Volume 125, Issue 9

Context Mental health conditions have been subject to significant societal stigma, which impacts the self-perception of people with mental illness and can impact their decision to seek treatment. General practitioners in the United States report overall negative attitudes toward people with severe mental illness; however, there are few studies into the beliefs of medical students on people with mental illnesses as well as the impact of stigmatizing language on these beliefs. Objectives The objectives of this survey were to evaluate the impact of stigmatizing language on medical students’ responses to case presentations of mental illnesses, and to determine how these perceptions vary across the course of medical education. Methods We conducted an online survey wherein medical student participants reviewed psychiatric case vignettes, which varied in their use of either person-centered language (PCL) or stigmatizing language. All current students at the authors’ institution were sent the survey link via email. Participants rated the case for symptom severity, their likelihood to recommend hospitalization, their level of comfort and safety when interviewing the patient, the trustworthiness of the patient’s report, and the likelihood that the condition would improve over the next year. For analysis, these responses were summed to yield a Student Perception Index Score from 1 to 60, with 60 being the “most stigmatizing” perspective (i.e., lowest comfort, most likely to hospitalize, etc.). Results There were 87 total respondents, of which 44 answered the Stigmatizing vignettes and 43 answered the PCL vignettes, with roughly even respondents per year in school. Overall, there was not a significant difference between the PCL and stigmatizing language versions (p=0.73 for the major depression case; p=0.29 for the schizophrenia case). However, compared to first-year medical students, third-year students had significantly higher Student Perception Index Scores for the stigmatizing depression case (p=0.002), and fourth-year students had significantly higher stigma scores for the PCL depression case (p=0.02). Conclusions Although there was no overall difference between the average Index Scores for the PCL and stigmatizing versions of the case presentations, significant differences in the Index Scores of certain presentations for students undergoing clinical education indicate that some targeted education on mental health stigma may be beneficial for third- and fourth-year medical students. Teaching empathetic approaches to patients with mental illness, regardless of whether their presentation was “stigmatizing,” emphasizes the holistic care expected through the osteopathic tenet describing the interconnectedness of mind, body, and spirit.

Context Research and scholarship are core drivers of medicine in the modern era. Evidence-based practice continues to replace expert opinion and long-held practice beliefs. Involvement in the development and writing of these guidelines is critical for Doctors of Osteopathic Medicine (DOs) to maintain a seat at the academic table. According to the American Osteopathic Association (AOA), 11 % of practicing physicians in the US are DOs. This number is growing, as nearly 25 % of current medical students attend an osteopathic medical school. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine. Objectives To quantify the contribution of DOs to the body of literature guiding practice, author information was extracted from all US-based guidelines published in the years 2021, 2022, and 2023 listed in the Emergency Care Research Institute (ECRI) Guidelines Trust database. Methods Authors of US-based guidelines listed in the ECRI Trust database from the years 2021–2023 were counted and categorized into one of three groups based on terminal degree: MD holders, DO holders, and Other-degree holders. Authors whose degrees could not be identified were counted as “Unidentifiable.” Additional data including sponsoring organization, organization type, and specialty were collected. Results A total of 674 guidelines were published by US organizations in 2021, 2022, and 2023, with 604 reporting author information. A total of 9,376 authors were counted. Of that, 7,253 held an MD (77 %), 110 held a DO (1.2 %), and 1,848 held another terminal degree (19.7 %); meanwhile, 1.66 % of counted authors did not have an identifiable degree. A total of 604 guidelines published by US organizations were identified. Of these, 88 (14.6 %) contained at least one DO author in their author list. Sixty-two unique specialties were identified, along with 130 unique sponsoring organizations. Of those specialties, 28 (44.4 %) had at least one DO author of at least one guideline. Of 130 sponsoring organizations, 44 (33.8 %) developed at least one guideline with at least one DO author. No osteopathic sponsoring organizations were identified. Conclusions Based on these results, we conclude that DOs are underrepresented in the development of guidelines.

