Home A Path to Osteopathic Distinction: The Touro California GROUPIE Program
Article Open Access

A Path to Osteopathic Distinction: The Touro California GROUPIE Program

  • Michael Clearfield
Published/Copyright: August 1, 2017
Download Article (PDF)
Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 117 Issue 8

Keywords: empathy; medical education; osteopathic identity

Since the inception of the osteopathic medical profession, there has been a continued internal dialogue within its ranks—and to a lesser extent an external dialogue with the public—as to its unique, distinctive, and distinguishing role within the US health care system.1

In the early years, the profession's distinction revolved around osteopathic manipulative treatment (OMT).2-4 However, when full practice privileges were granted to the profession, there was a shift from OMT toward a more comprehensive focus embracing the full scope of diagnostic and therapeutic modalities. Yet throughout its existence, there remains a profession-wide emphasis on community-based and primary care aligned with a “holistic” patient care approach enveloped within an overarching osteopathic philosophy.2-4 During the past half century, the continued convergence of allopathic and osteopathic medicine has resulted in phrases such as “separate but equal” and “parallel and distinctive” to describe conceptual differences.2-4

As time progresses, the conceptual difference between the osteopathic and allopathic professions continues to blur. Fewer osteopathic physicians (ie, DOs) use palpation and OMT, allopathic physicians (ie, MDs) make up a notable percentage of faculty at colleges of osteopathic medicine (COMs), and DO graduates increasingly choose Accreditation Council for Graduate Medical Education (ACGME) residency programs.4-9

Over the past decade, the number of osteopathic medical students has nearly doubled to more than 26,000 with 5323 graduating in 2015,10 and the number of DOs and students now exceeds 129,000.11 This expansion has led to arguably the most significant change: an agreement between the ACGME, the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine to create a single accreditation system for all graduate medical education (GME) programs.12

Osteopathic Distinction, Uniqueness, and Distinguishing Characteristics

A search on the The Journal of the American Osteopathic Association (JAOA) website for articles published between 1978 to July 2016 that demonstrate distinguishing characteristics, uniqueness, or distinctiveness of the osteopathic medical profession uncovered 479 citations. Of these citations, many did not align with the topic, and those that did were predominately opinion pieces (eg, editorials, letters to the editor). Fewer than 15 of these citations were original research presenting evidence-based outcomes demonstrating osteopathic medicine's unique, distinguishing, and definitive contributions. Those areas in which the research demonstrated a difference can be coalesced into 4 themes: OMT, practice characteristics, innovation and educational outcomes, and other outcomes.

OMT

Osteopathic manipulative treatment was the most robust theme. Research was centered on low back pain and suggested that benefits from OMT could be attained with less medication, fewer referrals to specialists, and earlier and improved function.13-16 Two OMT pilot studies on otitis media in children and pneumonia in adults produced provocative results, but neither study was large enough for conclusive recommendations.17,18 Other areas focused on retrospective anecdotal data in wound healing, headache, geriatric ambulation, and generalized management of pain.19-22

Practice Characteristics

Practice characteristics were based principally on reviews of large sets of national survey data. These analyses suggested that DO and MD practice patterns were generally similar. In the subgroup of DOs who used OMT predominantly, OMT was generally prescribed for musculoskeletal conditions and short-term pain relief.23-26 Another differentiating characteristic was the larger percentage of DOs choosing a career in primary care, rural medicine, and community-based medicine. However, none of these characteristics is unique to osteopathic medicine, and all have far more practicing MDs than DOs.2

Innovation and Educational Outcomes

Although the data for innovation and educational outcomes are not robust, osteopathic medicine differs from allopathic medicine in the cost to produce a physician. Compared with allopathic medical schools, osteopathic medical schools typically employ fewer faculty and staff, rely more on volunteer community-based practitioners, and have a significantly smaller infrastruture.27,28 They also have fewer affiliations with tertiary care centers and markedly smaller research infrastructures.27,28 These differences may serve as a double-edged sword, where on the one hand, the time spent in tertiary care centers is significantly curtailed for osteopathic medical students, while on the other hand, more time is spent in community settings, where the majority of health care is provided.

