Volume 118, Issue 11

Context To improve chronic disease self-management among an underserved population and to improve the skills of second-year osteopathic medical students, an educational curriculum, The Other 45, was developed. In addition to a typical 15-minute office visit, this program allows second-year students to provide chronic disease education to patients for 45 minutes in an effort to improve patient disease self-management and associated health outcomes. Objective To determine whether patients who participate in The Other 45 report improvements in their ability to manage their chronic disease(s) and their health outcomes and whether second-year osteopathic medical students report changes in patient-centered care, clinical confidence, and medical/teaching knowledge. Methods Patients with a previously diagnosed chronic disease participated in 3 visits for The Other 45. Chronic disease self-management and health outcomes were measured using the Health Education Impact Questionnaire, which participants completed at each visit. Students received a formal presentation on teaching skills, and those who participated in The Other 45 completed a pre- and postclinic survey measuring 3 focused domains: patient-centered care, clinical confidence, and medical/teaching knowledge. Results A total of 47 patients and 69 students participated in the study. As measured by the Health Education Impact Questionnaire, patients’ skill and technique acquisition ( P =.01), constructive attitudes and approaches ( P =.01), and health services navigation ( P =.03) showed significant improvement at the 3-week follow-up visit, and self-monitoring and insight showed significant improvement ( P =.01) at the 3-month follow-up visit. Patients’ positive and active engagement in life ( P =.04 and P =.03) and emotional well-being ( P =.003 and P =.0007) significantly improved at the 3-week and 3-month follow-up, respectively. The students improved significantly in all 3 domains as a result of participating in the program: patient-centered care ( P =.012), clinical confidence ( P <.001), and medical/teaching knowledge ( P =.002). Conclusions The Other 45 was effective in improving patients’ ability to manage their chronic disease(s), as well as improving second-year osteopathic medical students’ ability to educate a patient with chronic disease. Implementing this type of program has the potential to affect patients with chronic disease as well as medical students in a rural underserved setting.

Background Thyroid nodules are increasingly common. Although guidelines have been published, it is unclear whether recommendations for the use of fine-needle aspiration (FNA) and ultrasonography are followed. Objective To evaluate the impact of a quality improvement initiative regarding utilization of FNA and ultrasonography before resection of malignant thyroid neoplasms at a community-based hospital. Methods A retrospective medical record review of patients who received thyroidectomy with histologically proven malignant thyroid neoplasms at a community-based teaching center in the Midwest in 2014 revealed inconsistent use of FNA and ultrasonography per national guidelines. Thus, a quality improvement initiative was conducted using the PDSA (Plan, Do, Study, Act) method and included both an intradepartmental outreach effort and an interdisciplinary hospital cancer committee presentation. To determine the success of the initiative, medical records were reviewed from January 1, 2015, through July 1, 2016 (after the initiative) and compared with findings from 2014 (before the initiative). Results The medical records of 366 patients were reviewed over a 2.5-year period, and 23 records (12 in 2014 and 11 in 2015-2016) met the inclusion criteria. In 2014, FNA was performed on 58% of patients before operative management of thyroid malignancy. After the quality improvement initiative, FNA was performed on 100% of patients before operative management of thyroid malignancy ( P =.0155). Before the quality improvement initiative, 75% of patients undergoing an operation for malignant thyroid neoplasms underwent preoperative ultrasonography, compared with 100% after the initiative ( P =.0753). Conclusion A performance improvement initiative that used the PDSA framework effectively influenced physician adherence to national guidelines for thyroid neoplasms.

Obesity and climate change conspire to create an environment in which subclinical vascular inflammation leads to progressive atherosclerosis, which contributes to the number 1 cause of global mortality: cardiovascular disease. The syndemic model requires 2 or more diseases or contributors to disease (such as obesity and climate change) clustering within a specific population in addition to the associated societal and social factors, ultimately creating an environment supportive of a greater adverse interaction. This article explores the syndemic of obesity and climate change as a driver for cardiovascular disease.

Type 2 diabetes mellitus (T2DM) is a common chronic metabolic condition. Before receiving this diagnosis, persons typically have a long period of prediabetes. There is good evidence that T2DM can often be prevented or delayed by means of lifestyle interventions (39%-71%), medications (28%-79%), or metabolic surgery (75%). However, despite consistent data demonstrating their efficacy, these tools are underused, and knowledge about them among primary care physicians is limited. In an effort to engage physicians in addressing this public health crisis more effectively, the authors reviewed the evidence that T2DM can be prevented or delayed in persons at risk.

Context Osteopathic manipulative treatment (OMT) and yoga are both recommended by systematic reviews in the evidence-based research literature for low back pain management. It is unknown, to the authors’ knowledge, what the effect of personal experience with OMT or yoga, reading research articles on OMT or yoga, or both will have on medical students’ recommendations for these treatment options to future patients with chronic low back pain. Objective To evaluate the likelihood of osteopathic medical students recommending OMT or yoga to treat patients with chronic low back pain based on their personal experience or reading research articles that recommend OMT or yoga for patients with chronic low back pain. Methods In this prospective cohort study, researchers administered an anonymous 18-question online survey for osteopathic medical students. The survey included a patient vignette, 2 evidence-based articles, and multiple choice, yes/no, and Likert-type questions. Participants were recruited via email from all 4 years of medical school. Between-group differences in proportions were assessed with descriptive statistics and χ 2 tests; differences within groups were assessed with the McNemar test; and Fischer exact tests were used when expected cell counts were less than 5. Results A total of 180 participants (100 male, 80 female) completed the study. Personal experience increased the likelihood of osteopathic medical students recommending OMT ( P< .018) or yoga ( P <.001) to a future patient or to a patient in a case vignette ( P <.05) with chronic low back pain. Students who read research articles were more likely to recommend OMT to the case patient and future patients before and after reading the intervention article regardless of their experience ( P <.001). Conclusion Personal experience and reading evidence-based research may increase the likelihood that osteopathic medical students will recommend OMT to future patients with chronic low back pain.

Advances in ultrasonography (US) have allowed this technology to play an increasingly important role in numerous fields of medicine. It is important that medical schools incorporate this broadly applicable tool into their curricula. Touro University College of Osteopathic Medicine-CA has implemented a progressive US curriculum that is intended to complement osteopathic education, keep pace with medical advances, and arm future physicians with the most advanced skills and tools to practice medicine. In this article, the authors highlight the importance of US training in medical education and demonstrate the relative ease, cost-effectiveness, and direct benefit to students of implementing such a curriculum. The authors discuss the specifics of the US curriculum in osteopathic undergraduate medical education and describe how a staged rollout helped the college address the need for funding, faculty, and facilities. Plans for continued expansion, the successful and effective use of peer educators, the outcomes measured from this project, and avenues for further study are also discussed.

Public health and interprofessional education (IPE) are included among the osteopathic core competencies and Entrustable Professional Activities that should be reflected in osteopathic medical curricula. Cognizant of the importance of these 2 areas, Touro University College of Osteopathic Medicine-CA (TUCOM) has developed initiatives to advance them on campus as well as within its academic curriculum. The authors acknowledge the importance of incorporating public health content into osteopathic medicine as well as expanding IPE in the health professions as part of a larger project to impart a unique identity and relevance to osteopathic medical education at TUCOM. The authors describe TUCOM's public health and IPE initiatives and outcomes in the context of current and future relevance for osteopathic medicine. Future directions to assess the quality and impact of these programs that may be of value for other colleges of osteopathic medicine are also discussed.