Suggestions and Questions for Osteopathic Medical Education

To the Editor: I applaud the excellent points made by Norman Gevitz, PhD, about the current state of the osteopathic medical profession in the March 2006 issue of JAOA—The Journal of the American Osteopathic Association (“Center or periphery? The future of osteopathic principles and practices.” 2006;106: 121–129). Dr Gevitz's erudite and succinct observations, pronouncements, and suggestions should be required reading for the leaders of colleges of osteopathic medicine (COMs), osteopathic specialty societies, and interested organizations, including the American Osteopathic Association (AOA), the American Academy of Osteopathy, the American Association of Colleges of Osteopathic Medicine, and the Association of Osteopathic Directors and Medical Educators.

Dr Gevitz makes excellent recommendations for moving osteopathic principles and practice (OPP) back to the center from the periphery of the osteopathic medical profession, specifically with regard to student admissions, resources, organization, and curricula.

To these recommendations, I would offer my personal views on COM organization, as well as ideas for the continuum of osteopathic medical education.

Regarding organization, it is true that COMs need more faculty to serve as table trainers, as Dr Gevitz notes in his editorial. However, it is not sufficient for OPP to be taught primarily by osteopathic physicians who are family physicians and general practitioners. Such individuals typically make up the majority of the OPP faculty at COMs.

Colleges of osteopathic medicine should be encouraged to use osteopathic specialists from all fields (eg, internal medicine, general surgery, physical medicine and rehabilitation) as table trainers—assuming these specialists are skilled in osteopathic manipulative treatment (OMT), willing and able to serve as trainers, and properly compensated. Incorporating a greater variety of specialists into OPP education would help demonstrate to osteopathic medical students that OPP can be applied across a wide spectrum of medical conditions and by a wide range of medical practitioners. This, in turn, would lend greater credibility to the teaching of OPP, which previously has primarily been the privy of one discipline.

At the New York College of Osteopathic Medicine of New York Institute of Technology (NYCOM/NYIT) in Old Westbury, NY, we have always had a separate department dedicated to OPP. In 2000, it was renamed the Stanley Schiowitz, DO, FAAO, Department of Osteopathic Manipulative Medicine after Dr Schiowitz, a NYCOM/NYIT dean emeritus who is well known for developing the set of osteopathic manual techniques known as facilitated positional release.¹ In recent years, NYCOM/NYIT has added OMT table trainers from clinical disciplines other than family medicine and general practice. Three of these trainers are from the Department of Internal Medicine. I'm a general internist and one of the trainers. Another trainer is a general surgeon who is working full time in the Schiowitz OMM department. The third trainer is the department's chairman, Wolfgang G. Gilliar, DO, who is a physiatrist. We believe that such “cross-fertilization” helps our students appreciate the fact that OMT can be used no matter what specialty they ultimately pursue.

I should note that the current standards of the AOA Commission on Osteopathic College Accreditation require that a COM must have on its faculty only one full-time osteopathic physician who is either certified through the American Osteopathic Board of Neuromusculoskeletal Medicine or is in possession of AOA certification in the specialty of neuromusculoskeletal medicine and osteopathic manipulative medicine.²

Regarding the continuum of osteopathic medical education, it is incumbent on those who wish to maintain the identity of the osteopathic medical profession as unique and distinct from allopathic medicine to examine the entire continuum of osteopathic medical education—not just the 4 years of undergraduate study. How osteopathic are our internships and residencies, for example? In other words, what makes them osteopathic aside from having program directors and faculty who are osteopathic physicians?

Looking beyond the continuum of formal education, how do osteopathic physicians maintain their skills in OMT after they have completed their residencies? Is attending enough lectures and conferences to meet the continuing medical education requirements of the AOA sufficient to maintain these skills and stay abreast of the steadily growing number of advances and research findings in OMT? The members of the osteopathic medical profession need to decide individually and collectively the answers to such questions.

Dr Gevitz is challenging us to face complex realities about the future character and identity of the osteopathic medical profession. Let us do so at every level—from junior faculty members to experienced practitioners—and across every discipline to arrive at a consensus of who we are, whom we want to be, where we want to go, and how we intend to get there. The status quo (and its consequences) is a viable option only if we agree to settle for it.