Other Outcomes

Although the data are limited, another potential difference between osteopathic and allopathic medical students is their perception of empathy. Preliminary data suggest osteopathic medical students may not have as marked of a decline in empathy as allopathic medical students during training.29,30

GROUPIE Overview

Given the lack of hard evidence-based outcomes demonstrating the osteopathic difference, the Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo initiated a prospective outcomes-based program in 2010 with the objective of showing what may distinguish TUCOM graduates. The acronym GROUPIE represents 7 distinct and measureable outcomes that can help define the unique and distinctive skills of TUCOM graduates as health care providers:

G = Global health

R = Research

O = Osteopathic manipulative medicine and obesity

U = hand-held Ultrasonography

P = Public health

I = Interprofessionalism

E = Empathy

Although none of these skills individually is unique to TUCOM when combined, we at TUCOM hope they will demonstrate an osteopathic difference that will ultimately enhance patient adherence to medical advice, improve quality outcomes, and boost practice efficiency while reducing cost by enriching communication throughout the entire health care system.

In the following paragraphs, I briefly describe each of the GROUPIE components to explain how these areas are interconnected in establishing DO graduates with unique, distinctive characteristics that will meet the challenges of providing health care.

Global Health

The global health program includes a robust international program. Since its inception in 2004, TUCOM has had approximately one-third of its students electively participate at 1 or more of 6 international sites. These students were more satisfied with their understanding of multicultural issues and global health care disparities.

The global health program at TUCOM also includes a local global experience in the school's 3 community-based Federally Qualified Healthcare Centers (FQHCs). Through these FQHCs, students provide preventive and primary care to ethnically diverse populations of medically underserved people. This program aims to measure the effectiveness in improving the social mission for all TUCOM students and demonstrate their ability to effectively communicate with all patients to eliminate health disparities across race and ethnicity.

Research

The research component of GROUPIE represents a specific focus of TUCOM's research efforts in exploring the root biologic causes of the detrimental effects of metabolic syndrome.31 For example, in this issue of the JAOA, Schwarz et al32 focus on the cross talk between sugar, hepatic fat, metabolic syndrome, and cardiovascular disease. This type of research is rapidly translated into clinical applications and taught to TUCOM students in both didactic and clinical settings.

Osteopathic Manipulative Medicine and Obesity

The evidence base demonstrating the efficacy of OMT from randomized controlled trials is limited.3 The Reducing Inflammation by Osteopathic Treatment (RIOT) trial is investigating the ability of OMT to reduce the silent inflammation noted in obese patients with metabolic syndrome. This trial is being conducted in parallel with the Cardiovascular Inflammation Reduction Trial (CIRT), which is a multicenter study supported by the National Institutes of Health and is investigating the potential benefit of low-dose methotrexate as an anti-inflammatory agent to reduce cardiovascular events in persons at high risk for cardiovascular disease.33 Currently, CIRT has approximately 400 participating centers in the United States and Canada, with 29 of the sites affiliated with osteopathic programs. If the CIRT demonstrates a reduction in cardiovascular events and RIOT demonstrates that OMT can reduce subclinical inflammation, then further studies can address the benefit of OMT in individuals at high risk for cardiovascular disease either added to proven therapies or independent of those therapies to reduce the number one cause of mortality, coronary heart disease.30

Obesity has become a global pandemic. In 2011, after the United States failed to achieve the Healthy People 2010 obesity goals, the AOA House of Delegates passed Resolution 435A, which stipulated that all DOs should address the obesity epidemic in their practice. At that time, TUCOM designed and implemented the Fundamentals for an Osteopathic Obesity Designed Study (FOODS), which was designed to test the hypothesis that by improving osteopathic medical students’ knowledge of obesity, their inherent bias against obese patients34 would improve. In this issue, Gayer et al35 report the first 5 years of data from FOODS and demonstrate that a comprehensive obesity curriculum can significantly improve the inherent student bias and that improvement can be sustained over all 4 years of medical school. The second phase of FOODS will investigate if this curriculum is transferable to COMs and selected primary care residency programs.

