optionsc Before residency Currently
Definitely/possibly works 24 33
No role/never thought of it 19 10
aThoughts on OMM Efficacy was assessed by the question, “Overall thoughts about the efficacy of OMM?” bp=0.04. cOf the four response options, “Definitely works” and “Possibly works” were combined as one response, and “Never thought of it” and “No role for OMM” were combined as the second response. MD, allopathic physician; OMM, osteopathic manipulative medicine.
Table 2:
Assessing MD residents’ thoughts about the efficacy of OMT (n=44).a,b
Response optionsc Before residency Currently
Definitely/possibly works 24 33
No role/never thought of it 19 10
aThoughts on OMM Efficacy was assessed by the question, “Overall thoughts about the efficacy of OMM?” bp=0.04. cOf the four response options, “Definitely works” and “Possibly works” were combined as one response, and “Never thought of it” and “No role for OMM” were combined as the second response. MD, allopathic physician; OMM, osteopathic manipulative medicine.
×
Of the 44 MD residents, 29 (65.9%) provided free-text responses, and 15 (34.1%) opted not to respond when asked, “Since being at NCH, what are your thoughts about OMT and osteopathic care?” Each of the 29 residents who responded stated that they would refer a future patient for OMT/osteopathic-specific care. The most common conditions for which they would refer included musculoskeletal system (MSK)-related issues (18 residents; 62.1%), headaches (three residents; 10.3%), and plagiocephaly (one resident; 3.4%). Several respondents mentioned OMT’s use in patients with chronic pain. Twenty-five of 43 MD residents (58.1%) stated that they would be interested in learning some basic OMT skills. Finally, one of the MD residents commented that being a resident at NCH “significantly changed my perception of DO physicians in general-I see them as similar to myself except with more skills than an MD has.” 
Educational sessions
Four noon conference sessions were held with a combined total of 140 attendees. Because of the nature of our scheduling, a given resident would most likely attend only one or two of these sessions. Regarding the attendees, 76 (54.2%) were medical students (the actual breakdown of MD or DO student was not asked, but, in general, NCH has a mix of two-thirds MD students and one-third DO students at lectures); 48 (34.2%) were MD residents in our program; 10 (7.1%) were non-ORT DO residents in our program; three (2.1%) were MD faculty members, and 3 (2.1%) were unknown. The overall responses were similar from session to session, so the data from all four sessions are presented in aggregate. When asked if they found the educational session beneficial, 138 (98.5%) replied, “yes.” When asked if they would refer a patient for OMT, 132 (94.2%) replied, “yes.” When asked about their prior knowledge and comfort with the potential use of OMT for the case presented, the results were: one (0.7%) “no knowledge,” 97 (69.3%) “some but not familiar with details,” 28 (20%) “OK knowledge,” and 14 (10%) with “strong knowledge.” After attending the session, the results were: zero (0%) “no knowledge,” 52 (37.1%) “some but still not familiar with details,” 75 (53.6%) “OK knowledge,” and 13 (9.3%) with “strong knowledge.” Table 3 demonstrates the pre- and postsession knowledge base of participants. 
Table 3:
Knowledge level before and after one of the four educational sessions (n=44).
Response options Presession Postsession
No knowledge/not familiar 98 52
OK/strong knowledge 42 88
aOf these four response options, “No knowledge/not familiar” were combined as one response, and “Ok/strong knowledge” were combined as the second response. bp<0.00001.
Table 3:
Knowledge level before and after one of the four educational sessions (n=44).
Response options Presession Postsession
No knowledge/not familiar 98 52
OK/strong knowledge 42 88
aOf these four response options, “No knowledge/not familiar” were combined as one response, and “Ok/strong knowledge” were combined as the second response. bp<0.00001.
×
Discussion
Although the ORT is a small part of our overall pediatric training program, it seems to have had a significant impact on MD residents’ understanding of OMT and their belief that OMT is an efficacious treatment strategy. Additionally, a significant percentage of MD residents showed a desire to learn more about OMT and were receptive to initial demonstrations of OMT during the educational sessions. This finding is consistent with previous literature regarding MD resident and faculty attitudes toward osteopathic-specific care. 
