Assessing patient experience of the tenets of osteopathic medicine.

CONTEXT: Previous studies document that both osteopathic physicians and third-party observers identify an approach to the patient that is consistent with the philosophy and tenets of osteopathic medicine, often without investigating whether patients identify or are satisfied with it. Osteopathic physicians and the medical education community understand the distinctiveness of an osteopathic approach to the patient. Understanding the outcomes of an osteopathic approach to patient care includes confirming whether patients experience the tenets of osteopathic medicine in physician visits and, if so, how it relates to their experience of physician empathy and satisfaction with the visit. OBJECTIVES: The objectives of this study were to assess patient experience of the tenets of osteopathic medicine, physician empathy, and satisfaction with the visit and to compare the results for patients who saw DOs with those who saw MD physicians. METHODS: More than 2000 patients at four outpatient clinic facilities were surveyed after a clinical visit on 22 prompts regarding their experiences of physician behaviors, physician empathy, and their own satisfaction with the encounter. Adult patients who were treated by an osteopathic or allopathic physician for a nonemergency encounter and who were not pregnant were included in the analysis. Survey results for 1,330 patient-physician encounters were analyzed utilizing linear regression models comparing constructs representing patient experiences of the tenets of osteopathic medicine (Tenets), physician empathy (Physician Empathy), satisfaction (Satisfaction) with the encounter, as well as additional demographic and encounter variables. RESULTS: Approximately 23.8 % of patients approached during the study period completed a survey (n=2,793), and among those, 54.7 % of patients who consented to the study and who saw a physician provider (n=1,330/2,431) were included. Significant (p≤0.01), positive associations among patient experiences of Satisfaction with the visit and Physician Empathy were observed among those who saw both DO and MD physicians. Patients experienced the Tenets during encounters with both DO and MD physicians, but linear regression showed that their experience of the Tenets was significantly (p≤0.01) and positively explained by their experience of Physician Empathy (ß=0.332, p=0.00, se=0.052) and Satisfaction with the visit (ß=0.209, p=0.01, se=0.081) only when the physician was a DO. CONCLUSIONS: Patients identified physician behaviors consistent with the Tenets and positively associated their experiences of Physician Empathy and Satisfaction with the visit regardless of physician training background. Patient experience of the Tenets significantly explained their experiences of Physician Empathy and Satisfaction after visits with a DO but not after visits with an MD.

Clinical Preceptors' Perceptions of Empathy: The Empathy in Osteopathic Training and Education (EMOTE) Study.

CONTEXT: Physician empathy influences rapport with patients and improves outcomes, but it is not well understood as an outcome of osteopathic medical education. OBJECTIVE: To determine how clerkship preceptors at Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo define empathy and how they compare observed empathetic behavior of TUCOM students with that of other medical students. METHODS: Cross-sectional data were obtained from a survey of TUCOM clinical preceptors comparing TUCOM students with other medical students on 10 behaviors. Results were analyzed with a 2-tailed z test of proportional difference at the 95% confidence level. RESULTS: Of 650 preceptors contacted, 177 responded and were included in the final analysis (27%). Survey item reliability was high (Cronbach α=0.96). A majority of preceptors (59% to 71%) considered TUCOM students "similar" to other medical students for each behavior. A majority of preceptors (107 [60%]) shared a definition of empathy with one another and with the National Board of Osteopathic Medical Examiners and the American Association of Colleges of Osteopathic Medicine. Approximately 39% of preceptors rated TUCOM students "better" or "advanced" for "displays of empathy" compared with approximately 30% of preceptors who rated students as better or advanced across all 10 behaviors. Preceptors who shared a definition of empathy rated TUCOM students as better or advanced at a significantly higher rate for "displays of empathy" (z=1.982, P<.05) compared with preceptors who did not share a definition (n=70). Osteopathic preceptors (n=67) rated TUCOM students significantly higher on "displays of empathy" (z=2.82, P<.05) and "clear and effective communication to patients, families and co-workers" (z=2.83, P<.01) than did allopathic preceptors. No significant differences were found based on number of years as a preceptor or on the combination of types of students the preceptor taught. CONCLUSION: Most clinical preceptors shared a definition of empathy, and they were able to observe and rate displays of it in clerkship students. Preceptors rated TUCOM students more favorably than other students they taught for displays of empathy.

Scoring system for estimating age in the foot skeleton.

This study assesses chronological age of immature individuals from the degree of ossification evident in the foot skeleton. We considered all tarsal and ray bones in various combinations to determine the most sensitive indicators of chronological age. Skeletal maturity was rated according to a subjective but simple scoring system applied to radiographs of normal feet of children of known chronological age. Scales for assessing the primary center of ossification, secondary center of ossification, and state of fusion are defined. In general, as expected, females show earlier onset of skeletal maturity than males; in particular, females in our sample are skeletally mature in most elements beginning 48 months prior to the earliest incidence of skeletal maturity in males for the same bones. Females in our sample show a marked tendency toward skeletal maturity of all elements by 150 months of age, while males do not show the same tendency until approximately 200 months of age. In general within each sex, consecutive states of fusion show broad overlap in range of chronological age within each bone. Combining scores from several different bones enables a reasonable estimate of potential age in a test application of the model.

Fractal analysis of sagittal suture morphology.

Quantifying shape is a broad problem in the morphological sciences. Most techniques for numerically describing shape abstract the shape into the most logical ideal Euclidean dimension. The fractional, or fractal, dimension is a simple computation that expresses shape in real, rather than ideal, space. The structured walk technique developed for the fractal analysis of rugged boundaries is applied here to the contour of the human sagittal suture in order to discriminate the separate morphological patterns of interfingering and interlocking. These attributes contribute differentially to the suture's "complexity," a concept often used in biomechanical hypotheses. Previous techniques for estimating sutural complexity do not isolate small-scale from large-scale morphological patterns. Results indicate that despite the visual appearance of great variation, human sagittal sutures are remarkably consistent in the degree of complexity expressed separately by large-scale interfingering lateral excursions and small-scale interlocking ruggedness. There is no significant correlation between the absolute or bregma-lambda chord length of the human sagittal suture and its degree of complexity as determined by the structured walk technique.