Doctors of Osteopathic Medicine as Plastic Surgery Residents: Demographics, Credentials, and Pathways to Residency.

OBJECTIVE: Doctors of Osteopathic Medicine (DOs) are sparsely represented within plastic and reconstructive surgery (PRS) and recent changes including the elimination of step 1 scoring have further disadvantaged DO applicants. The demographics, degrees, and scholarly output of DO PRS trainees were compared to that of Doctors of Medicine (MDs) to identify areas of focus which could be used to increase competitiveness of DO applications. DESIGN: A cross-sectional study was created, including ACGME-accredited PRS program trainees during the 2020 to 2021 academic year. DO and MD trainee demographics and scholarly accomplishments were compared using t-test and chi-squared analysis. SETTING: Web-based publicly available information was collected for subjects. PARTICIPANTS: A total of 1092 PRS MD and DO trainees were identified. DOs made up only 2.7% (n = 30) and MDs made up 97.3% (n = 1062). RESULTS: More DOs trained in independent programs (63.3%) than integrated (36.7%) compared to MDs (88.2% v. 11.8%, p < 0.001) and more DOs trained at lower ranked PRS programs (60.0% of DOs and 18.1% of MDs trained at Q4 programs, p < 0.001). DOs had fewer publications (median, IQR: 1, [0-2]) compared to MDs (3, [1-8]), fewer citations (0, [0-6]) vs. (10, [1-56]) and lower H-index (1, [0-1]) vs. (1, [1-3]). CONCLUSION: DO candidates should consider research years in the field of PRS and optimize clinical experience opportunities to increase the competitiveness of their PRS applications. Special attention should be paid to providing networking and research opportunities to DOs who lack home institutions.

Diversity in osteopathic medical school admissions and the COMPASS program: an update.

In the United States, the 40 colleges of osteopathic medicine and 157 schools of allopathic medicine face challenges in recruiting candidates who are underrepresented in medicine (URiM), and gaps in racial disparity appear to be widening. In this commentary, the authors provide an analysis of the data collected from 8 years of conducting a URiM recruitment and welcoming social events. The event is sponsored by a student special interest group called Creating Osteopathic Minority Physicians Who Achieve Scholastic Success (COMPASS) at the Touro College of Osteopathic Medicine - New York (TouroCOM-NY). The results of the 8-year data analysis supports the conclusion that the COMPASS program has benefited the school environment through increased diversity.

Expansion of osteopathic medicine practitioner education on substance use disorders.

CONTEXT: Medical school graduates are generally not well prepared to treat patients with substance use disorders (SUDs), even though opioid overdose deaths in the United States have increased in recent years. When it comes to training in SUDs, osteopathic medicine lags far behind allopathic medicine. It was only in 2019 that the American Osteopathic Association approved Board Certification in Addiction Medicine to help combat the opioid epidemic. Few articles have been published in the literature pertaining to substance use education for osteopathic students and trainees. OBJECTIVES: The goal of this study was to expand the education of osteopathic medical students and primary care residents in SUDs and measure the effect that education had on the attitudes and knowledge of student and residents about SUDs. METHODS: This study collected anonymous data in the form of a voluntary online survey from third- and fourth-year students at an osteopathic medical school and family medicine residents. The survey was completed by 115 students and 29 family medicine residents. Participants completed a pretest survey and then participated in the Physician Undergraduate and Resident Substance Use Education (PURSUE) curriculum developed by the researchers. This consisted of three online modules covering Screening, Brief Intervention, and Referral to Treatment (SBIRT), substance use assessments, and treatment of SUDs. Upon conclusion of the training modules, medical student participants then completed a posttest survey to assess for any changes in knowledge and attitude. Participants also answered questions related to clinical case scenarios involving patients at varying risk levels who were assessed utilizing SBIRT. RESULTS: Students and residents who participated in the training demonstrated an increase in their average scores between the pretest and posttest, indicating effectiveness in learning from the modules. The overall increase in average scores on the pretest and posttest was 6.5 %, which was determined to be statistically significant (p<0.01). Interestingly, participants who reported growing up in underprivileged circumstances performed worse than those participants who reported not growing up in underprivileged circumstances. CONCLUSIONS: The results of our project support the need and benefit of incorporating educational modules on this topic area within medical school curriculums and residency training. Expanding the number of healthcare workers proficient in providing this type of care in these types of settings will improve the quality of and access to medical care in some of our highest-need populations.

