Home Medicine Concerns of osteopathic medical students during the COVID-19 pandemic
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Concerns of osteopathic medical students during the COVID-19 pandemic

  • Odeh Hanna , Christopher J. Vinyard ORCID logo and Sharon Casapulla ORCID logo EMAIL logo
Published/Copyright: May 15, 2024
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 124 Issue 11

Abstract

Objectives

This study aims to quantify the areas of most concern in medical students in relation to their residency application in the setting of the COVID-19 pandemic and to identify risk factors for all that cause concern and specific areas of concern in a population with well-established high rates of anxiety at baseline. The COVID-19 pandemic introduced sweeping changes to medical education that had wide-ranging effects on medical students and their applications for medical residencies.

Methods

In August 2020, we utilized a cross-sectional study to quantify student’s areas of concern related to residency application related to the COVID-19 pandemic. We asked participants to rate their levels of concern in 15 different aspects related to medical residency applications and the perceived impact that COVID-19 had on each.

Results

The survey was distributed to 984 osteopathic medical students, with 255 complete responses. The three areas of greatest impact were shadowing opportunities (4.15), volunteer opportunities (4.09), and conferencing opportunities (4.09). The most salient demographic variables were year in school, sex, and locale. Females reported higher levels of concern across all categories in the study compared to males, with statistical significance across all categories (all p<0.05, Range d=0.16 to 0.43), except for letters of recommendation and sub-internships.

Conclusions

The areas of most concern identified in our study were consistent with prior studies and may implicate the pressures that female medical students may feel compared to their male counterparts. The underlying cause(s) may be subject to future research.

Keywords: COVID; medical students; residency

The impact of medical training and its association with negative psychological consequences compared with the general population is well established [1], [2], [3], [4], [5]. Medical training, for a variety of reasons, is correlated with increases in major depressive disorder and generalized anxiety disorder compared to the general population [5, 6] and even similarly aged postsecondary students. 7 Multiple studies have attempted to quantify the prevalence of generalized anxiety disorder in medical students prior to COVID-19 and after the pandemic began [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. There is a lack of consensus on the prevalence of anxiety and its shift throughout the course of the pandemic, along with the risk and protective factors for preclinical and clinical medical students in the United States.

Some studies have indicated that the prevalence of anxiety has increased [13, 17], [18], [19], [20], whereas others indicate that it has not changed significantly or has even decreased [10, 11]. One study very early in the pandemic (April–May 2020) found that one quarter of respondents screened were at risk for PTSD [17]. Multiple risk factors and protective factors for anxiety in medical students during the COVID-19 pandemic have been identified [11, 16, 21], [22], [23]. Risk factors include: poor coping skills, having a friend or relative affected by COVID-19, preclinical students, living in rural areas, extrinsic motivation for choosing to pursue medicine, economic effects of the pandemic, effect on daily life, and delays in academic activities [11, 13, 22, 23]. There are mixed results about whether female students would experience increased risk for negative psychological effects [10, 16], [17], [18], [19], [20, 23]. Lasheras et al. [11] reported similar findings in their systematic review of the topic.

The concerns of medical students vary by year [24]. Byrnes et al., [24] for example, found that 26.4 % of second-year medical students indicated that their specialty choice would be affected. The most common reason was due to limited “opportunity to explore their specialty of choice,” followed by not being able to strengthen their application to residency. The three most frequently cited concerns were conferences and networking opportunities, clinical experience, and board examination scores. First-year medical students most frequently cited concerns about research. Second-year students cited concerns about board examinations and clinical experiences. Third=year students cited subinternships, letters of recommendation, and the interview trail. This highlights the varying challenges and effects that longitudinal change in medical education can have on various types of students [24].

Given the well-established literature regarding high levels of anxiety in this study population and preliminary research showing that the COVID-19 pandemic has raised concerns over the medical residency application in students, we hypothesized that students in our study population would have increased concerns related to the impact of the COVID-19 pandemic. We also hypothesized that year in school, gender, and campus location would be risk factors for those concerns. With this study, we aimed to quantify the areas of most concern in medical students in relations to their residency application in the setting of the COVID-19 pandemic.

Methods

We utilized a survey to quantify and describe medical students’ areas of concern related to residency application and to identify risk and protective factors resulting from the COVID-19 pandemic. We also attempted to identify areas of potential anxiety that may impact general levels of concern.

