Increasing osteopathic manipulative treatment skills and confidence through mastery learning.

Several recent studies document the declining use of osteopathic manipulative treatment (OMT) in clinical practice. In this article, the authors contend that developing new teaching materials based on the mastery learning approach can augment time-tested methods of teaching OMT and help to stop or reverse this decline. The Spencer technique for shoulder manipulation is used to demonstrate the development and evaluation of OMT mastery learning materials. These materials could be developed as part of a progressive teaching sequence requiring increasing diagnostic acumen, palpatory skill, and therapeutic subtlety. Such a program could be used throughout osteopathic medical training and for continuing medical education to increase skills and confidence in the use of OMT.

Interexaminer agreement on palpatory diagnosis and patient self-assessment of disability: a pilot study.

To evaluate interexaminer agreement on palpatory diagnostic findings, we compared interexaminer results, patient disability self-evaluations, and assessment of patients' progress by referring physicians. Three examiners (two clinicians and a third-year osteopathic medical student fellow) monitored patients' progress using negotiated examination procedures. The patients were examined independently by each examiner at each of eight weekly visits. Patients completed a disability assessment form at each visit, and the referring physicians recorded changes in their patients' condition. The patients' disability self-rating and examiner test results did not show clear correlation. There was a 62.2% agreement between the two physician examiners when the general descriptors "improvement," "no change," or "aggravation" were used. The student examiner's agreement with the clinician examiners was 60.2% and 51.8%. Interexaminer agreement of findings from osteopathic testing procedures appears to depend on general clinical experience and specific experience with the testing procedures.

The evolution of osteopathic manipulative technique: the Spencer technique.

The Spencer technique is a standardized series of shoulder treatments with broad application in diagnosis, treatment, and prognosis. The evolution of this technique is traced from 1916 to date to try to identify factors in the development of manipulative methods. Few suggestions about the basic steps to be followed in developing any new manipulative technique were seen. Of chief importance were changes in sequence, the addition of steps, and the combination of one technique with another, as in the addition of muscle-energy methods to each step. One change, accidentally introduced in the 1970s, displaced a critical step in the procedure. The principal element guiding the development of the Spencer technique appears to be clinical necessity interpreted in terms of anatomy and pathology.

Laterally transposed pelvis: a new and proper name for an old problem.

There is need for specific terminology for osteopathic findings, including the findings in postural examination. A static test for laterally transposed pelvis is sometimes critical to the establishment of a diagnosis of postural imbalance, particularly in the minor forms of this important clinical entity. There is need for a word or phrase that identifies this clinical finding and nothing else. The phrase laterally transposed pelvis is nominated to indicate a specific finding in the static evaluation of pelvic position in the frontal (coronal) plane in relation to the vertical extension of the midheel line (sagittal plane). The definition of laterally transposed pelvis is: With the patient standing, knees fully extended bilaterally and the feet together on a flat horizontal surface, the median (midsagittal) plane of the pelvis is observed to lie laterally to the vertically extended midheel line (median/midsagittal plane).