Neurosurgery Clerkships in United States Medical Schools: A Survey of Doctor of Medicine-Granting and Doctor of Osteopathic Medicine-Granting Schools.

OBJECTIVE: Exposure to neurosurgery is important for knowledge of neurosurgical conditions that physicians may encounter. The current status of neurosurgery nonsubinternship clerkships in the United States is unknown; this study determined the availability and format of non-subinternship neurosurgery clerkships in DO (Doctor of Osteopathic Medicine)-granting and MD (Doctor of Medicine)-granting U.S. medical schools. METHODS: Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites were used to obtain contact information for all U.S. medical schools. Respondents were asked whether their school offered a non-subinternship neurosurgery clerkship, if it was required, clerkship length, and whether the clerkship was embedded in another clerkship. Nonsubinternship clerkships/electives/selectives were defined as an exploratory neurosurgery rotation. For nonresponding schools, data were collected from school websites. RESULTS: Data were obtained for 180/199 U.S. medical schools; 142 (79%) provided neurosurgery non-subinternships, including 125/150 (83.3%) MD-granting and 17/30 (57%) DO-granting schools. Four MD-granting schools (2.8%) required the clerkship; 87/142 (61%) offered a stand-alone clerkship, 34/142 (24%) an embedded clerkship, and 21/142 (15%) offered both. In total, 200 clerkships were offered across 142 schools. Most were either >1-2 weeks or >3-4 weeks (69/200, 35% and 89/200, 45%, respectively). CONCLUSIONS: Most U.S. medical schools provide elective neurosurgery non-subinternships. Fewer, although still a majority, of DO-granting schools offer a neurosurgery non-subinternship compared with MD-granting schools.

An assessment of surgery core rotation quality at osteopathic medical schools.

CONTEXT: Osteopathic medical schools have traditionally placed a heavy emphasis on the field of primary care. While graduating osteopathic students continue to pursue family medicine, internal medicine, and pediatrics at higher rates than their allopathic counterparts, it is unknown whether students feel that surgical rotations are held to similar standards. OBJECTIVES: The purpose of this study was to assess osteopathic medical student opinions of the quality of their surgical clerkships and to determine if good or poor experiences influenced their decision to continue pursuing surgery. METHODS: After Institutional Review Board approval, a voluntary and anonymous Qualtrics survey was sent to all nationally registered members of the American College of Osteopathic Surgeons, Medical Student Section (ACOS-MSS) in their final 2 years of medical school. Analyses were conducted utilizing R statistical software. RESULTS: A total of 345 responses were recorded from the Qualtrics survey sent to 2182 ACOS students from the national registry (response rate of 15.8 %). Students who found a mentor during their surgical rotations were more likely to consider a surgical career after they completed their rotations (odds ratio [OR]=1.43, p=0.003). Students at academic sites had more opportunities for research than those at community hospitals (p=0.019). Most students responded that they were still considering surgery as a career after rotation completion; a significant portion (OR=0.36, p<0.001) responded that they were no longer interested. CONCLUSIONS: Medical students are most likely to review a surgical rotation favorably if they can connect with a mentor while on rotation. Osteopathic medical schools may benefit from instituting mentorship programs for students interested in surgery, as well as ensuring that their students have ample opportunity for research.

The Effects of Single Accreditation and Pass/Fail Licensing Exams on Osteopathic Medical Students Applying to Surgical Residency Programs.