Ultrasonography

Ultrasonography has been used for decades by traditional imaging specialists as a diagnostic tool. The recent development of portable and handheld equipment has led to the use of this technology by the clinician at the point of care. To this end, TUCOM joined Ultrasound in Medical Education, California (UMeCali), which consists of a consortium of medical schools in California. The mission of UMeCali is to introduce a longitudinal ultrasonography education program addressing specific competencies.36 Along with UMeCali, many medical schools are developing curricula to improve students’ diagnostic and procedural skills. Preliminary data from COMs suggest a benefit in enhancing osteopathic palpatory skills and OMT outcomes.37,38 The AEIOU (An Education In Osteopathic Ultrasound) program has been initiated in which TUCOM is measuring anatomic knowledge and diagnostic skills in concert with the collaborating schools in UMeCali. However, beyond the standard diagnostic and therapeutic outcomes, plans have been made to initiate a TOUCH (Targeting OMT or Ultrasound or Combination for Health) program to help determine whether patient-physician communication is improved with OMT or ultrasonography and whether the combination of these 2 modalities enhances communication and patient adherence to an even greater extent.

Public Health

Education in public health is recommended to be incorporated into the medical school curriculum by the Institute of Medicine.39 In 2006, the dual-degree MPH program was first offered at TUCOM. The program has grown to be the largest DO/MPH program in the osteopathic medical profession, to our knowledge. In 2012, TUCOM partnered with 3 local FQHCs, thus opening the full array of county public health services to all TUCOM students. This affiliation underscored the school's commitment to public health and stands as a significant contributor related to its success in the public health component of GROUPIE. The strong public health culture derives much of its strength from its ability to overlap with various components of GROUPIE, such as the global health program, where 43% of dual-degree DO/MPH students are receiving their MPH in Global Public Health.

Interprofessional Education

The Commission on Osteopathic College Accreditation standards now includes interprofessional education for all COMs under standard 6.4.40 As one example, the Diabetes Prevention Program (DPP) includes a full spectrum of health care providers at Touro University California (students from the osteopathic medicine, physician assistant, nursing, public health, and pharmacy schools) working as a collaborative team. To date, the DPP has trained more than 340 certified lifestyle coaches across all disciplines, and TUCOM is the first medical school in the nation to register with the Centers for Disease Control and Prevention to have a certified, university-accredited DPP (Jay H. Shubrook, DO, oral communication, June 2017).

Empathy

Empathy as an essential component of professionalism may indicate a potential outcome that may differentiate osteopathic and allopathic medical students.29,30 In the Empathy in Osteopathic Training and Education (EMOTE) trial, Davis et al41 describe a different perspective in the evaluation of empathy in medical students. Preceptors for students at TUCOM and at least 1 other medical school (DO or MD) were surveyed on their perception of students’ empathy during rotations. As Davis et al41 report, 40% of the preceptors rated TUCOM students as better or advanced compared with other medical students for displays of empathy. This analysis differs from prior studies in that it surveys the preceptor's perception of empathy rather than the student's self-perception. Taken together, these analyses complement each other in giving a fuller evaluation of empathy, opening options for the osteopathic medical profession to continue to explore this interesting potential distinction.

Discussion

Where is the osteopathic medical profession now in terms of osteopathic distinctiveness? In 2015, the AOA launched a national awareness compaign for the profession with the following key messages incorporated throughout the campaign42:

  • ■ DOs have additional training in OMT and use this tool to help diagnose, manage, and prevent illness and injury.

  • ■ DOs listen to and partner with their patients to help them get healthy and stay well.

  • ■ DOs focus on prevention by gaining a deeper understanding of one's lifestyle and environment, rather than just managing symptoms.

  • ■ DOs are trained to see the person inside the patient.

  • ■ DOs practice a distinct philosophy. They strive to help patients be truly healthy in mind, body, and spirit.

These points are intended to increase awareness of the profession, but other than OMT, they do not exhibit the necessary outcome data that demonstrate why DOs are unique.