Setting and participants

This cross-sectional study took place at an osteopathic medical school in the Midwest with an enrollment of approximately 984 in August 2020.

Instruments

We created an online survey in Qualtrics that was emailed to all enrolled medical students in August 2020 (Supplementary Material). The survey was released in August 2020 and left open for a total of 3 weeks. We sent three reminders over the 3-week period. The approved consent form was included at the beginning of the online survey. After data analysis, a Google number generator was performed to award two $50 prizes for participation in the survey.

Outcomes measured

The survey included 11 demographic questions (gender, age, marital status, race, ethnicity, campus locale, year in school, preferred specialty, contracted COVID, friend had COVID-19, or loved one had COVID-19) and 15 Likert-type response statements. We asked participants to rate their levels of concern (none, a little, moderate amount, a lot, and a great deal) in 15 different aspects of medical residency applications and of the perceived impact of COVID-19 on those 15 aspects. We also asked participants to rate the five areas of greatest concern from those 15 aspects. We also asked if their research projects had been affected as a result of the COVID-19 pandemic. The 15 different aspects and the section regarding research was heavily influenced by previous work done by Guadix et al. [25] Lastly, we composed a three-question scale to assess levels of anxiety related specifically to the pandemic. We were unable to find validity and reliability studies for Guadix et al. [25].

Analysis of outcomes

Descriptive statistics, F tests (analysis of variance [ANOVAs] and post hoc tests), and independent samples t tests were performed utilizing SPSS statistical software version 26 (IBM, Armonk, NY). The self-reported level of concern across the 15 aspects of medical residency applications were compared across demographic variables of interest (year in school, gender, whether a friend or loved one contracted COVID-19, campus, area, and race).

Institutional Review Board (IRB) statement

This study was approved by the Institutional Review Board (20 × 132) at Ohio University.

Sample size and statistical power

An a priori power analysis revealed a targeted sample size of n=180. This was calculated based on an F test detecting a medium effect with 80 % power.

Results

The survey was distributed to 984 medical students, and there were 255 complete responses for a completion rate of 26 %. The study population had 157 female respondents (61.6 %) and 98 male respondents (38.4 %), 209 respondents self-identified as White (82.0 %), 10 as Black or African American (3.9 %), 18 as Asian (7.1 %), 10 as multi-racial (3.9 %), 6 as other (2.3 %), and 2 preferred not to disclose this information (0.8 %). The study had 54 respondents who reported living in a rural setting (21.2 %), 158 in a suburban setting (62.0 %), and 43 in an urban setting (16.8 %). There were 103 first-year osteopathic medical students (40.4 %), 54 s-year osteopathic medical students (21.2 %), 45 third-year medical students (17.6 %), 51 fourth-year medical students (20.0 %), and 2 transitional-year students (0.8 %) in the study. A total of 102 respondents indicated that a friend or loved one had contracted COVID-19 (40 %), as opposed to 151 respondents who had not (59.2 %), with another 2 respondents preferring not to answer (0.8 %) (Table 1).

Table 1:

Demographic data.

Characteristic n, %
Gender
 Male 98 (38.4)
 Female 157 (61.6)
Age
 Mean=24.7, median=24, mode=23 250 (98.0)
 Prefer not to answer 5 (2.0 %)
Marital status
 Married 42 (16.5)
 Single 194 (76.1)
 Engaged 16 (6.3)
 Prefer not to answer 3 (1.1)
Race
 White 209 (82.0)
 Black or African American 10 (3.9)
 Asian 18 (7.1)
 Two or more races 10 (3.9)
 Other 6 (2.3)
 Prefer not to answer 2 (0.8)
Ethnicity
 Hispanic or Latino or Spanish origin 9 (3.5)
 Not Hispanic or Latino or Spanish origin 246 (96.5)
Locale
 Rural 54 (21.2)
 Suburban 158 (62.0)
 Urban 43 (16.8)
Year in school
 1 103 (40.4)
 2 54 (21.2)
 3 45 (17.6)
 4 51 (20.0)
 Research or transitional year 2 (0.8)
Desired specialty
 Family medicine 64 (25.1)
 Pediatrics 33 (12.9)
 Emergency medicine 37 (14.5)
 Internal medicine 44 (17.3)
 Obstetrics/Gynecology 11 (4.3)
 General surgery 27 (10.6)
 Anesthesia 9 (3.5)
 Psychiatry 6 (2.4)
 Dermatology 6 (2.4)
 PM&R 6 (2.4)
 Pathology 3 (1.2)
 ENT 2 (0.8)
 Neurology 3 (1.2)
 Ophthalmology 1 (0.4)
 Radiology 1 (0.4)
 Undecided 2 (0.8)
Contracted COVID-19
 Yes 6 (2.4)
 No 246 (96.5)
 Prefer not to answer 3 (1.1)
Friend or loved one contracting COVID-19
 Yes 102 (40.0)
 No 151 (59.2)
 Prefer not to answer 2 (0.8)

