Understanding and preference toward DOs and OMT before and after an osteopathic principles and practice fellow lecture series

Methods

Intervention description

The first part of the project took place during the 2020–2021 academic year and was utilized to identify if preferences toward OMM change effectively after a virtual seminar series. The virtual presentations were held via a video conferencing platform. Participants were asked to consent and complete the presurvey prior to the beginning of the presentation. The presentations were approximately 50 min in length and covered predetermined objectives as developed by the research team. The virtual presentations were delivered in October-November 2020. The second part of the project took place during the 2021–2022 academic year and was utilized to identify the effectiveness of virtual seminar series in comparison to in-person seminar series with the same objectives. The in-person presentations were held in classrooms and clinical skills labs on campus. The same format was utilized for the in-person series as the virtual series in the fall of 2020. The in-person presentations were delivered in October-November 2021.

The general topics covered in these seminars are summarized in Figure 1A. Slide presentations were created for both arms of the project. The presentations each covered the same objectives but differed in the presentation format: either virtually or in-person. Both presentations included student interactions. Virtual participants were able to type or verbally respond to the questions asked, whereas in-person participants were able to verbally respond. Participants were given opportunities to ask for clarification or to discuss confusing topics.

Figure 1:

The osteopathic medicine topics covered and the assessment questionnaire. (A) The topics and subtopics covered in the lecture series. (B) The assessment questionnaire developed to evaluate the attitudes, preferences, and understanding of the osteopathic medicine concepts delivered.

Results

In the session delivered in 2020, a total of 86 MSBS students responded to the presurvey and 52 MSBS students responded to the postsurvey. For the session delivered in 2021, 83 MSBS students responded to the presurvey and 61 MSBS students responded to the postsurvey. Internal consistency, measured through a standardized Cronbach’s alpha, was 0.8067 for the virtual vs. in-person assessment. The 2020 cohort reported an internal consistency alpha value of 0.8373, and the 2021 cohort reported a value of 0.7770. All of the internal consistency values indicate a satisfactory level of internal consistency [16].

Delivery method average scores for the portion of the study comparing virtual vs in-person are presented in Figure 2, and formal testing outcomes of these comparisons are presented in Table 1. The average scores in this assessment indicate that preferences are higher than understanding. Only understanding questions displayed a significant difference (Q6 and Q7). This representation only evaluated the delivery model and does not distinguish pre- and postimprovements. This finding suggests that understanding is the only area where the delivery methods had an impact, thus no additional confounders were considered for this assessment. For the second part of our study evaluating the intervention effectiveness (pre-vs. post-) there is a strong effect observed in preferences. Average scores are presented in Figure 3 with formal testing presented in Table 1. The observed effect is larger among preferences as compared to understanding. The largest increase observed was on Q2 (understanding the origins and history of the osteopathic profession in the United States). The in-person delivery methods displayed no difference in the understanding sections (Q6 and Q8). Our findings in this part of the study indicate that the educational seminar provides a consistent benefit by consistently increasing the scores for preferences regardless of the delivery method. Our data suggest that increasing understanding of osteopathic medicine presents a higher challenge and our interventions were not sufficient for significantly increasing scores.

Figure 2:

The average score responses between the delivery methods (virtual and in-person). Error bars represent the standard error of the mean (SEM).

Figure 3:

The average score responses for (A) effectiveness of changing attitudes and preferences, and (B) effectiveness of changing understanding. Error bars represent the standard error of the mean (SEM).

Discussion

Within our institution, it has been assumed that our MSBS graduates attending DO schools have some concept of osteopathic medicine and optimally a positive outlook toward the field, but these assumptions have not been formally evaluated. MSBS students in this institution have historically relied on informal interactions with DO faculty and students on campus to learn about osteopathic philosophy, OMM, and OMT, with no program-level measurement of preferences and understanding of OMM. This lecture series was designed to accomplish the goals of offering formal exposure and optimally improving preferences and understanding about OMM in the MSBS students. In addition, this exposure to osteopathic concepts could provide benefits to MSBS graduates that attend nonosteopathic institutions because they would be able to act as liaisons for the osteopathic field.