OBJECTIVE: To examine the effects of single accreditation and pass/fail licensing exams on osteopathic (DO) medical students applying for surgical residency. DESIGN: Electronic surveys were distributed to 1509 program directors (PD) in 10 surgical specialties. PDs were separated into 2categories based on their program's accreditation status prior to single accreditation: formerly accredited by the American Osteopathic Association (AOA) or not accredited by the AOA. Separate chi-squared and binomial tests were used to determine statistical differences between PDs in each category and within each surgical specialty. SETTING: Voluntary, anonymous, electronic survey. PARTICIPANTS: Three hundred survey responses were received (response rate 19.8%) and 234 responses were included in statistical analyses. Sixty-six responses were excluded because the survey was incomplete, the survey was not completed by a PD, or the PD indicated disqualification of DO applicants from matching at that program. RESULTS: The majority of PDs in both categories recommend or require that DO students take both United States Medical Licensing Examination (USMLE) Step1 [Χ2 (2, N = 234) = 8.939, p = 0.011] and USMLE Step 2 CK [Χ2 (2, N = 234) = 4.161, p = 0.125] despite pass/fail outcomes only on Step 1 and Level 1. When deciding whom to interview, PDs in both categories highly ranked USMLE Step 2 CK scores and letters of recommendation (LOR). Formerly-AOA-accredited programs highly ranked COMLEX-USA Level 2 scores (p = < 0.001) and completion of an audition rotation (p = 0.001). Non-AOA-accredited programs highly ranked the Medical Student Performance Evaluation (MSPE) (p = < 0.001) and clerkship grades/evaluations (p = 0.001). CONCLUSIONS: Significant differences exist in programs despite single accreditation. DO applicants should take both USMLE Step 1 and Step 2 CK to be considered competitive for any surgical specialty. Additionally, DO students should prioritize formerly-AOA-accredited programs for audition rotations.

Impact of the USMLE Step 1 and COMLEX Level 1 transition to Pass/Fail on osteopathic medical student stress levels and board preparation.

CONTEXT: The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 1 transitioned from a numeric scoring system to a Pass/Fail designation in 2022. This transition intended to decrease stress, improve medical student well-being, and encourage residency program directors to emphasize other aspects of residency applications. Pass/Fail score transitions in the undergraduate medical education curriculum have improved medical student psychological well-being and satisfaction; whether these same benefits translate to the board examination period is unknown. OBJECTIVES: The objectives of this study are to assess the impact of USMLE Step 1 and COMLEX Level 1 grade scale transition on medical student stress, wellness, board preparation decisions, and future residency selection processes. Investigators hypothesized that students under the Pass/Fail designation would experience less stress during the intensive study period leading up to USMLE Step 1 and COMLEX Level 1 and devote more time to other aspects of their residency applications. METHODS: To examine the impact on osteopathic medical student (OMS) stress and approach to board preparation, two surveys were administered to Rocky Vista University College of Osteopathic Medicine (RVU-COM) students before (Class of 2023) and after (Class of 2024) the transition to a Pass/Fail designation. All students within the RVU-COM Classes of 2023 and 2024 were invited to participate. The Cohen Perceived Stress Scale (PSS-10) was administered at the beginning of the focused board study period in May 2021 and 2022 to the Class of 2023 and 2024, respectively. The investigator-designed Licensing Exam Questionnaire (LEQ), meant to capture board preparation patterns, residency application perspectives, and wellness during examination preparation, was administered immediately after the board examination deadline in July 2021 and 2022 to the Class of 2023 and 2024, respectively. Statistical analysis included the use of independent t tests (numeric variables) and chi-square tests (categorical data). This project was considered exempt from full Institutional Review Board review. RESULTS: Approximately one-third of the Class of 2023 (PSS-10: n=86; LEQ: n=93) and 2024 (PSS-10=89; LEQ: n=92) responded. No difference was detected in mean PSS-10 score, 20.14 (SD=7.3) compared to 19.92 (SD=6.56) for the Class of 2023 and 2024 (p=0.84), respectively. The Class of 2023 reported more weeks studying (mean 6.27 weeks, SD=0.79) vs. the Class of 2024 (mean 5.44 weeks, SD=0.007), p<0.001, more practice examinations taken X 2 (1, n=182)=13.75, p<0.001, and a greater proportion scheduled examinations after June 20 X 2 (1, n=182)=29.01, p<0.001. No difference existed in hours studying per day, sequence of Step 1/Level 1, time between examinations, money spent, or type of study resources utilized. CONCLUSIONS: The transition of USMLE Step 1 and COMLEX Level 1 to a Pass/Fail designation did not reduce stress for OMSs at a single, multicampus COM. Respondents, however, altered board preparation practices in meaningful ways. As student behaviors and board-study patterns emerge, these insights must be connected to outcomes in the future.