  1. ENT, ear, nose, and throat; PM&R, physical medicine and rehabilitation.

Medical student concern related to COVID-19

We asked participants which areas of their application for medical residency would be most impacted by the COVID-19 pandemic. The three areas of greatest perceived impact were volunteer opportunities (4.09), shadowing opportunities (4.15), and conferencing opportunities (4.09). The most salient demographic variables were year in school, gender, and locale. An F test revealed a significant effect of year in school on concern in areas related to subinternships (F [4, 248]=9.61, p<0.001, η 2=0.13), clinical skills (F [4, 248]=7.25, p<0.001, η 2=0.11), class rank (F]4, 248]=14.98, p<0.001, η 2=0.19), and quality of medical school education (F [4, 248]=4.99, p<0.001, η 2=0.08) (Table 2).

Table 2:

Year in training and variables of concern.

Variable Year in training n Mean, SD SE p-Value
Networking within field(s) of interest Preclinical 157 3.662 (0.951) 0.076 0.362
Clinical 96 3.781 (1.088) 0.111
Obtaining letters of recommendation Preclinical 157 3.032 (1.201) 0.096 0.001
Clinical 96 3.542 (1.256) 0.128
Board performance Preclinical 157 2.777 (1.228) 0.098 <0.001
Clinical 96 3.396 (1.119) 0.114
Subinternships Preclinical 157 3.318 (1.132) 0.090 <0.001
Clinical 96 3.969 (1.252) 0.128
Volunteer opportunities Preclinical 157 4.108 (0.910) 0.073 0.663
Clinical 96 4.052 (1.118) 0.114
Shadowing opportunities Preclinical 157 4.217 (0.865) 0.069 0.149
Clinical 96 4.031 (1.165) 0.119
Clinical skills Preclinical 157 3.611 (1.119) 0.089 0.233
Clinical 96 3.781 (1.058) 0.108
Communication skills with patients Preclinical 157 3.000 (1.251) 0.100 0.612
Clinical 96 3.083 (1.295) 0.132
Class rank Preclinical 157 2.567 (1.351) 0.108 <0.001
Clinical 96 1.990 (1.091) 0.111
Preclinical/clinical grades Preclinical 157 2.904 (1.208) 0.096 <0.001
Clinical 96 2.354 (1.161) 0.118
Research experience Preclinical 157 3.720 (1.148) 0.092 <0.001
Clinical 96 2.990 (1.277) 0.130
Conferencing opportunities Preclinical 157 4.070 (1.155) 0.092 0.814
Clinical 96 4.104 (1.061) 0.108
Quality of medical education Preclinical 157 3.389 (1.090) 0.087 0.003
Clinical 96 3.792 (0.994) 0.101
Educational timeline (taking years off) Preclinical 157 2.140 (1.298) 0.104 0.140
Clinical 96 2.385 (1.243) 0.127
Competitiveness of residency application Preclinical 157 3.293 (1.351) 0.108 0.428
Clinical 96 3.427 (1.220) 0.125
Total 255

  1. SD, standard deviation; SE, standard error.

Post hoc tests revealed that students in their fourth year were more concerned about sub-internships as compared to first-year (p<0.001), second-year (p=0.004), and third-year medical students (p=0.002). Similarly, second- and fourth-year medical students had elevated concern regarding how their clinical skills would be impacted compared to students in year 1 (p<0.003). Second-year students had elevated concern compared to those in year 3 (p=0.02). Furthermore, second-year students had greater concerns about class rank compared all other classes when compared directly (all p<0.001). Of all years, fourth-year medical students had the highest level of concern about quality of medical education (p<0.001).