One of the characteristics not highlighted in these bullet points is the social mission and accountability that the osteopathic medical profession provides toward an overall public good. In 2010, an analysis of the social mission of medical education in 124 allopathic (17 community based) and 17 osteopathic medical schools was conducted.43 For this analysis, the definition of social mission was based on 3 factors: (1) percentage of graduates who practice primary care, (2) percentage who work in health professional shortage areas, and (3) percentage who are underrepresented minorities. In this study,43 COMs produced relatively more primary care physicians and practiced slightly more in underserved commmunities but trained a smaller percentage of underrepresented minorities. The authors concluded that medical schools with a strong social mission were generally best prepared to produce primary care for the underserved.43

Osteopathic medicine's foundation was based in primary care and rural medicine.44 Although not explicitly stated, it could be inferred that the osteopathic medical profession continues to follow its roots as manifested by opening new schools that are predominantly located in rural and underserved communities. The new schools’ missions are to a great extent focused on producing primary care physicians for the communities in which they reside. However, for more than a century, the osteopathic medical profession has steadfastly proven it can produce high-quality physicians, with a majority practicing primary care and at a fraction of the cost of its allopathic counterparts. This outcome begs the question, what is unique, distinctive, and distinguishing about osteopathic medicine to allow this pheneomena to persist for 140 years?

At TUCOM, we appreciate the opportunity offered by the JAOA ENGAGE Initiative, which allows COMs to showcase their scholarly activity.45 In this issue, TUCOM shares findings from a few of its programs and efforts, with GROUPIE representing just one of vast possibilities that may distinguish osteopathic medical students, COMs, and the profession. As with most COMs, TUCOM ranks near the top for the percentage of students selecting a career in primary care.46 However, a focus on primary care and community-based practice, even when adding osteopathic principles and practice, is inadequate to truly define TUCOM or osteopathic medicine's unique contributions to health care. As stated by Chen and Mullan in 2009, “The structure of today's osteopathic medical schools may be hard to distinguish from that of their allopathic counterparts, but the output of osteopathic medical schools remains clearly distinctive, and the nation's health care system benefits as a result.”27 If all COMs could find their particular “GROUPIE,” the osteopathic medical profession could individually and collectively demonstate an evidence-based approach detailing public benefits that are unique, with distingishing characteristics and distinctive outcomes that represent and define osteopathic medicine for this millenium.

Conclusion

This brief overview of the GROUPIE program at TUCOM and the 3 articles in this issue of the JAOA related to the school's research only scratch the surface in identifying what makes osteopathic medicine distinct. As the GROUPIE program matures, TUCOM will collect additional data that it hopes will further distinguish its students as distinctive DOs. The goal is to eventually measure a systematic osteopathic adherence result that will evaluate an osteopathic approach through GROUPIE on health care outcomes. By meeting the objectives within each aspect of GROUPIE, TUCOM expects that the combined effect will improve patient-physician communication and thus result in improved quality outcomes, improved patient adherence, more cost-effective team-based approach, enhanced empathy, and improved mindfulness for DOs.

Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Michael Clearfield, DO, Touro University College of Osteopathic Medicine-CA, Dean's Office, 1310 Club Dr, Vallejo, CA 94592. E-mail:

References

1. Gevitz N . A degree of difference: the origins of osteopathy and the first use of the “DO” designation.J Am Osteopath Assoc. 2014;114(1):30-40. doi:10.7556/jaoa.2014.005Search in Google Scholar PubMed

2. Gevitz N. Parallel and distinctive: the philosophic pathway for reform in osteopathic medical education. J Am Osteopath Assoc. 1994;94(4):328-332.10.7556/jaoa.1994.94.4.328Search in Google Scholar

3. Gevitz N. Center or periphery? the future of osteopathic principles and practices. J Am Osteopath Assoc . 2006;106(3):121-129.Search in Google Scholar

4. Rogers FJ , D’AlonzoGEJr, GloverJC, et al. Proposed tenets of osteopathic medicine and principles for patient care.J Am Osteopath Assoc.2002;102(2):63-65.Search in Google Scholar

5. Bates BR , MazerJP, LedbetterAM, NoranderS. The DO difference: an analysis of causal relationship affecting the degree-change debate. J Am Osteopath Assoc. 2009;109(7):359-369.Search in Google Scholar

6. Johnson SM , KurtzME. Diminished use of osteopathic manipulative treatment and its impact on the uniqueness of the osteopathic profession.Acad Med.2001;76(8):821-828.10.1097/00001888-200108000-00016Search in Google Scholar PubMed

7. Chamberlain NR , YatesHA. A prospective study of osteopathic medical students’ attitudes toward use of osteopathic manipulative treatment in caring for patients.J Am Osteopath Assoc.2003;103(10):470-478.Search in Google Scholar