Key factors for residency interview selection from the National Resident Matching Program: analysis of residency Program Director surveys, 2016-2020.

CONTEXT: As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application. OBJECTIVES: We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview. METHODS: Data from residency PD surveys from 2008 to 2021 were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs' evaluation of the residency factors for interview, namely, "percent citing factor" and "average rating" on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year. RESULTS: The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean's Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021 PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment. CONCLUSIONS: The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than the more traditional, quantitative, and objective metrics. Medical students and educators need to continually apprise themselves of the NRMP data to inform students' preparation endeavors throughout medical school to strengthen their application portfolios and enhance their competitiveness for the matching process.

Equal but Separate: The Slow Assimilation of Osteopathic Surgery Residents Two Years After the Unified Match.

OBJECTIVES: The purpose of this study was to monitor the integration of general surgery residency programs before and after the 2020 unified match. We hypothesized that integration of osteopathic (DO) surgery residents would increase. DESIGN: We performed a retrospective cohort study of surgery residency programs between 2019 and 2021 utilizing data provided by the Association of American Medical Colleges. Program composition (2021) and changes in composition (2019-2021) were compared by program type. Multivariable logistic regression models assessed variables associated with DO presence (2021) and integration (2019-2021). SETTING: General surgery residency programs across the United States. PARTICIPANTS: Civilian surgery residencies that completed the 2019-2021 program survey. RESULTS: Out of 320 programs, DO residents were integrated at 69% (221/320), including 52% (63/122) university programs, 78% (101/129) university-affiliated programs and 83% (57/69) community programs (p < 0.01). Overall, 23 (8%) programs integrated DO residents from 2019 to 2021, and 9 (21%) ex-American Osteopathic Association programs integrated MD residents (both p < 0.01). The median number of DO residents was 1 (interquartile range, IQR 0-2) at university programs, 2 (IQR 1-7) at university-affiliated programs, and 5 (IQR 2-12) at community programs (p < 0.01). The median number of DO residents at all programs increased from 1 (IQR 0-5) to 2 (IQR 0-6) since 2019 (p < 0.01). Community (OR 2.6, p = 0.04), university-affiliated (OR 2.3, p = 0.02), and programs with DOs in 2019 (OR 19.0, p < 0.01) were associated with increased odds of DOs present in 2021, while DO faculty (OR 2.6, p = 0.02) was the only factor independently associated with integrating DOs after 2019. CONCLUSIONS: While some programs have integrated DO residents, progress is slow, median numbers of DO residents remain low, and familiarity with DOs is most associated with integration. We explore barriers to integration, and advance recommendations to eliminate potential disparities.

Increasing Diversity in the Physician Workforce: Pathway Programs and Predictive Analytics.