Our intervention was also motivated in part by COVID-19 restrictions. During the COVID-19 pandemic, many educational institutions were required to give instruction virtually on topics that would traditionally only be given in-person. Although initially there were concerns with the effectiveness and practicality of online learning, studies have found that online learning is just as effective in developing understanding as compared to an in-person setting [17], [18], [19], although a combination of both methods is often preferred now [20]. The efficacy of online learning vs. the in-person modality of OMT teaching has not previously been explored. One aim of this study was to explore that efficacy. Our study found improved student preferences toward DO physicians and OMT, and this was successfully achieved with both delivery modalities. This was an encouraging finding because utilizing a virtual platform may be effective for teaching historically in-person content, such as labs. Even when the practical experience should still be provided in person, teaching these concepts through virtual delivery can be utilized to provide additional reinforcement.

An exciting and significant finding was an increased likelihood of recommending a family member to a DO. This suggests that interventions like the one presented have a strong potential to increase a patient’s desire to be seen by DOs and to develop premedical students into advocates for the osteopathic profession and the osteopathic philosophy regardless of their future careers. A study evaluating influences on medical school applicants found that those that concurred with a higher number of osteopathic understanding statements were more likely to apply to DO schools [21]. Therefore, changing the preferences of applicants could lead to an increase in applications to osteopathic medical schools.

This study did not provide evidence that specific understanding of OMT improved in either experimental arm. The reasons for this are not entirely clear. The lectures contained elements such as enthusiastic presenters, provided learning objectives (elements that increase the effectiveness of a lecture) [22], and included the repetition of key concepts that are important for increasing retention [23]. However, didactic content was delivered as traditional lecture, with intermittent active learning practices. Passive learning is known to be less effective in increasing knowledge than active learning but, interestingly, more effective in raising confidence about knowledge [24]. It is possible that the Dunning–Kruger effect [25] was observed in this study, because the surveys revealed an increase in confidence and fairly high confidence about the subject of OMT and DO physicians without a demonstratable increase in specific understanding and with rubric grades that we believe best correlate with a novice learner. Despite that, it is important to highlight that preferences toward osteopathic medicine were significantly improved following the seminar series, regardless of the delivery format. The opportunity for utilization of a seminar series in the MSBS curriculum to improve preferences toward osteopathic medicine is supported by our results. Our study was inconclusive as to whether change in understanding of osteopathic medicine was achieved. Understanding of osteopathic medicine is something that students matriculating into DO school will inevitably develop. For those students who will choose different career paths, further exploration into how to reliably increase understanding through participation in a seminar series is needed.

Some limitations in our study are that it was done in a single program within our institution, part of its approach was motivated by pandemic restrictions, and no control group was included. This acknowledges that an expansion of the study to other programs and institutions with the addition of a more defined experimental design format could provide more accurate findings. Of particular benefit would be collaboration with other osteopathic medical schools with MSBS-type programs. Bias mitigation consisted only in assuring the anonymity of the study and by making the participation voluntary. Expansion and collaboration would allow enough anonymity to collect robust demographic data, including participant background exposure to osteopathic medicine and participant journey to becoming a physician. Our study does not address whether improving preferences toward osteopathic medicine through a seminar series, such as the one utilized in our study, would directly result in increased application or matriculation rates to US osteopathic medical schools. This is something that could be answered with a larger cohort, wider institutional representations, and longer-term follow-up. The success of this seminar series in changing preferences through a virtual platform suggests the viability of an informational series targeted toward both healthcare and nonhealthcare populations. For example, this series could be tailored toward staff, faculty, and administrators employed at osteopathic institutions, undergraduate students interested in becoming physicians, those who would hire DO physicians, and the public who have a choice of selecting their providers. This could be a successful marketing opportunity for the osteopathic profession while empowering patients to make informed decisions regarding their healthcare team.

Conclusions

In this study, we showed that our curriculum was successful in changing preferences regarding the osteopathic profession in a MSBS student population based on our rubric. Both a virtual and in-person delivery platform successfully improved preferences; however, neither platform was effective in increasing the understanding of osteopathic medicine. Improving the preferences of prehealth students, like the MSBS students, could hopefully encourage application to osteopathic medical schools, although more research is needed ideally collaborating with other osteopathic medical schools and MSBS-type programs. While specific study of the impact for those that enter other health professions must be pursued, we are hopeful that the positive change in preferences toward osteopathic medicine observed in this study could possibly have an impact on the awareness, collaboration, and utilization of the osteopathic profession in their future practice.