The effect of the COVID-19 pandemic on osteopathic education in ACGME-OR residencies from February 2020 to February 2021

Didactic education

As shown in Table 1, prior to February 2020, 88.3% (53) of ACGME-OR programs responding to the survey reported in-person-only didactics, with only 6.7% (4) reporting a combination of in-person and virtual platform (Zoom or other videoconferencing software) didactic sessions. No programs reported utilizing a virtual platform as their only delivery mechanism for their didactic curriculum. Didactic sessions that covered OMM were reported as occurring monthly in 61.7% (37) of programs, followed by every 3 months in 18.3% (11) of programs, as shown in Table 2. During the height of the pandemic from February 2020 to June 2020, there was a dramatic decrease of in-person-only didactic sessions, with only 8.3% (5) of respondents indicating utilization of this delivery method, as shown in Table 1. There was an increased utilization of combined in-person/virtual didactics to 31.7% (19) of programs and virtual-only didactics utilized at 46.7% (28) of programs, also shown in Table 1. There was additionally a decrease in the number of programs offering monthly didactic sessions with OMM to 40.0% (24) of programs, and 26.7% (16) of programs provided no OMM didactic education during this period (Table 2). During the recovery period of July 2020 to February 2021, programs continued to utilize a hybrid of in-person and virtual didactics or virtual-only didactics at higher rates than before the COVID-19 pandemic, at 53.3% (32) and 41.7% (25) respectively (Table 1). The number of programs offering no OMM didactic education fell to 8.3% (5) (Table 2). Figure 1 summarizes the information in Table 2 by showing the number of programs offering OMM didactic sessions with frequencies of >12, 7–12, 3–6, 1–2, and 0 times per academic year for the three time periods analyzed in this study.

Figure 1:

The impact of the COVID-19 pandemic on osteopathic manipulative medicine (OMM) didactic education in Accreditation Council for Graduate Medical Education-Osteopathic Recognition (ACGME-OR) programs as gauged by the number of OMM didactic sessions per academic year.

Table 3 demonstrates a dramatic change in the method of instruction of OMM didactic education going into the lockdown period and from the lockdown period into the recovery period. Before the lockdown period, the favored method of instruction was a combination of resident and attending lecture with a hands-on component (55.0%; 33). Resident lectures with a hands-on component (8.3%; 5) were favored over resident lectures without a hands-on component (3.3%; 2). The same held true for attending lectures, with 15.0% (9) reporting a hands-on component and 5.0% (3) reporting no hands-on component. During the lockdown period, the favored method of instruction became a combination of resident and attending lectures without a hands-on component (28.3%; 17). Lectures without hands-on components were preferred over those with a hands-on component for lectures by attendings (20.0%; 12 compared to 1.7%; 1) and by residents (10.0%; 6 compared to 0.0%; 0). After the lockdown period, the preferred method of instruction again became a combination of resident and attending lecture with a hands-on component (36.7%; 22), as it was before the lockdown period. However, resident lectures without a hands-on component (6.7%; 4) were still preferred over those with a hands-on component (0.0%; 0) and attending lectures without a hands-on component (16.7%; 10) were still preferred over those with a hands-on component (6.7%; 4), as it was during the lockdown period.

OMM direct patient care

The impact of the COVID-19 pandemic on the utilization of OMM in patient care in ACGME-OR programs is demonstrated in Tables 4 and 5. Prior to February 2020, 56.7% (34) of respondents reported residents or fellows utilized OMM in patient care at least weekly, and 21.7% (13) reported utilizing OMM one to three times per month (Table 4). A total of 63.3% (38) of programs reported that residents were utilizing OMM for direct patient care in both an outpatient and inpatient environment, whereas 26.7% (16) reported utilization only in the outpatient care of patients (Table 5). During the height of the pandemic from February 2020 to June 2020, there was a dramatic decrease in the number of designated osteopathic residents and fellows utilizing OMM in patient care. The reported frequency of utilization of OMM in patient care was 16.7% (10) utilizing OMM at least weekly and 31.7% (19) utilizing OMM one to three times per month. The proportion of programs reporting residents not utilizing OMM in the care of patients rose to 30.0% (18), compared to 0.0% (0) prior to February 2020 (Table 4). From February to June 2020, there was a decrease in utilization in the combined inpatient and outpatient environment to 26.7% (16) and an increase in the outpatient-only environment to 43.3% (26) (Table 5). In July 2020 to February 2021, programs reported residents and fellows increasing the utilization frequency of OMM, but its use was still at a lower frequency than prior to the start of COVID-19 pandemic in February 2020. A total of 40.0% (24) of programs reported utilization of OMM during patient care at least weekly, and 33.3% (20) of programs reported utilization one to three times per month. However, 6.7% (4) of programs continued to report that residents and fellows were not utilizing OMM in patient care (Table 4). Similarly, 41.7% (25) of programs reported that OMM patient care was only occurring in the outpatient environment (Table 5).

Study strengths and limitations

The strengths of this study include presenting responses from a wide variety of specialties and a wide regional distribution of ACGME-OR programs. This study examines utilization practices of OMM in the didactic and patient care environment before the pandemic and then in the active lockdown and postlockdown environments, and this could benefit researchers looking at the osteopathic learning environment in the future. The limitations of this study include its response rate of only 24.5% (69 out of 282). Although this may be considered a reasonable response rate for a survey-based research project, it is difficult to know with certainty whether programs responding are representative of the larger group. The study data are also limited by recall bias, particularly in the assessment of prepandemic baselines and early pandemic events. Finally, this study only covers a relatively short amount of time in the postlockdown period and does not take into account future lockdown periods or spikes in COVID-19 cases beyond February 2021. Ideally, further studies will shed light on whether or not osteopathic residency education returns to, for example, incorporating the same level of hands-on training as it did before the pandemic.

Data exclusions

ONMM programs were excluded from the data analysis. These programs are governed by the ACGME program requirements in ONMM [8]. These program requirements define the amount and frequency of learning and patient care required in OMM and would have skewed the results to a higher frequency of OMM didactic education and patient care experiences.