PROBLEM: Lack of diversity in the physician workforce has well-documented negative impacts on health outcomes. Evidence supports the use of pathway or pipeline programs to recruit underrepresented in medicine students. However, data on how a pathway program should deliver instruction are lacking. This report describes a multiyear project to build such a system with the goal of increasing diversity within medical school cohorts and ultimately the physician workforce. APPROACH: In the 2015-2016 academic year, the Ponce Health Sciences University started a 3-phase project to create a data-driven medical school feeder system by coupling a pathway program with predictive analytics. Phase 1 launched the pathway program. Phase 2 developed and validated a predictive model that estimates United States Medical Licensing Examination (USMLE) Step 1 performance. Phase 3 is underway and focuses on adoption, implementation, and support. OUTCOMES: Data analysis compared 2 groups of students (pathway vs direct) across specific factors, including Medical College Admission Test (MCAT) score, undergraduate grade point average (GPA), first-generation status, and Step 1 exam performance. Statistically significant differences were found between the 2 groups on the MCAT exam and undergraduate GPA; however, no significant differences were found between groups for first-generation status and performance on the Step 1 exam. This finding supports the authors' hypothesis that although pathway students have significantly lower mean MCAT exam scores compared with direct students, pathway students perform just as well on the USMLE Step 1 exam. NEXT STEPS: Next steps include expanding the project to another campus, adding more socioeconomic status and first-generation data, and identifying best curricular predictors. The authors recommend that medical school programs use pathway programs and predictive analytics to create a more data-centered approach to accepting students with the goal of increasing physician workforce diversity.

The effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs.

CONTEXT: In light of the COVID-19 pandemic, healthcare-associated infections have taken center stage. Healthcare has adjusted workflows to accommodate for more robust disinfecting regiments to help protect the community. This has resulted in the need for medical institutions to reevaluate the current disinfection protocols down to the student level. The osteopathic manipulative medicine (OMM) laboratory provides an optimal avenue for assessing the effectiveness of medical students' ability to clean examination tables. With OMM laboratories having a high level of interaction, adequate disinfection is important for the health and safety of students and teaching faculties. OBJECTIVES: This study will evaluate the effectiveness of the current disinfection protocols in the medical school OMM labs. METHODS: A cross-sectional, nonrandomized study was performed on 20 OMM examination tables utilized for osteopathic training. Tables were chosen based on their close proximity to the podium. Close proximity was utilized as a criteria to increase the probability of utilization by students. The sampled tables were observed to ensure their use by students during class. Initial samples were collected in the morning after disinfection by Environmental Services. Terminal samples were collected after Osteopathic medical students utilized and disinfected the OMM examination tables. Samples were collected from the face-cradle and midtorso regions and analyzed utilizing adenosine triphosphate (ATP) bioluminescence assays with an AccuPoint Advanced HC Reader. This reader provides a digital readout of the quantity of light measured in relative light units (RLUs), which is directly correlated to the amount of ATP present in the sample, providing an estimated pathogen count. For statistical analysis, a Wilcoxon signed-rank test was utilized to find statistical differences in RLUs in samples after initial and terminal disinfection. RESULTS: The face cradle showed a 40 % increase in failure rate in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed an estimated pathogen level for face cradle that was significantly higher after terminal disinfection (median, 4,295 RLUs; range, 2,269-12919 RLUs; n=20) compared to initial disinfection (median, 769 RLUs; range, 29-2,422 RLUs; n=20), z=-3.8, p=0.00008, with a large effect size, d=2.2. The midtorso region showed a 75 % increase in samples after terminal disinfection when samples were compared after initial disinfection. A Wilcoxon signed-rank test revealed that the estimated pathogen levels for midtorso were significantly higher after terminal disinfecting (median, 656 RLUs; range, 112-1,922 RLUs; n=20) compared to initial disinfecting (median, 128 RLUs; range, 1-335 RLUs; n=20), z=-3.9, p=0.00012, with a large effect size, d=1.8. CONCLUSIONS: This study suggests that medical students frequently failed to disinfect high-touch regions on examination tables, such as the midtorso and the face cradle. It is recommended that the current OMM lab disinfection protocol be modified to include the disinfection of high-touch regions in order to reduce the possibility of pathogen transmission. Further research should explore the effectiveness of disinfection protocols in clinical settings such as outpatient offices.

Awareness and interest in osteopathic manipulative treatment in allopathic medical students.

