Trends in osteopathic medical education: a scoping review

Methods

Evidence selection

Following the search, all identified citations were collated and uploaded to PICO Portal (2022, PICO Portal, New York, NY), and duplicates were removed. Following a pilot test, titles and abstracts were screened by two independent reviewers for assessment against the inclusion criteria for the review. The inclusion criteria are documented in a supplemental file (Supplementary Material, Appendix 2). Potentially relevant sources were retrieved in full, and their citation details were imported into Google Drive. The full text of the selected citations was assessed in detail against the inclusion criteria by two or more independent reviewers. Because osteopathic physicians have full practice and equivalent rights to a medical doctor in the United States while internationally, and the designations of Doctor of Osteopathic Medicine (DO) vary considerably, this review excluded research at institutions not accredited in the United States. Reasons for excluding sources of evidence that did not meet the inclusion criteria at the full-text screening stage were recorded and reported in the scoping review. Any disagreements that arose between the reviewers at each stage of the selection process were resolved with additional reviewers. The search results and the study inclusion process are reported in the PRISMA-ScR flow diagram (Figure 1).

Figure 1:

Search results and the study inclusion process.

Results

A total of 8,083 articles were identified and included through searches of all listed databases and resources. A total of 3,795 duplicates were identified and removed. Thus, 4,288 titles and abstracts were screened, and 2,343 articles were excluded. As a result, a total of 1,945 articles were included and moved on to full-text screening. A total of 1,203 articles were included after full-text screening. KH and MM reviewed the remaining articles to identify trends in the areas of publication type, osteopathic schools creating the content, and topics covered in these sources.

The publication types (Table 1) were almost evenly split between articles from peer-reviewed journals (42.0 %; n=505) and conference abstracts (40.1 %; n=482). Other publication types included opinion/editorials (11.9 %; n=143), publications such as policy papers and magazine articles (5.2 %; n=63), and theses/dissertations (0.8 %; n=10). Table 2 identifies the top publishing colleges of osteopathic medicine that authored presentations or publications.

This scoping review identified 23 primary trends in osteopathic medical education (Table 3), many of which had subtrends (Supplementary Material, Appendix 4). Each source could have multiple trends, so the trend numbers exceed the number of sources. The top three trends were residency (26.4 %; n=318), curriculum (19.5 %; n=235), and pedagogy (14.8 %; n=178).

The residency trend (n=318) covered anything pertaining to GME, excluding fellowships. There were 39 residency subtrends, such as accreditation, osteopathic recognition, and information related to specific types of residency programs like pediatrics. Within the residency trend, the top three subtrends were family medicine (n=43), emergency medicine (n=39), and specialty selection (n=21).

The curriculum trend (n=235) pertained to the content covered in the curriculum. There were 22 curriculum subtrends, such as redesign, specialty exposure, and health systems science. Within the curriculum trend, the top three subtrends were clinical skills (n=27), assessment (n=19), and clerkship specialty (n=16).

The pedagogy trend (n=178) referred to different instructional methods to teach the curriculum. There were 19 pedagogy subtrends, such as content delivery method, learner characteristics, and teaching methods like case-based learning. Within the pedagogy trend, the top three subtrends were anatomy (n=22), active learning not otherwise specified (n=20), and technology (n=20).

Discussion

While the primary objective of this scoping review was to examine the significant trends in osteopathic medical education, it also highlighted interesting aspects related to research being conducted in this area, including gaps, and how that research is being disseminated. The authors found the body of literature wide-ranging, with 23 primary trends and dozens of secondary trends identified in just the one decade that this review covered.

The top trend identified in this scoping review was related to osteopathic residencies and residents, representing 26.4 % of the body of work examined. Discussion focused on single accreditation is included under a separate trend, although there is some inevitable overlap between the two. With the historical emphasis on family medicine for osteopathic physicians [12], it was not surprising that this was the top subtrend in the residency category. Articles and presentations covered topics such as the training of family medicine residents [13], the attitudes toward and use of OMT in residency environment [14], and the work environment and its impact on resident well-being [15].