8. Ching LM , BurkeWJ. Osteopathic distinctiveness in osteopathic predoctoral education and its effect on osteopathic graduate medical education.J Am Osteopath Assoc.2011;111(10):581-584.Search in Google Scholar

9. McClain E. Osteopathic medical education: innovations in a changing environment [editorial]. J Am Osteopath Assoc . 2016;116(4):196-198. doi:10.7556/jaoa.2016.038Search in Google Scholar PubMed

10. Trends in Osteopathic Medical School Applicants, Enrollment and Graduates. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; 2016. http://www.aacom.org/docs/default-source/data-and-trends/2016-trends-COM-AEG.pdf?sfvrsn=52. Accessed July 6, 2017.Search in Google Scholar

11. 2016 Osteopathic Medical Profession Report. Chicago, IL: American Osteopathic Association; 2016. http://www.osteopathic.org/inside-aoa/about/aoa-annual-statistics/Documents/2016-OMP-report.pdf. Accessed June 28, 2017.Search in Google Scholar

12. Kelley C. Impact of the single accreditation agreement on GME governance and the the physician workforce [health policy]. J Am Osteopath Assoc. 2014;114(7):518-523.Search in Google Scholar

13. Task Force on the Low Back Pain Clinical Practice Guidelines. American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain. J Am Osteopath Assoc.2016;116(8):536-549. doi:10.7556/jaoa.2016.107Search in Google Scholar PubMed

14. Licciardone JC , KearnsCM, MinottiDE. Outcomes of osteopathic manual treatment for chronic low back pain severity: results from the OSTEOPATHIC Trial.Man Ther.2013;18(6):533-540.10.1016/j.math.2013.05.006Search in Google Scholar PubMed

15. Licciardone JC , GatchelRJ, AryalS. Recovery from chronic low back pain after osteopathic manipulative treatment: a randomized controlled trial. J Am Osteopath Assoc. 2016;116(3):144-155. doi:10.7556/jaoa.2016.031Search in Google Scholar PubMed

16. Andersson GB , LucenteT, DavisAM, KapplerRE, LiptonJA, LeurgansS. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341(19):1426-1431.10.1056/NEJM199911043411903Search in Google Scholar PubMed

17. Steele KM , CarreiroJE, ViolaJH, ConteJA, RidpathLC. Effect of osteopathic manipulative medicine treatment on middle ear effusion following acute otitis media in young children: a pilot study.J Am Osteopath Assoc. 2014;114(6):436-447. doi:10.7556/jaoa.2014.094Search in Google Scholar PubMed

18. Noll DR , DegenhardtBF, MorleyTF, et al. Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;(4):2-13. doi:10.1186/1750-4732-4-2Search in Google Scholar PubMed PubMed Central

19. Anglund DC , ChannellMK. Contribution of osteopathic medicine to care of patients with chronic wounds.J Am Osteopath Assoc.2011;111(9):538-542.Search in Google Scholar

20. Bronfort G , AssendelftWJ, EvansR, HaasM, BouterL. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-466.10.1016/S0161-4754(01)99423-0Search in Google Scholar

21. Snider KT , SniderEJ, JohnsonJC, HaganC, SchoenwaldC. Preventative osteopathic manipulative treatment and the elderly nursing home resident: a pilot study. J Am Osteopath Assoc. 2012;112(8):489-501.Search in Google Scholar

22. Goff MB , NelsonMA, DeightonMM, FredricksCT. Pain management and osteopathic manipulative medicine in the Army: new opportunities for the osteopathic medical profession.J Am Osteopath Assoc.2011;111(5):331-334.Search in Google Scholar

23. Carey TS , MotykaTM, GarrettJM, KellerRB. Do osteopathic physicians differ in patient interaction from allopathic physician? an empirically derived approach.J Am Osteopath Assoc. 2003;103(7):313-318.Search in Google Scholar

24. Licciardone JC , ClearfieldMB, GuilloryVJ. Clinical practice characteristics of osteopathic and allopathic primary care physicians at academic health centers: results from the National Ambulatory Medical Care Survey.Acad Med.2009;84(6):744-750. doi:10.1097/ACM.0b013e3181a424fcSearch in Google Scholar PubMed