As far as any of the authors are aware, these four educational sessions were the first osteopathically-focused didactic series presented to the entire residency program in program history. Informal, single-session presentations had been completed previously about 10 years prior as part of the resident noon conference series. About five years prior to the series presented in this article, a grand rounds presentation was given at Nationwide Children’s Hospital on osteopathic manipulative medicine. Since the initial survey occurred before the educational series, having the ORT residents embedded into the larger programs allows for the inherent sharing of their knowledge and expertise. The ORT residents are strongly encouraged to do OMT in both clinic and inpatient settings, so other residents potentially had prior exposure. 
There are several limitations to this study. First, the initial survey response rate was low overall (41.8%) among all residents and particularly low (35.4%) amongst MD residents, which may have introduced bias toward residents who were already more knowledgeable about or interested in OMT. Although the results from the educational session evaluations showed that most of the attendees viewed OMT as a valid treatment option, those results may be biased if the MD residents and faculty members who completed the surveys had existing positive opinions regarding OMT. This bias may be limited, though, as noon conferences are required educational sessions for all available residents at NCH regardless of interest in OMT. Faculty attendance is optional, though encouraged, at noon conferences, and typically represents a variety of backgrounds. Resident attendance at educational sessions was limited by clinical rotation schedules, which did not allow for consistency regarding which residents were present for each session. Another variable, which was not formally assessed, is the impact of rotating students from Ohio University Heritage College of Osteopathic Medicine on the MD residents. However, one could argue that an osteopathic medical student’s utilization of OMT on their rotation would be under the direction of osteopathic residents and faculty and less likely to impact MD residents. Though it was not specifically studied, the presence of the ORT may make a substantial impact on medical student education. Lastly, the session evaluations were completed immediately after the presentations, so the long-term impact is unknown. 
Based on these results, our program is working on several initiatives to increase knowledge about OMT among our non-ORT residents. These initiatives include (1) having more OMT-focused case reports completed by our ORT residents, (2) developing short didactics about OMT basics that the ORT residents can share with their non-ORT colleagues, (3) developing a more formalized way to incorporate our non-ORT DOs interested in OMT into our ORT curriculum, and (4) most importantly, allowing our ORT residents to do more OMT in all clinical settings, since it has been theorized that this role-modeling is what has been most effective. We also need to assess how long the knowledge obtained by MD residents is retained after completion of the education sessions. 
Further studies should be designed to better delineate the educational session survey responses from osteopathic and allopathic medical students, residents, and faculty. This was a limitation of the current study and could be easily corrected in future studies. Separating those responses would provide more clarification about the true impact of these sessions. Other goals of future studies should be to assess the long-term retention of osteopathic knowledge by MD residents and to evaluate the long-term effect on MD referrals to an OMT provider based on their exposure to an ORT. Future projects may also look at the effect of an ORT on the education of MD and DO medical students. 
For our training program, a significant limitation in increasing the osteopathic presence in the hospital and residency program is the limited number of DO faculty members. Of the nearly 850 faculty physicians involved in teaching the pediatric residency, 6% are osteopathic physicians. 11 Even fewer faculty at Nationwide Children’s Hospital practice osteopathic treatment techniques in their clinical practice. At the time of this study, there was only one faculty member performing OMT in clinical practice. The limited number of osteopathic faculty restricts the osteopathically-focused clinical opportunities for ORT residents and for the entire program. If this number could be increased, it may allow MD residents opportunities for direct clinical exposure to OMT. As demonstrated in the 2019 Osteopathic Medical Profession Report from the American Osteopathic Association, 12 there continues to be drastic growth for the osteopathic profession, with DOs representing 11% of the American physician population. Ohio currently has the seventh highest number of practicing osteopathic physicians in the United States, with 5,695 DOs in practice, representing 5.4% of all osteopathic physicians in the US. 12 Our program hopes to capitalize on this growth and increase osteopathic presence in years to come. 
In the ORT program at NCH, we have experienced barriers to practicing OMT as described in previous literature, including time constraints on the part of both trainees and faculty members, lack of research demonstrating a clear benefit of OMT in a wide variety of clinical situations, and physician insecurity with OMT skills. 13 Despite these barriers, if other residency programs have osteopathic residents and faculty with enthusiasm for OMT, we feel that MDs would be willing and eager to learn about osteopathic medicine. 