CONTEXT: Osteopathic manipulative treatment (OMT) is utilized by clinicians to diagnose and treat a variety of musculoskeletal conditions including acute and chronic pain, and other medical conditions. Previous studies have examined attitudes of allopathic (MD) residents toward OMT and have implemented residency-based curricula; however, literature is lacking on the attitudes of MD students toward OMT. OBJECTIVES: The objective of this study was to determine MD students' familiarity with OMT and to evaluate their interest in an elective osteopathic curriculum. METHODS: A 15-item online survey was electronically sent to 600 MD students at a large allopathic academic medical center. The survey assessed familiarity with OMT, interest in OMT and in participating in an OMT elective, educational format preference, and interest in pursuing primary care. Educational demographics were also collected. Descriptive statistics and Fisher's exact test were utilized for categorical variables, and nonparametric tests were utilized for the ordinal and continuous variables. RESULTS: A total of 313 MD students submitted responses (response rate=52.1 %), of which 296 (49.3 %) responses were complete and utilized for analysis. A total of 92 (31.1 %) students were aware of OMT as a modality in treating musculoskeletal disorders. Among the respondents who indicated "very interested" in learning a new pain treatment modality, the majority: (1) observed OMT in a prior clinical or educational setting (85 [59.9 %], p=0.02); (2) had a friend or family member treated by a DO physician (42 [71.2 %], p=0.01); (3) were pursuing a primary care specialty (43 [60.6 %], p=0.02); or (4) interviewed at an osteopathic medical school (47 [62.7 %], p=0.01). Among those interested in developing some OMT competency, the majority: (1) were pursuing a primary care specialty (36 [51.4 %], p=0.01); (2) applied to osteopathic schools (47 [54.0], p=0.002); or (3) interviewed at an osteopathic medical school (42 [56.8 %], p=0.001). A total of 230 (82.1 %) students were somewhat or very interested in a 2-week elective course in OMT; among all respondents, hands-on labs were the preferred method for delivery of OMT education (272 [94.1 %]). CONCLUSIONS: The study found a strong interest in an OMT elective by MD students. These results will inform OMT curriculum development aimed at interested MD students and residents in order to provide them with OMT-specific theoretical and practical knowledge.

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.

Utilization and reimbursement trends of osteopathic manipulative treatment for Medicare patients: 2000-2019.

CONTEXT: Osteopathic manipulative treatment (OMT) has been established as a beneficial and noninvasive treatment option for multiple conditions. With the total number of osteopathic providers tripling and the subsequent increase in osteopathic physician representation, we would expect the clinical use of OMT to increase accordingly. OBJECTIVES: To that end, we evaluated the utilization and reimbursement of OMT services among Medicare beneficiaries. METHODS: Current procedural terminology (CPT) codes 98925 to 98929 were accessed from the Center for Medicare and Medicaid Services (CMS) from 2000 to 2019. These codes indicate OMT treatment, 98925 (1-2 body regions treated), 98926 (3-4 body regions treated), 98927 (5-6 body regions treated), 98928 (7-8 body regions treated), and 98929 (9-10 body regions treated). Monetary reimbursement from Medicare was adjusted for inflation, and total code volume was scaled to codes per 10,000 beneficiaries to account for the increase in Medicare enrollment. RESULTS: Overall OMT utilization declined between 2000 and 2019 by 24.5%. A significant downward trend in the utilization of CPT codes for OMT involving fewer body regions (98925-98927) was observed, and was contrasted by a slight upward trend in the use of codes for more body regions (98928, 98929). The adjusted sum reimbursement of all codes decreased by 23.2%. Lower value codes showed a higher rate of decline, whereas higher value codes changed less dramatically. CONCLUSIONS: We conjecture that lower remuneration for OMT has disincentivized physicians financially and may have contributed to the overall decline in OMT utilization among Medicare patients, along with a decreased number of residencies offering specific training in OMT, and increased billing complexity. In considering the upward trend of higher-value code usage, it is possible that some physicians are increasing the comprehensiveness of their physical assessment and associated OMT to reduce the overall financial impact of reimbursement cuts.

Establishing a baseline for multilingual capabilities of medical students at the Michigan State University College of Osteopathic Medicine.