25. Degenhardt BF , JohnsonJC, GrossSR, HaganC, LundG, CurryWJ. Preliminary findings of the use of osteopathic manipulative treatment: outcomes during the formation of the practice-based research network, DO-Touch.NED.J Am Osteopath Assoc.2014;114(3):154-170. doi:10.7556/jaoa.2014.033Search in Google Scholar PubMed

26. Licciardone JC . A national study of primary care provided by osteopathic physicians.J Am Osteopath Assoc.2015;115(12):704-713.10.7556/jaoa.2015.145Search in Google Scholar PubMed

27. Chen C , MullenF. The separate osteopathic medical education pathway: uniquely addressing national needs [point]. Acad Med.2009:84(6):695. doi:10.1097/ACM.0b013e3181a3dd28Search in Google Scholar PubMed

28. Cohen JJ . The separate osteopathic medical education pathway: isn't it time we got our acts together [counterpoint]?Acad Med.2009:84(6):696. doi:10.1097/ACM.0b013e3181a3ddaaSearch in Google Scholar PubMed

29. Kimmelman M , GiacobbeJ, FadenJ, KumarG, PinckneyCC, SteerR. Empathy in osteopathic medical students: a cross-sectional analysis. J Am Osteopath Assoc. 2012;112(6):347-355.Search in Google Scholar

30. Calabrese LH , BiancoJA, MannD, MasselloD, HojatM. Correlates and changes in empathy and attitudes toward interprofessional collaboration in osteopathic medical students. J Am Osteopath Assoc. 2013;113(12):898-907. doi:10.7556/jaoa.2013.068Search in Google Scholar PubMed

31. Aguilar M , BhuketT, TorresS, LiuB, WongRJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA.2015;313(19):1973-1974. doi:10.1001/jama.2015.4260Search in Google Scholar PubMed

32. Schwarz JM , ClearfieldM, MulliganK. Conversion of sugar to fat: is hepatic de novo lipogenesis leading to metabolic syndrome and associated chronic diseases? J Am Osteopath Assoc. 2017;117(8):520-527. doi:10.7556/jaoa.2017.102Search in Google Scholar PubMed

33. Everett BM , PradhamAD, SolomonDH, et al. Rationale and design of the Cardiovascular Inflammation Reduction Trial: a test of the inflammatory hypothesis of atherothrombosis. Am Heart J. 2013;166(2):199-207. doi:10.1016/j.ahj.2013.03.018Search in Google Scholar PubMed PubMed Central

34. Miller DP Jr , SpanglerJG, Vitolins MZ, et al. Are medical students aware of their anti-obesity bias? Acad Med. 2013;88(7):978-982. doi:10.1097/ACM.0b013e318294f817Search in Google Scholar PubMed PubMed Central

35. Gayer G , WeissJ, ClearfieldM. Fundamentals for an Osteopathic Obesity Designed Study: the effects of education on osteopathic medical students’ attitudes regarding obesity. J Am Osteopath Assoc. 2017;117(8):495-502. doi:10.7556/jaoa.2017.099Search in Google Scholar PubMed

36. Chiem AT , SoucyZ, DinhVA, et al. Integration of ultrasound in undergraduate medical education at the California medical schools: a discussion of common challenges and strategies from the UMeCali experience. J Ultrasound Med. 2016;35:e1-e13.10.7863/ultra.15.05006Search in Google Scholar PubMed

37. Shaw KA , DoughertyJJ, TrefferKD, GlarosAG. Establishing the content validity of palpatory examination for the assessment of lumbar spine using ultrasonography: a pilot study.J Am Osteopath Assoc.2012;112(12):775-782.10.7556/jaoa.2012.112.12.775Search in Google Scholar PubMed

38. Kondrashova T , LockwoodMD. Innovative approach to teaching osteopathic manipulative medicine: the integration of ultrasonography.J Am Osteopath Assoc.2015;115(4):212-220. doi:10.7556/jaoa.2015.043Search in Google Scholar PubMed

39. The Future of the Public's Health in the 21st Century . Washington, DC: Institute of Medicine; 2002.Search in Google Scholar

40. Accreditation of Colleges of Osteopathic Medicine: COM Accreditation Standards and Procedures. Chicago, IL: Commission on Osteopathic College Accreditation; 2016.Search in Google Scholar