The second major trend included topics related to the curriculum in osteopathic medical education, representing 19.5 % of the information pulled in this scoping review. Articles and presentations focused on assessing student performance across the curriculum, curricular design and redesign, and specific content to include the curriculum. The top subtrend in the curriculum category included information about integrating clinical skills, such as ultrasonography, into osteopathic medical education settings.

The final significant trend, representing 14.8 % of the literature examined in the scoping review, was topics related to pedagogy in osteopathic medical education. These sources examined specific teaching strategies, such as different approaches to teaching anatomy, teaching clinical skills, and utilizing technology in teaching. The top trend in the pedagogy category was articles and presentations related to active learning techniques, such as utilizing Socratic circles [16], interactive small groups [17], and gamification [6]. Other active approaches were categorized separately, such as problem-based and team-based learning.

Although it did not make it to the list of top trends, there were many papers and presentations on transitioning to a single GME accreditation system. This process started in 2015 and went through 2020 [7], which covered half of the time period this review examined and was a significant shift in the world of GME. Most sources expressed optimism [18], whereas some wondered what this would mean for osteopathic distinctiveness [19].

The primary trends with the lowest percentages were Diversity, Equity, and Inclusion in Osteopathic Medical Education (DEI-OME) Populations (1.3 %), Faculty (1.2 %), and Pathway Programs (1.2 %). These are the areas in which additional research could be conducted and published.

Beyond the previously mentioned trends, the authors of this scoping review wanted to learn more about who was researching and creating this content and where this information was being disseminated. The authors found that much of the literature in this area was being created by osteopathic education institutions that have been around for many years and have established research programs. Hopefully, there would be a broader representation of schools if a similar review were to be conducted in the future due to the opening of new osteopathic institutions that did not exist during the years that this scoping review covered.

A finding that needs further examination is where information about osteopathic medical education was disseminated. This scoping review found an almost even split between journal articles (42.0 %) and conference presentations/posters (40.1 %). The authors of the review could not access 4 years of AACOM Educating Leaders conference abstracts. It can be assumed that conference representation would go up with that additional data. The fact that funding for research at osteopathic institutions is much lower than that at allopathic schools, and a lack of emphasis placed on building a research culture [20] may contribute to sharing information through conferences instead of peer-reviewed journals. This could limit the reach of the important work that educators are doing in osteopathic settings. A review comparing trends in osteopathic medical education to allopathic medical education during this same time period would be beneficial.

When reviewing the articles during data extraction, KH and MM completed a separate analysis of topics from 2017 to 2020 to see if any emerging trends differed from what had already been identified. There was a slight increase in the number of articles and conference presentations on teaching content related to DEI during this time. The pedagogy trend saw a consistent decrease, whereas sources related to student wellness increased from only 1.6 % of all articles in 2017 to 12.4 % in 2020.

Limitations

Four years of conference abstracts from AACOM’s Educating Leaders annual conference (2012, 2013, 2014, and 2016) could not be retrieved, which alters the publication type, publication year, and trend results. Osteopathic physicians/educators were consulted because relevant stakeholders but were not part of the scoping review team. Included studies were limited to those published in English.

Conclusions

This scoping review provided a comprehensive examination of the significant trends in osteopathic medical education over the course of a decade before the COVID-19 pandemic. The authors identified 23 primary trends and numerous secondary trends, offering insights into the evolving landscape of osteopathic education. The dominance of topics related to residency, curriculum, and pedagogy demonstrate a focus on the more practical aspects of education.

Additionally, the distribution of information about osteopathic medical education raised concerns, with an almost equal split between journal articles and conference presentations. Although there is active scholarship in this field, the reach may be limited due to the heavy representation from conferences. Leaders in osteopathic education and scholarship should identify strategies to increase osteopathic-specific education research in published journals.