When considering preclinical (first and second years) to clinical students (e.g., third- and fourth-year students), a t-test revealed that clinical students were more concerned than preclinical students about letters of recommendation (t [251]=−3.22, p=0.001, d=−0.42), board scores (t [251]=−4.02, p<0.001, d=−0.52), subinternships (t [251]=−5.26, p<0.001, d=−0.55), and quality of medical education (t [251]=−2.95, p=0.003, d=−0.38). Preclinical students were more concerned about grades (t [251]=3.57, p<0.001, d=0.46), class rank (t [251]=3.54, p<0.001, d=0.50), and research opportunities (t [251]=4.70, p<0.001, d=0.61) (see Table 2).

There were also gender differences detected, with females reporting higher levels of concern across all categories in the study compared to males with statistical significance across all categories (all p<0.05, Range d=0.16 to 0.43) except for letters of recommendation and subinternships (Table 3).

Table 3:

Gender and variables of concern.

Variable Gender n Mean, SD SE p-Value
Networking within field(s) of interest Female 156 3.821 (1.0250) 0.082 0.023
Male 97 3.526 (0.948) 0.096
Obtaining letters of recommendation Female 156 3.301 (1.210) 0.097 0.219
Male 97 3.103 (1.295) 0.131
Board performance Female 156 3.212 (1.153) 0.092 <0.001
Male 97 2.691 (1.270) 0.129
Subinternships Female 156 3.660 (1.205) 0.096 0.116
Male 97 3.412 (1.231) 0.125
Volunteer opportunities Female 156 4.119 (0.926) 0.074 0.023
Male 97 3.907 (1.071) 0.109
Shadowing opportunities Female 156 4.269 (0.875) 0.875 0.012
Male 97 3.948 (1.131) 1.131
Clinical skills Female 156 3.788 (1.084) 1.084 0.038
Male 97 3.495 (1.100) 1.100
Communication skills with patients Female 156 3.173 (1.296) 1.296 0.024
Male 97 2.804 (1.187) 1.187
Class rank Female 156 2.500 (1.342) 1.342 0.017
Male 97 2.103 (1.159) 1.159
Preclinical/clinical grades Female 156 2.878 (1.236) 1.236 0.002
Male 97 2.402 (1.133) 1.133
Research experience Female 156 3.590 (1.264) 1.264 0.017
Male 97 3.206 (1.190) 1.190
Conferencing opportunities Female 156 4.244 (0.986) 0.986 0.004
Male 97 3.825 (1.267) 1.267
Quality of medical education Female 156 3.705 (1.011) 1.011 0.002
Male 97 3.278 (1.116) 1.116
Educational timeline (taking years off) Female 156 2.436 (1.316) 1.316 0.001
Male 97 1.907 (1.155) 1.155
Competitiveness of residency application Female 156 3.538 (1.262) 1.262 0.002
Male 97 3.031 (1.311) 1.311
Total 255

  1. SD, standard deviation; SE, standard error.

Those who indicated that a friend or loved one contracted COVID-19 were more concerned about preclinical/clinical grades (M=2.971, SD=1.246) compared to those who did not (M=2.510, SD=1.165), t [251]=2.99, p=0.003, d=0.38. Similarly, those who indicated a friend or loved one having contracted COVID-19 were more concerned about research experience (M=3.667, SD=1.137) compared to those who did not (M=3.291, SD=1.299), t [251]=2.37, p=0.02, d=0.30.

Those who lived in suburban areas were more concerned about networking opportunities (F [2, 250]=4.53, p=0.01, η 2=0.04) and board performance (F [2, 250]=3.44, p=0.0, η 2=0.03) than either rural or urban areas. No other areas were statistically significant. Analyses were conducted entering race as a covariate to examine whether area of residence had a significant effect controlling for race. In these analyses, area remained significant in the presence of race as a covariate (Table 4).

Table 4:

Area of participant and variables of concern.

Variable Area Mean, SD p-Value
Networking opportunities Rural 3.566 (1.010) 0.012
Suburban 3.643 (1.025)
Urban 4.116 (0.823)
Board performance Rural 3.075 (1.253) 0.034
Suburban 2.879 (1.200)
Urban 3.419 (1.200)

  1. SD, standard deviation.

People that self-identified as Black or African American indicated higher levels of concern about board performance (F [4, 248]=3.73, p=0.006) and subinternships (F [4, 248]=2.77, p=0.03) than those who identified as White or “other” (Table 5). When looking at race, people that self-identified as “other” reported lower concern with both board performance (F [4, 248]=4.99, p=0.002) and subinternships (F [4, 248]=2.98, p=0.03).

