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Center for the Future of the Health Professions June 2022 digest

This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2022. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce to effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion around the past, present, and future of osteopathic manipulative medicine. This update is presented by Karen Snider, DO, FAAO, FNAOME, professor and assistant dean for osteopathic principles & practice integration, neuromusculoskeletal medicine/osteopathic manipulative medicine at A.T. Still University’s Kirksville College of Osteopathic Medicine (ATSU-KCOM). Osteopathic manipulative medicine (OMM) is a systematic approach to patient care that acknowledges the body’s ability to heal itself and optimizes the health of the patient’s body, mind, and spirit. We look forward to your comments.

Randy Danielsen, PhD, PA-C Emeritus, DFAAPA

Professor & Director

The Center for the Future of the Health Professions

A.T. Still University

Osteopathic Manipulative Medicine: Past, Present, and Future

Past

Osteopathic medicine, developed by Dr. Andrew Taylor Still, is a systematic approach to patient care that acknowledges the body’s ability to heal itself and optimizes the health of the patient’s body, mind, and spirit.1,2 Hands-on diagnosis and manual treatment, known as osteopathic manipulative medicine (OMM), are used to address development and progression of disease. OMM has always been a component of holistic patient management in the osteopathic educational curriculum.

Although all osteopathic physicians initially used OMM in patient care, its use has since declined. Reasons for this decline are multifactorial and include clinical time constraints, lack of skill mastery, and difficulties with reimbursement.3 Some suggest osteopathic medicine may now be considered indistinct from allopathic medicine.3 In the U.S., OMM is provided by a minority of osteopathic physicians.3-5 Internationally, the use of OMM is expanding, but is primarily provided by non-physician osteopaths and other manual medicine practitioners.6-8

OMM is beneficial for patients with various clinical problems, and our understanding of underlying physiological mechanisms of OMM is evolving.7,9,10 Like all procedural-based studies, OMM studies are criticized for having fewer participants than pharmacological studies, but meta-analysis can combine results from smaller studies for greater statistical power. Unfortunately, OMM studies will never meet “gold standard” double blinding of both patients and clinicians.

Present

Although clinical use has declined, OMM is still taught at every college of osteopathic medicine (COM), and research suggests hands-on learning of OMM influences empathy of students.11-13 Osteopathic medical students receive a well-rounded education in OMM during their first and second years, guided by the core OMM curriculum of the Education Council on Osteopathic Principles.14 Recommended as the minimum foundation for OMM, this curriculum is reflected on all National Board of Osteopathic Medical Examiners Comprehensive Osteopathic Medical Licensing Examination of the United States exams.15

The Commission on Osteopathic College Accreditation standards also require OMM training,16 but ensuring clinical training and mentorship of OMM during third-year and fourth-year clerkships are challenging.17,18 A.T. Still University’s Kirksville College of Osteopathic Medicine (ATSU-KCOM) addresses this challenge with the Advanced Osteopathic Principles and Practice (OPP) curriculum, now used at 15 COMs. This curriculum teaches students to integrate OMM for comprehensive management of 38 common clinical conditions.19

ATSU-KCOM also supports OPP integration in residency training through the National Center for Osteopathic Principles and Practice Education (NCOPPE),20 which provides scholarly activity support and education through live and on-demand video lectures and workshops. Currently, NCOPPE provides education in 31 residency programs, including surgery, family medicine, and internal medicine (IM).

Future

The future of OMM embodies hope and caution. The Accreditation Council for Graduate Medical Education (ACGME) Osteopathic Recognition program accredits residency programs integrating OPP.21 These programs are reviewed annually to ensure meaningful OPP integration. Thus, osteopathic and allopathic physicians who want to integrate OMM into patient care are mentored and trained during residency.

Although ACGME accepts American Osteopathic Association board certification for IM program directors,22 in 2024, residents under such directors will be ineligible to certify through the American Board of Internal Medicine (ABIM).23 Currently, ABIM is the only specialty board that excludes residents trained under osteopathically boarded physicians from eligibility. In future, IM physicians may avoid osteopathic board certification, reducing IM residency programs providing OPP training. Overcoming this barrier will require ABIM to grant eligibility to all residents completing ACGME-accredited IM residencies.

Ultimately, the future of OMM in the United States rests with those using it to care for patients. Although challenges to mentorship and training persist, they can be overcome by confronting professional biases and ensuring everyone has access to education and hands-on training. ATSU will continue to help the osteopathic profession meet these challenges with quality resources for OMM mentorship and training.

References

1. Seffinger MA, ed. Foundations of Osteopathic Medicine: Philosophy, Science, Clinical Applications, and Research. 4th ed. Wolters Kluwer; 2018.