41. Davis GE , HartwigWC, McTigheAJ. Clinical preceptors’ perceptions of empathy: the Empathy in Osteopathic Training and Education (EMOTE) study.J Am Osteopath Assoc.2017;117(8):503-509. doi:10.7556/jaoa.2017.100Search in Google Scholar PubMed

42. The DO difference. Doctors of Osteopathic Medicine website. http://doctorsthatdo.org/difference. Accessed July 6, 2017. Search in Google Scholar

43. Mullin F , ChenC, PettersonS, KolskyG, SpagnolaM. The social mission of medical education: ranking the schools. Ann Int Med. 2010;152(12):804-812.10.7326/0003-4819-152-12-201006150-00009Search in Google Scholar PubMed

44. Philips-Madson R , DharamsiS. Osteopathic medical education and social accountability. J Am Osteopath Assoc. 2016;116(4):202-206. doi:10.7556/jaoa.2016.044Search in Google Scholar PubMed

45. Orenstein R. ENGAGE initiative: showcasing osteopathic scholarly activity [editorial]. J Am Osteopath Assoc.2016;116(5):276-277. doi:10.7556/jaoa.2016.054Search in Google Scholar PubMed

46. Which schools turn out the most primary care residents? U.S. News and World Report. 2017. http://grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-medical-schools/primary-care-residents-rankings. Accessed June 22, 2017.Search in Google Scholar
Accepted: 2016-08-10
Published Online: 2017-08-01
Published in Print: 2017-08-01

© 2017 American Osteopathic Association

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

Articles in the same Issue

  1. SURF
  2. Effects of Clinical Exposure to Osteopathic Manipulative Medicine on Confidence Levels of Medical Students
  3. EDITORIAL
  4. A Path to Osteopathic Distinction: The Touro California GROUPIE Program
  5. ORIGINAL CONTRIBUTION
  6. Fundamentals for an Osteopathic Obesity Designed Study: The Effects of Education on Osteopathic Medical Students’ Attitudes Regarding Obesity
  7. Clinical Preceptors’ Perceptions of Empathy: The Empathy in Osteopathic Training and Education (EMOTE) Study
  8. REVIEW
  9. Functional Somatic Syndrome: Assessment and Management
  10. Conversion of Sugar to Fat: Is Hepatic de Novo Lipogenesis Leading to Metabolic Syndrome and Associated Chronic Diseases?
  11. MEDICAL EDUCATION
  12. Ready for Residency: A Bloomian Analysis of Competency-Based Osteopathic Medical Education
  13. CASE REPORT
  14. Pheochromocytoma-Induced Cardiomyopathy Mimicking Acute Coronary Syndrome
  15. CLINICAL IMAGES
  16. Vanishing Lung Syndrome
  17. Obliterated Temporomandibular Joint
https://doi.org/10.7556/jaoa.2017.098
Keywords for this article
empathy; medical education; osteopathic identity
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Effects of Clinical Exposure to Osteopathic Manipulative Medicine on Confidence Levels of Medical Students
  3. EDITORIAL
  4. A Path to Osteopathic Distinction: The Touro California GROUPIE Program
  5. ORIGINAL CONTRIBUTION
  6. Fundamentals for an Osteopathic Obesity Designed Study: The Effects of Education on Osteopathic Medical Students’ Attitudes Regarding Obesity
  7. Clinical Preceptors’ Perceptions of Empathy: The Empathy in Osteopathic Training and Education (EMOTE) Study
  8. REVIEW
  9. Functional Somatic Syndrome: Assessment and Management
  10. Conversion of Sugar to Fat: Is Hepatic de Novo Lipogenesis Leading to Metabolic Syndrome and Associated Chronic Diseases?
  11. MEDICAL EDUCATION
  12. Ready for Residency: A Bloomian Analysis of Competency-Based Osteopathic Medical Education
  13. CASE REPORT
  14. Pheochromocytoma-Induced Cardiomyopathy Mimicking Acute Coronary Syndrome
  15. CLINICAL IMAGES
  16. Vanishing Lung Syndrome
  17. Obliterated Temporomandibular Joint
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 12.9.2025 from https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.098/html
Scroll to top button