Table 5:

Race of participant and variables of concern.

Variable Race Mean, SD p-Value
Boards White 2.98 (1.20) 0.006
Black/AA 3.90 (1.18)
Asian 3.06 (1.37)
Bi/Multiracial 3.50 (1.28)
Other 1.67 (0.52)
Subinternships White 3.54 (1.23) 0.03
Black/AA 3.70 (1.31)
Asian 3.94 (1.02)
Bi/Multiracial 4.20 (1.04)
Other 2.33 (1.23)

  1. AA, African American; SD, standard deviation.

Impact on student research

When asked how the COVID-19 pandemic impacted their research, 64 (25.1 %) respondents reported they had ongoing research projects, whereas 89 (34.9 %) reported some level of impact on their research. In the overall sample, 14 participants indicated that their research had been cancelled (5.5 %), 18 reported that their research had stopped (7.1 %), 30 reported that their research had been slowed (11.8 %), 23 reported that their research had no bearing (9.0 %), and 4 responded that the pandemic expedited their research (1.6 %). When asked how the COVID-19 pandemic would impact future research plans, 41 respondents expressed that it canceled their plans (16.1 %), 56 expressed that it had no impact on their plans to conduct research (22.0 %), 24 responded that it shortened the time to do research (9.4 %), 6 responded that it gave them a new opportunity to conduct research (2.4 %), and 13 responded that it caused them to undertake a new project (5.1 %) (Table 6).

Table 6:

Impacts of COVID-19 on research.

Ongoing research
Impact n, %
It has canceled my research. 14 (5.5)
It has stopped my research. 18 (7.1)
It has slowed my research. 30 (11.8)
It has had no bearing on my research. 23 (9.0)
It has expedited my research. 4 (1.6)
I did not have ongoing research. 166 (65.1)
Plans to do research
It has canceled plans to do research. 41 (16.1)
It has had no impact on plans to do research. 56 (22.0)
It shortened the amount of time to do research. 24 (9.4)
It provided an opportunity to do research. 6 (2.4)
It has forced me to work on a different research project. 13 (5.1)
I did not have plans to do research. 122 (47.8)

Discussion

In relation to the COVID-19 pandemic, medical students in our study were most concerned about volunteer opportunities, shadowing opportunities, and conferencing opportunities. Ongoing student research was also negatively impacted for a majority of the respondents. Notably, our results revealed that female osteopathic medical students had higher levels of concern regarding the impact of the COVID-19 pandemic on their chances of successfully matching to a residency than their male counterparts.

Our data support other studies that found that female medical students had higher levels of concern compared to their male counterparts during the COVID-19 pandemic. Females had higher levels of concern on 14 of the 16 items, suggesting an overall higher concern on average. This is consistent with most other studies looking at similar topics in relation to anxiety [10, 11, 16, 19, 20]. This may be because of sexism [26], [27], [28], the culture of medicine [28, 29], differing adjustments to new stressors [19], being more sensitive to pressure [30], or another reason not listed.

Another demographic variable that was relevant was the year in school. Fourth-year medical students were more concerned about subinternships and quality of medical education than students in other years of medical school. It is reasonably expected that fourth-year medical students would be most concerned about subinternships. Their increased levels of concern compared to third-year students; however, these levels of concern might hint at the perceived transient nature of the pandemic for third-year medical students. Second- and fourth-year medical students had higher levels of concern about the impact of COVID-19 on their clinical skills than first- and third-years students. We speculate that some of this concern may be due to the transitions occurring for medical students (e.g., transition to clinical experiences and transition to residency). Not surprisingly, clinical-year students (third- and fourth-year students) were significantly more concerned with letters of recommendation and subinternships than preclinical students. Interestingly, concerns about board scores and quality of medical education were also higher in clinical students than preclinical students. This was surprising because we expected preclinical students to have higher rates of concern in these two categories due to stage of training and upcoming Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1/United States Medical Licensing Examination (USMLE) Step 1 examinations, which are perceived to be the most important among all of the medical licensure examinations. This again highlights the differing values that students have as they progress through their medical education [25].