Conclusion
Despite a relative lack of formal education about OMT for non-ORT residents, the presence of a small, passionate group of ORT residents has left an impact on their colleagues. This study shows preliminary data regarding efforts to highlight the clinical use of OMT in pediatric patients. Our small OMT educational series suggests that even brief exposure to osteopathic principles can enhance the knowledge of MD residents, medical students, and faculty. Although further research is needed to fully capture the benefit of educational sessions about OMT for MD colleagues, our approach may be adaptable for programs with or without similar osteopathic influences. 
  Research funding: None declared.
 
  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.
 
  Competing interests: Authors state no conflict of interest.
 
  Ethical approval: The Nationwide Children’s Hospital institutional review board deemed this study exempt.
 
References
Benefits of Single GME. Accreditation Council for Graduate Medical Education (ACGME). https://www.acgme.org/What-We-Do/Accreditation/Single-GME-Accreditation-System/Benefits-of-Single-GME. Accessed July 23, 2019.
American Association of Colleges of Osteopathic Medicine; “2017 Survey Results: Appeal of GME with Osteopathic Recognition Among Third-Year Osteopathic Medical Students”; https://www.aacom.org/news-and-events/news-detail/2017/02/09/2017-osteopathic-recognition-survey-results. Published September 2017. Accessed 23 June, 2020.
List of Programs Applying for and with Osteopathic Recognition. Accreditation Council for Graduate Medical Education (ACGME). https://apps.acgme.org/ads/Public/Reports/Report/17. Accessed July 23, 2019.
Association of American Medical Colleges ERAS website. List of ACGME Pediatrics programs https://services.aamc.org/eras/erasstats/par/display.cfm?NAV_ROW=PAR&SPEC_CD=320. Published in 2018. Accessed 23 June, 2020.
Rakowsky, A, Mahan, J, Donthi, R, Backes, C. The Doctors Hospital and Nationwide Children’s Hospital dually accredited pediatric residency program: a potential best model for pediatric osteopathic GME training. Journal of the American Osteopathic Association. 2015; 115(6):390-393.
Rakowsky, A, Backes, C, Mahan, J, Wolf, K, Zmuda, E. The Development of a Pediatric Osteopathic Recognition Track. Academic Pediatrics. 2019; 19:717–721.
Allee, B, Pollak, M, Malnar, K. Survey of Osteopathic and Allopathic Residents’ Attitudes Toward Osteopathic Manipulative Treatment. The Journal of the American Osteopathic Association. 2005; 105:551-561.
Athcison, J, Newman, R, Klim, G. Interest in Manual Medicine Among Residents in Physical Medicine and Rehabilitation. The Need for Increased Instruction. Am J Phys Med Rehabil. Nov-Dec 1995;74(6):439-43.
Hempstead, L, Rosemergey, B, Foote, S, Swade, K, Williams, K. Resident and Faculty Attitudes Toward Osteopathic-Focused Education. The Journal of the American Osteopathic Association. 2018; 118:253-263. https://doi.org/10.7556/jaoa.2018.050
Find a Doctor. https://www.nationwidechildrens.org/find-a-doctor. Accessed 18 November, 2020.
2019 Osteopathic Medical Profession Report. https://osteopathic.org/about/aoa-statistics/. Published February 2020. Accessed 30 June, 2020.
Roberge, R, Roberge, M. Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department. West J Emerg Med. 2009;10(30):184-189.
Appendix 1
Survey for Primary Study Results
Editorial Note: This survey is printed exactly as sent to recipients, without editing for style, format, or content. Only a list of Abbreviations was added.
  1. Are you a Dual Program Resident? 
    • Yes (only do Section 4 of this survey)
    • No (go on to next question)
  2. Are you trained as a D.O. (but not in dual program) or M.D.? 
    • D.O. (only do Section 3 of this survey)
    • M.D. (only do Section 2 of this survey)
Section 2
  • (3) BEFORE coming to NCH how often did you work with D.O. students or graduates? 
