Physician-Mentored Patient Rounds to Observe and Assess Entrustable Professional Activities 1 and 2 in Preclinical Medical Students.

CONTEXT: Thirteen entrustable professional activities (EPAs) for entering residency were created to aid medical educators as they prepare preclinical students for their residency and to assess student readiness for residency. The A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM) developed a program called physician-mentored patient rounds (PMPR), which focuses on EPA 1 and EPA 2. OBJECTIVE: To determine whether PMPRs could be used to assess expected behaviors of EPA 1 (gather a history and perform a physical examination) and EPA 2 (prioritize a differential diagnosis after a clinical encounter). METHODS: The PMPR sessions at ATSU-KCOM take place over several weeks (30-minute sessions per week), during which students gather a patient's history (sessions 1 and 2), observe a physical examination by the physician mentor (session 2), analyze diagnostic test results (session 3), and formulate a treatment plan (session 4). The PMPRs in this study used a real patient with confirmed chronic obstructive pulmonary disease (COPD). This study did not include the session-4 treatment plan. Between sessions, students completed an assignment to further demonstrate their behaviors as expected in the EPAs. Student responses were analyzed and summarized for physician feedback in the subsequent PMPR session. Students' diagnostic accuracy was measured at the conclusion of each session. RESULTS: A total of 516 students were included in the study. The PMPR weekly attendance was high (453-475). Although history gathering in the large-group setting was disorderly, diagnostic accuracy over the 3-session period improved. After history taking, 411 students (86.5%) included COPD in the differential diagnosis. A smaller number, 235 students (49.5%), listed COPD as the most likely diagnosis. After the physical examination, 439 included COPD in the differential diagnosis, and 385 listed COPD as the most likely diagnosis. After analysis of diagnostic test results, 468 students listed COPD as the most likely diagnosis. CONCLUSION: Physician-mentored patient rounds seem to be an effective means to assess preclinical students' expected behaviors as described in EPA 1 and EPA 2.

Osteopathic medical students' beliefs about osteopathic manipulative treatment at 4 colleges of osteopathic medicine.

CONTEXT: Osteopathic manipulative treatment (OMT) is a distinctive and foundational aspect of osteopathic medicine. Several studies have reported a decline in the use of OMT by practicing osteopathic physicians, but the reasons for this decline have not been fully investigated. OBJECTIVE: To investigate osteopathic medical students' attitudes and beliefs regarding osteopathic philosophy, including OMT. METHODS: A self-administered, 21-item, electronic questionnaire developed specifically for the current study was distributed to first- and second-year osteopathic medical students at 4 colleges of osteopathic medicine. The questionnaire contained items addressing student attitudes toward osteopathic philosophy, including OMT; perceptions of osteopathic predoctoral education; and plans for integrating OMT into future practice. RESULTS: Of 1478 questionnaires sent, 491 students completed the questionnaire for an overall response rate of 33%. Analysis of student responses revealed that a majority of first- and second-year osteopathic medical students (95%-76%, depending on the question asked) expressed agreement with osteopathic philosophy. Students who reported prior exposure to OMT had higher levels of agreement with osteopathic philosophy statements (P<.04) and with the intention to use OMT (P<.02) than students with no prior exposure. However, students who were drawn to an osteopathic medical school by the desire to become a physician regardless of degree reported lower levels of agreement with osteopathic philosophy and the intention to use OMT. Students' levels of agreement with osteopathic philosophy and intention to use OMT varied significantly based on the school that they attended, their current year of study, and whether or not they were participating in clinical rotations. CONCLUSION: The reason why a student decided to study osteopathic medicine was strongly associated with the level of agreement with osteopathic philosophy and the intention to use OMT in future practice. Prior experience receiving OMT, the medical school that a student attends, and the current year of study appear to be related to the students' levels of agreement with osteopathic philosophy and intention to use OMT.

A prospective study of osteopathic medical students' attitudes toward use of osteopathic manipulative treatment in caring for patients.

Two computer-assisted clinical case SOAP (subjective, objective, assessment, plan) note exercises were used for second-year osteopathic medical students, and a standardized patient was used during third year to measure recording behaviors regarding structural examinations and osteopathic manipulative treatment (OMT). Students were questioned before leaving campus for clinical rotations and at pregraduation to determine their attitudes toward use of these skills. Ninety-one percent of the students recorded structural examination findings in both computer-assisted clinical case SOAP notes, and 61% suggested OMT be given on their basic science SOAP (pneumonia). All of the students in the osteopathic theory and methods exercise suggested OMT. On a standardized patient with chronic obstructive pulmonary disease, 11% of the students performed a structural examination, and 0.7% suggested OMT. Preclinically, 73% of the students believed they were prepared to conduct structural examinations, and 71% believed they were prepared to use OMT. Between 64% and 73% of pregraduation students, however, reported they had few opportunities to use these skills during clinical rotations. Most of the students believed they would use palpatory diagnosis and OMT for fewer than 25% of their future patients and primarily for patients with musculoskeletal problems.