Limitations of our study include the cross-sectional nature of the study and convenience sampling. Additionally, our study looked only at students attending a single institution; a study attempting to capture perspectives across the United States might allow for increased generalizability. Because there was a response rate of 26 % among students attending this institution, it is possible that the internal validity of this study is compromised. Similarly, our study has a stronger proportion of first-year medical students, which may alter the all-cause highest levels of concern toward items that are more valued as a preclinical student rather than a clinical student.

Our study occurred relatively early in the COVID-19 pandemic and prior to the release of the COVID-19 vaccine. The COVID-19 pandemic introduced sweeping changes to medical education that had wide-ranging effects on medical students and their applications for medical residencies. Future studies should explore, perhaps qualitatively, female medical students’ levels of concern on aspects of their medical residency application in the postpandemic world and propose/test new approaches to mitigate this concern. Studies exploring the impact of the pandemic are starting to appear in the medical education [17, 31], [32], [33], but more are needed to paint a more complete picture of how COVID-19 has impacted medical students. The results of our study may provide a starting point for future studies investigating early pandemic student anxiety compared to postpandemic concerns.

Conclusions

We aimed to quantify the areas of most concern in medical students in relation to their residency application during the COVID-19 pandemic and to identify protective and risk factors for general concern and specific areas of concern. Relatively early in the pandemic, the medical students in this study were most concerned about volunteer opportunities, shadowing opportunities, and conferencing opportunities. Female osteopathic medical students had higher levels of concern regarding the impact of the COVID-19 pandemic on their chances of successfully matching to a residency.

Our results are consistent with prior studies and highlight the pressures that female medical students feel compared to their male counterparts [20]. Leaders in medical education should be aware of the varying concerns of medical students and consider any shortcomings related to research, conference attendance and perceived commitment to the specialty, and volunteer experiences in context. Taking students year in school into account also may prove important to reflect the concerns and needs of students.

We may have progressed to a postpandemic status, but future disruptive events are inevitable. Although this study is cross-sectional in nature and only captures a snapshot in time at the earlier stages of the COVID-19 pandemic, the lessons learned can translate into programs that foster resilience in all medical students and in the systems in which they train.

Corresponding author: Sharon Casapulla, MEd, EdD, MPH, Clinical Adjunct Assistant Professor, Department of Primary Care, Director of Education and Research, Office of Rural and Underserved Programs, Heritage College of Osteopathic Medicine, Ohio University, Heritage Hall 283G, 191 West Union Street, Athens, OH 45701, USA, E-mail:

Acknowledgments

The authors wish to thank Lisa Forster (Chief Communications Officer, Ohio University Heritage College of Osteopathic Medicine) for assisting with the initial design of the study, and Hannah Osborn (Graduate School Advisor, Psychology Advising and Resource Center, Experimental Social Psychology, Ohio University) for assisting with the data analysis.

  1. Research ethics: This study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). This study was approved by the Institutional Review Board (20 × 132) at Ohio University.

  2. Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission. OH and SC developed the instrument and drafted the manuscript. CV edited the manuscript and assisted with data analysis and interpretation.

  4. Competing interests: None declared.

  5. Research funding: None declared.

  6. Data availability: Data not available.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jom-2023-0092).

Received: 2023-04-19
Accepted: 2024-03-21
Published Online: 2024-05-15

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2023-0092
Keywords for this article
COVID; medical students; residency
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. Medical Education
  3. Original Article
  4. Concerns of osteopathic medical students during the COVID-19 pandemic
  5. Musculoskeletal Medicine and Pain
  6. Original Article
  7. Pelvic joint stiffness and fear of falling in patients over 75 years of age: a prospective cohort study of 100 patients
  8. Neuromusculoskeletal Medicine (OMT)
  9. Review Article
  10. A systematic review of manual therapy modalities and anxiety
  11. Pediatrics
  12. Original Article
  13. Association of prenatal substance exposure and the development of the amygdala, hippocampus, and parahippocampus
  14. Public Health and Primary Care
  15. Original Article
  16. Feasibility of a cinematic-virtual reality training program about opioid use disorder for osteopathic medical students: a single-arm pre–post study
  17. Letters to the Editor
  18. Regarding “Issues of informed consent for non-specialists conducting colorectal cancer screenings”
  19. Response to: Regarding “Issues of informed consent for non-specialists conducting colorectal cancer screenings”
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