    • Worked with them often
    • Occasional rotations with them
    • Little exposure
    • No contact
  • (4) BEFORE coming to NCH what was your level of understanding about Osteopathic Manipulative Medicine (OMM) or other unique aspects of osteopathic care? 
    • Strong Understanding
    • OK Understanding
    • Not familiar with details but had heard of OMM/Osteopathic specific medicine
    • Never heard of OMM/Osteopathic specific medicine
  • (5) Overall thoughts about the efficacy of OMM BEFORE coming to NCH 
    • Definitely works for certain conditions
    • Possibly works but wasn’t sure
    • Never thought about this
    • Thought there was no role for OMM
  • (6) CURRENTLY, what is your level of understanding about OMM or other unique aspects of osteopathic care? 
    • Strong Understanding
    • OK understanding
    • Not familiar with details but some understanding
    • Still have never heard of it
  • (7) CURRENTLY, what are your overall thoughts about the efficacy of OMM? 
    • Definitely works for certain conditions
    • Possibly works but not sure
    • Still have not really thought about this
    • Think that there is no role for OMM
  • (8) Since being at NCH what are your thoughts about OMM and osteopathic care? Have they changed over the last year(s)? 
    • Respondents able to provide free text response
  • (9) Do you have any interest at this time to learn some OMM skills? 
    • Yes
    • No
  • (10) Would you refer a future patient to a D.O. colleague for OMM or other osteopathic specific care? 
    • Yes
    • No
  • (11) If you WOULD refer, what conditions would you consider sending to a D.O. colleague? 
    • Respondents able to provide free text response
Section 3
  • (12) Were you interested in continuing your OMM training during residency? 
    • Yes, definitely important to me
    • Yes, but not a top priority when ranking residency programs
    • Ambivalent
    • Not an issue at all for me
  • (13) Since being at NCH has your interest in maintaining your OMM training/skills increased/decreased/stayed the same? 
    • Increased
    • Decreased
    • The same as before
  • (14) Please comment about your response to Question #13 above 
    • Respondents able to provide free text response
  • (15) Do you have any plans to use OMM in your future practice? 
    • Yes
    • No
    • Not sure
  • (16) Would you be interested in taking an OMM refresher course (3–4 day course)? 
    • Yes
    • No
    • Not sure
  • (17) Any comments regarding your responses to Questions #15 and #16 above 
    • Respondents able to provide free text responses
Section 4
  • (18) Do you feel that NCH has been supportive of your ability to learn and do OMM? 
    • Yes
    • No
    • Not sure
  • (19) Do you feel that your OMM work is accepted by colleagues outside the Dual program? 
    • Yes
    • No
    • Not sure
  • (20) Comments about your responses to the two questions above 
    • Respondents able to provide free text responses
  • (21) Do you feel that you have made an impact in helping your colleagues outside the dual program learn more about OMM and the other unique skills that D.O.s possess? 
    • Yes
    • No
    • Not sure
  • (22) Comments about your response to question #21 
    • Respondents able to provide free text responses
  • (23) Would you have preferred to train at an institution that had nearly all D.O. graduates in its pediatric residency program(s)? 
    • Yes
    • No
    • Not sure
  • (24) Comments about your reply to question #23 
    • Respondents able to provide free text responses
  • (25)
    Final thoughts about how the dual program and the categorical program intertwined? Were you pleased with this close relationship or not?
Abbreviations: DO, osteopathic physician; MD, allopathic physician; NCH, Nationwide Children’s Hospital. 
Survey used for Educational Sessions
Editorial Note: This survey is printed exactly as sent to recipients, without editing for style, format, or content. Only a list of Abbreviations was added.
 
M.D. D.O. (not in ORT) Medical student Attending
M.D. D.O. (not in ORT) Medical student Attending
×
  • Identify yourself (please circle one):
  • BEFORE coming to NCH how often did you work with D.O. students or graduates? 
    • Worked with them often
    • Occasionally worked with them
    • Little exposure
    • No contact
  • BEFORE coming to NCH what was your level of understanding about Osteopathic Manipulative Medicine (OMM) or other unique aspects of osteopathic care? 