2. Haxton J. Andrew Taylor Still: Father of Osteopathic Medicine. Truman State University Press; 2016.

3. Healy CJ, Brockway MD, Wilde BB. Osteopathic manipulative treatment (OMT) use among osteopathic physicians in the United States. J Osteopath Med. 2021;121(1):57-62. doi:

10.1515/jom-2020-0013

4. Johnson SM, Kurtz ME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession. Acad Med. 2001;76(8):821-828.

doi:10.1097/00001888-200108000-00016

5. Spaeth DG, Pheley AM. Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties. J Am Osteopath Assoc. 2003;103(1):16-26.

6. Ellwood J, Carnes D. An international profile of the practice of osteopaths: a systematic review of surveys. Int J Osteopath Med. 2021;40:14-21. doi:10.1016/j.ijosm.2021.03.007

7. Osteopathic medicine and osteopathy: defining the profession. Osteopathic International Alliance. Accessed April 6, 2022. https://oialliance.org/about-us/osteopathic-medicine-and-osteopathy/.

8. The OIA global report: global review of osteopathic medicine and osteopathy 2020. Osteopathic International Alliance. Accessed April 6, 2022.

9. Nelson KE, Glonek T, eds. Somatic Dysfunction in Osteopathic Family Medicine. 2nd ed. Wolter Kluwer Health; 2015.

10. Hruby RJ, Tozzi P, Lunghi C, Fusco G, eds. The Five Osteopathic Models: Rationale, Application, Integration—From an Evidence-Based to a Person-Centered Osteopathy. Handspring Publishing; 2017.

11. Licciardone JC, Schmitt ME, Aryal S. Empathy in medicine osteopathic and allopathic physician interpersonal manner, empathy, and communication style and clinical status of their patients: a pain registry-based study. J Am Osteopath Assoc. 2019;119(8):499-510. doi:10.7556/jaoa.2019.092

12. Rizkalla MN, Henderson KK. Empathy and osteopathic manipulative medicine: is it all in the hands? J Am Osteopath Assoc. 2018;118(9):573-585. doi:10.7556/jaoa.2018.131

13. Kimmelman M, Giacobbe J, Faden J, Kumar G, Pinckney CC, Steer R. Empathy in osteopathic medical students: a cross-sectional analysis. J Am Osteopath Assoc. 2012;112(6):347-355.

14. Hensel K, Cymet T. A Teaching Guide for Osteopathic Manipulative Medicine. 2nd ed. American Association of Colleges of Osteopathic Medicine; 2018.

15. COMLEX-USA master blueprint: osteopathic principles, practice, and manipulative treatment. National Board of Osteopathic Medical Examiners. Accessed April 6, 2022.

https://www.nbome.org/assessments/comlex-usa/master-blueprint/competency-domains/principle s/.

16. Accreditation of colleges of osteopathic medicine: COM continuing education standards. Commission on Osteopathic College Accreditation. Updated July 1, 2019. Accessed April 6, 2022.

https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf.

17. Shubrook JH Jr, Dooley J. Effects of a structured curriculum in osteopathic manipulative treatment

(OMT) on osteopathic structural examinations and use of OMT for hospitalized patients. J Am Osteopath Assoc. 2000;100(9):554-558.

18. Teng AY, Terry RR, Blue RJ. Incorporating a mandatory osteopathic manipulative medicine (OMM) curriculum in clinical clerkships: impact on student attitudes toward using OMM. J Am Osteopath Assoc. 2011;111(4):219-224.

19. A.T. Still University (ATSU) catalog: 2021-22 university catalog. A.T. Still University. Accessed April 6, 2022. https://catalog.atsu.edu/mime/media/16/286/2021-22+University+Catalog.pdf.

20. National Center for Osteopathic Principles and Practice Education. A.T. Still University. Accessed April 6, 2022. https://www.atsu.edu/ncoppe/.

21. Osteopathic recognition requirements. Accreditation Council for Graduate Medical Education. Updated July 1, 2021. Accessed April 6, 2022.

https://www.acgme.org/globalassets/pfassets/programrequirements/801_osteopathicrecognition_2 021v2.pdf.

22. ACGME program requirements for graduate medical education in internal medicine. Accreditation Council for Graduate Medical Education. Updated February 7, 2021. Accessed April 6, 2022. https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/140_InternalMedicine_2022_ TCC.pdf?ver=2021-02-19-152901-957&ver=2021-02-19-152901-957.

23. AOA staff. Announcement regarding ABIM program director policy. American Osteopathic Association. Published February 9, 2022. Accessed April 6, 2022.

https://osteopathic.org/2022/02/09/announcement-regarding-abim-program-director-policy/#:~:tex t=ABIM%20will%20continue%20to%20accept,by%20ABIM%20in%20their%20discipline.

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