Context Simulation-based medical education (SBME) is a method for enhancing learner skill prior to initiating care for real patients. Although the use of SBME continues to grow, there is limited data on simulations related to osteopathic medical training. Osteopathic manipulative medicine (OMM) applies hands-on techniques to facilitate healing. We hypothesized that the use of SBME to closely mimic OMM provided to the hospitalized patient would help to increase individual knowledge and comfort with OMM techniques and increase the likelihood of a learner utilizing OMM techniques on patients. Objectives This study aimed to determine the effectiveness of the SBME lab to enhance the learning of medical learners of OMM on hospitalized patients, and to determine the favorability of the OMM SBME experience by learners. Methods This was a single-institution pilot quality improvement project that utilized a novel simulation to provide OMM to critically ill and hospitalized patients. The simulation was a single instructor-led event lasting 2 h. The OMM experience utilized specialized simulation gowns and hospital beds to mimic the treatment of postsurgical ileus, acute respiratory failure, and congestive heart failure (CHF) exacerbation. Learners alternated between the role of physician (practicing technique) and the patient (wearing the simulation gown). Pre- and postsurveys evaluated learners’ knowledge and comfort regarding OMM in hospitalized patients. Graduate medical residents/fellows from five osteopathic-recognized programs and medical students on rotations (n=35) participated in the simulation, and n=32 completed the postsimulation survey. The survey included 15 questions and utilized a 5-point Likert Scale. Results were analyzed with the chi-square test. Results The average knowledge pretest score ranged from 2.5 to 3.5 for the 15 questions. Learner knowledge improved for all areas evaluated, with a range of 3.6–4.6 for the postsurvey. The p-value was significant for each question. In addition, lab, simulation, and lecturers were evaluated and were received positively. Conclusions This study demonstrates that simulation may be an effective way to increase knowledge and comfort on how to apply OMM in a hospital setting.

Context Although a large proportion of US emergency physicians are osteopathic physicians (Doctor of Osteopathic Medicine [DOs]), the frequency of osteopathic manipulative medicine (OMM) use in emergency departments (EDs) is unknown. Objectives We aimed to estimate the frequency of OMM in EDs across the US and describe the cohort who received OMM. Methods We performed a retrospective cohort study of ED patients from 2018 to 2021 in the Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Encounters with OMM were identified by diagnosis and procedure codes. We calculated weighted frequencies of encounters with OMM per 100,000 ED encounters with 95 % confidence intervals (CIs) by year, accounting for the complex survey design of NEDS. Results We identified 9,576 encounters with OMM during the study period. The weighted frequency of encounters with OMM per 100,000 ED encounters was 6.9 (95 % CI, 3.8 to 11.5) for 2018, 8.6 (4.3–15.5) for 2019, 12.6 (3.5–32.0) for 2020, and 5.5 (3.3–8.5) for 2021. Most patients were female (5,669, 59.2 %) with a median age of 53 (interquartile range [IQR] 36 to 67). The majority were from metropolitan teaching hospitals (7,094, 74.1 %), and about half were admitted (4,565, 47.7 %). The most common osteopathic diagnosis code was segmental and somatic dysfunction of the thoracic region (4,202 of 21,358 [19.7 %] codes). Conclusions OMM is infrequently provided across hospital-owned US EDs. Further research is needed to describe the frequency of OMM across all acute care settings.

Context A small percentage of patients comprise a high proportion of healthcare utilization, particularly the costs associated with Emergency Department (ED) visits and inpatient hospitalization readmissions. Objectives The purpose of this study was to demonstrate a decrease in ED utilization and hospital readmissions in a selected group of super-utilizers post-intervention by a Community Care Coordination (CCC) team and to determine cost avoidance. Methods This was a retrospective chart analysis of selected super-utilizers enrolled in our CCC program. Each patient served as their own historical control to compare utilization rates, and a cost-benefit analysis was performed. Results A total of 368 patients participated in the CCC program during the specified time period. We found a significant reduction in ED visits and hospital admissions post-enrollment. The cost-benefit analysis showed an overall cost avoidance of $2,508,899.40, which is a 46 % cost reduction. Conclusions Our study demonstrates a reduction in healthcare utilization and provides critical information to fix the significant, national burden that ED super-utilizers impose on the healthcare system. This program aligns well with the osteopathic principles of the whole-person approach, emphasizing prevention and wellness and prioritizing dignity in healthcare.