    • Strong Understanding
    • OK Understanding
    • Not familiar with details but had heard of OMM/osteopathic-specific medicine
    • Never heard of OMM/Osteopathic-specific medicine
  • What were your overall thoughts about the efficacy of OMM BEFORE coming to NCH? 
    • Definitely works for certain conditions
    • Possibly works but wasn’t sure
    • Never thought about this
    • Thought there was no role for OMM
  • CURRENTLY, what is your level of understanding about Osteopathic Manipulative Medicine (OMM) or other unique aspects of osteopathic care? 
    • Strong Understanding
    • OK Understanding
    • Not familiar with details but have heard of OMM/osteopathic-specific medicine
    • Never heard of OMM/Osteopathic-specific medicine
  • CURRENTLY, what are your overall thoughts about the efficacy of OMM? 
    • Definitely works for certain conditions
    • Possibly works but not sure
    • Still have never thought about this
    • Think that there was no role for OMM
  • Would you refer a patient to a D.O. colleague for OMM or osteopathic-specific care? 
    • Yes
    • No
  • How likely are you to apply the information you learned today? 
    • Very likely
    • Likely
    • Neither likely or likely
    • I would think about using, but I probably would not
    • Never
  • Do you feel like this lecture was beneficial for your overall medical knowledge? 
    • Yes
    • No
Free text: 
Do you have anything you would like to share with us about this case? 
Abbreviations: DO, osteopathic physician; MD, allopathic physician; NCH, Nationwide Children’s Hospital; ORT, osteopathic recognition track. 
Table 1:
Assessing MD residents’ understanding of OMT (n=44).a,b
Response optionsc Before residency Currently
Strong/OK understanding 10 16
Not familiar/never heard of 33 27
aUnderstanding of OMT was assessed by the question, “What was your level of understanding about OMM or other unique aspects of osteopathic care?” bp=0.16. cOf the four options, “Strong” and “OK understanding” were combined as one response, and “Not familiar” and “Never heard of” were combined as the second. MD, allopathic physician; OMT, osteopathic manipulative treatment.
Table 1:
Assessing MD residents’ understanding of OMT (n=44).a,b
Response optionsc Before residency Currently
Strong/OK understanding 10 16
Not familiar/never heard of 33 27
aUnderstanding of OMT was assessed by the question, “What was your level of understanding about OMM or other unique aspects of osteopathic care?” bp=0.16. cOf the four options, “Strong” and “OK understanding” were combined as one response, and “Not familiar” and “Never heard of” were combined as the second. MD, allopathic physician; OMT, osteopathic manipulative treatment.
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Table 2:
Assessing MD residents’ thoughts about the efficacy of OMT (n=44).a,b
Response optionsc Before residency Currently
Definitely/possibly works 24 33
No role/never thought of it 19 10
aThoughts on OMM Efficacy was assessed by the question, “Overall thoughts about the efficacy of OMM?” bp=0.04. cOf the four response options, “Definitely works” and “Possibly works” were combined as one response, and “Never thought of it” and “No role for OMM” were combined as the second response. MD, allopathic physician; OMM, osteopathic manipulative medicine.
Table 2:
Assessing MD residents’ thoughts about the efficacy of OMT (n=44).a,b
Response optionsc Before residency Currently
Definitely/possibly works 24 33
No role/never thought of it 19 10
aThoughts on OMM Efficacy was assessed by the question, “Overall thoughts about the efficacy of OMM?” bp=0.04. cOf the four response options, “Definitely works” and “Possibly works” were combined as one response, and “Never thought of it” and “No role for OMM” were combined as the second response. MD, allopathic physician; OMM, osteopathic manipulative medicine.
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Table 3:
Knowledge level before and after one of the four educational sessions (n=44).
Response options Presession Postsession
No knowledge/not familiar 98 52
OK/strong knowledge 42 88
aOf these four response options, “No knowledge/not familiar” were combined as one response, and “Ok/strong knowledge” were combined as the second response. bp<0.00001.
Table 3:
Knowledge level before and after one of the four educational sessions (n=44).
Response options Presession Postsession
No knowledge/not familiar 98 52
OK/strong knowledge 42 88
aOf these four response options, “No knowledge/not familiar” were combined as one response, and “Ok/strong knowledge” were combined as the second response. bp<0.00001.
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