CONTEXT: The language proficiencies of Michigan State University College of Osteopathic Medicine (MSUCOM) medical students are unknown. As of 2015, approximately 8% (or roughly 25 million) of the US population over the age of five were considered "limited English proficient". Research indicates, however, that it is valuable to patients to be able to communicate in their primary language with their primary care physician. If medical students' language proficiencies were known, the medical school curriculum could be adapted to leverage or enhance a student's language proficiencies, preparing students to serve in communities where their patients language proficiencies align. OBJECTIVES: The aim of this pilot study was to survey MSUCOM medical students in order to assess their language proficiencies with two goals in mind: first, to develop medical school curriculum that would leverage student's language proficiencies, and second, to encourage student placement within diverse communities throughout the state of Michigan where these physicians-in-training speak or understand the primary language of the local community to better serve patients. METHODS: For this cross-sectional descriptive pilot study, a short, author-created survey was sent to 1,226 osteopathic medical students (OMS-I to OMS-IV) at MSUCOM. Participants were asked questions pertaining to language proficiency, number of languages spoken, prior exposure to education abroad, and demographic information. All participant data were only reported in grouped, collective, de-identified terms. Descriptive statistical analyses (frequencies, percentages) were calculated utilizing SPSS Version 25 software. RESULTS: Over the course of several months, 698 (58.7%) current MSUCOM medical students participated in the study. Of those students, 382 (54.7%) responded that they were multilingual. The top three second languages reported spoken were: English 332 (47.6%), Spanish 169 (24.2%), and Arabic 64 (9.2%). In addition, 249 (37.2%) said they had prior exposure to education abroad, and 177 (26.4%) said they had lived in another country for more than 6 months. CONCLUSIONS: The majority, 382 (54.7%), of the MSUCOM students who participated in the survey have some degree of multilingual capabilities. The student population at MSUCOM may benefit from completing primary care rotations in diverse communities within the state of Michigan. Likewise, the communities throughout Michigan may benefit from having bilingual and multilingual medical students serve in their medical facilities. Further research on the efficacy of leveraging language skills in various communities, as well as broadening the population sample, is warranted to refine and validate the observed pilot study results.

Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?

CONTEXT: Osteopathic manipulative treatment (OMT) for the allopathic resident is an elective at the University of Minnesota North Memorial Residency that engages the resident in the basic tenants of osteopathic medicine, with exposure to the vast application of OMT with a curricular focus on low back pain management. Implementing an elective curriculum is a feasible way to improve attitudes in OMT for MDs in a Family Medicine residency, and residents can learn OMT in an elective rotation. OBJECTIVES: This article aims to determine if MDs who complete an OMT for the allopathic physician elective rotation have higher comfort caring for patients with back pain compared to those who do not complete the elective. Further, this article is designed to evaluate if these MDs continue to incorporate OMT into the care they provide once they graduate from their residency programs. METHODS: Graduates from the University of Minnesota North Memorial Family Medicine Residency (2013 to 2019) were sent an email invitation in August 2020 to complete a Qualtrics survey regarding their comfort with caring for patients with back pain, referral patterns for these patients, and the ongoing use of OMT in their practices. Doctor of Osteopathic Medicine (DO) graduates who responded to the survey were removed from the analysis. RESULTS: Among emailed graduates, 61.8% (42/68) completed the survey, with representation from each class ranging from 1 to 7 years postresidency. The five DO graduates who responded were removed from the analysis. Among the remaining 37 respondents, 27 had completed the OMT for the allopathic rotation ("elective participants") during their residency training and 10 had not ("control"). Half (50.0%) of the control group provide OMT care compared to 66.7% of the elective participants, with a comfort score of 22.6 (standard deviation [SD] 32.7) in the control group vs. 34.0 (SD 21.0) in elective participants (on a 0-100 scale; 100 being completely comfortable; p=0.091). Among the control group, 40.0% regularly refer to a DO provider compared to 66.7% of those who completed the elective (p=0.257). The mean comfort score for performing a physical examination on patients presenting with back pain was 78.7 (SD 13.1) and 80.9 (SD 19.3) in the control and elective participants groups, respectively (p=0.198). CONCLUSIONS: Allopathic Family Medicine residents who completed an elective rotation in OMT have a slight increase in frequency of referring to DOs. They also have a meaningful increase in comfort performing OMT. With the limited number of DOs being a common barrier to OMT care, more widely implemented training in OMT for allopathic Family Medicine residents may be a reasonable intervention to improve the care of patients with back pain.

