Volume 103, Issue 6

Because clinical skills play an important role in health services, many medical credentialing organizations are making performance-based assessments part of the board-certification and licensure processes. While clinical skills are taught and evaluated at colleges of osteopathic medicine, the development and validation of standardized assessment methodologies is far from complete. The purpose of this study was to gather data to support the use of a performance-based assessment of osteopathic clinical skills. A sample of 121 fourth-year osteopathic medical students was tested using the Comprehensive Osteopathic Medical Licensing Examination-USA performance-based clinical skills examination (COMLEX-USA-PE) prototype, a standardized patient performance evaluation that involves a series of 12 simulated encounters. Students were evaluated in a number of domains that included history taking, physical examination, osteopathic manipulative treatment techniques, written communication and clinical problem solving, and physician-patient communication. The analysis of data from 1452 standardized patient encounters suggests that reliable and valid scores can be obtained using the current prototype. The use of COMLEX-USA-PE to assess the readiness of osteopathic medical students to provide patient care in supervised graduate medical education training programs is supported.

The Second Osteopathic Survey of Health Care in America (OSTEOSURV-II), a national telephone survey conducted during 2000 using random-digit dialing, was used to address questions about public awareness of the osteopathic medical profession and use of osteopathic physicians. A total of 499 adult, noninstitutionalized, household respondents were surveyed. The main outcomes included prevalence of and multivariate factors associated with awareness and use of osteopathic physicians. The overall response rate was 64%. The prevalence of awareness, lifetime use, and current use of osteopathic physicians among unscreened respondents was 46%, 16%, and 7%, respectively. Among lifetime users, 84% received primary care; 52%, osteopathic manipulative treatment; and 25%, specialty care. The multivariate factors most strongly associated with awareness of osteopathic physicians were college education (rate ratio [RR], 1.86; 95% confidence interval [CI], 1.43-2.40), 60 or more years of age (RR, 1.52; 95% CI, 1.15-2.01), and Midwest residence (RR, 1.39; 95% CI, 1.05-1.84). Nonwhites, including Hispanics, were less likely to be aware of osteopathic physicians (RR, 0.54; 95% CI, 0.38-0.76). Respondents with college education (RR, 2.34; 95% CI, 1.44-3.79), respondents of intermediate age (RR, 1.71; 95% CI, 1.12-2.61), and women (RR, 1.68; 95% CI, 1.12-2.52) were more likely to report lifetime use of osteopathic physicians. Nonwhites were less likely to report lifetime use (RR, 0.25; 95% CI, 0.11-0.57). Greater promotional efforts are needed to increase awareness of osteopathic medicine and to remove barriers to using osteopathic physicians, particularly among nonwhites.

The purpose of this study was to assess procedural accomplishment, work productivity, and efficiency for emergency medicine residents in a community-based, osteopathic emergency medicine residency. These data are compared with limited existing data from other training sites. The authors conducted a retrospective analysis of patient-encounter data logged into a computerized main-frame database over 8 years by 19 resident physicians. Only data from residents who had complete logs for all 3 years of residency were included. Procedures and diagnoses were from the core content areas defined in the basic standards for approval of residency training programs in emergency medicine. Approximately 98,000 patient encounters were logged during the study period. First-year emergency medicine residents saw an average of 1.06 patients per hour, second-year emergency medicine residents an average of 1.33 patients per hour, and third-year emergency medicine residents an average of 1.41 patients per hour. Residents performed an average of 65 intubations, 533 adult resuscitations, 144 pediatric resuscitations, 49 central line insertions, 47 lumbar punctures, and 280 laceration repairs. Residents tend to see more patients per hour as their training progresses. Residents in this program get significant experience in some procedures but little or no clinical exposure to other procedures. These results are consistent with the few other published reports attempting to quantify the emergency medicine resident experience. The data may assist in setting clinical objectives and establishing uniform tracking systems and coding terminology.