Perceived Value of Osteopathic Recognition.

BACKGROUND AND OBJECTIVES: In 2020 the Accreditation Council on Graduate Medical Education (ACGME) became the sole accrediting body for osteopathic and allopathic residency programs, with an option for programs to apply for Osteopathic Recognition (OR) to distinguish their training in osteopathic principles and practice. There is limited research regarding this transition. The goal of our study was to assess the perceived value of OR and perceived difficulty of obtaining OR for family medicine residency programs. METHODS: We performed analyses regarding the difficulty of obtaining OR status and the value of OR and Osteopathic Principles and Practice (OPP) using questions on the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey. RESULTS: Of the 280 program directors (PD) responding, 69 (24.6%) had OR status, 126 (45.0%) were considering applying or would apply if needed resources were available, and 85 (30.4%) were not considering OR. Of the 73 PDs reporting on experience with the OR process, 28 (38.4%) found it "very smooth," 30 (41.1%) found it "a little bumpy," and 15 (20.5%) found it "very bumpy"; 87.0% of PDs (60 of 69) with OR felt it had value in recruiting DO students and 31.8% (22/69) in recruiting MD students; 86.9% of programs with OR status perceived OPP to be somewhat or very valuable in enhancing patient satisfaction compared to 77% of those considering OR and 44.7% not considering OR. CONCLUSIONS: Program directors perceive value in OR status for recruiting and in osteopathic practice for patient care. Since 75.4% of responding program directors have or are interested in achieving OR status, further research is needed on its benefits and barriers.

Barriers to research opportunities among osteopathic medical students.

CONTEXT: Despite the increase of importance placed on research, both by residency program directors and the medical field at large, osteopathic medical students (OMS) have significantly fewer research experiences than United States (U.S.) allopathic medical students and non-U.S. international medical graduates. However, few studies have addressed this long-standing discrepancy, and none directly have focused on osteopathic medical students to assess their unique needs. The literature would benefit from identifying the barriers osteopathic medical students encounter when participating in research and understanding the currently available resources. OBJECTIVES: To assess the barriers that OMS face when seeking research opportunities, identify resources currently available to osteopathic medical students at their respective schools, and investigate factors that contribute to an osteopathic medical student's desire to pursue research opportunities. Additionally, to investigate osteopathic medical students' confidence in research methodology. METHODS: A survey was created by the investigators and administered to participants over a three-month period via a GoogleForm. Research participants were surveyed for demographic information, as well as their involvement in research projects in the past, mentor availability, institutional resources, motivation to participate in research, individual barriers to participation, and confidence in their ability to do independent research. Responses were de-identified and analyzed using Microsoft Excel functions to count data and calculate percentages, as well as Pearson's chi square analysis. RESULTS: After relevant exclusion, 668 responses were included. Of the students surveyed, 85.9% (574) indicated they currently and/or in the past were involved in research. More than half of the respondents that are not currently involved in research are interested in pursuing it (86.9%; 344). The primary barriers students reported facing include lack of time (57.8%; 386), feeling overwhelmed and unsure how to start (53.4%; 357), and lack of access to research (53%; 354). 34.7% (232) of students stated they either did not have resources from their school or were unsure whether these resources were available. The two most cited motivations to pursue research included boosting their residency application and/or interest in the area of study. Male gender and current research were associated with reported confidence in research ( [4, n=662]=10.6, p<0.05). CONCLUSIONS: Findings from this study provide a synopsis of the barriers to research opportunities among osteopathic medical students. Notably, ⅓ of OMSs reported an absence or unawareness of available research resources at their osteopathic medical schools.