Volume 109, Issue 9

In response to the shifting demographics observed in the United States, a variety of organizations have begun issuing consensus statements and patient care guidelines to help health professionals meet the anticipated medical needs of the older population. The authors describe a collaborative effort within the osteopathic medical profession focused on translating geriatric core competencies into curricula guidelines for osteopathic medical education. Osteopathic physicians will likely be the “first responders” for elder care needs in the United States as a result of their disproportionately high rates of primary care practice.

Context : With the formal adoption of the seven core competencies, the American Osteopathic Association's Commission on Osteopathic College Accreditation instructed osteopathic medical educators to guide curricular development with these goals in mind. Tools to facilitate and monitor these purposes have been under development separately at each of the nation's colleges of osteopathic medicine. Objective : To demonstrate the utility of a checklist-based curriculum assessment tool, the Matrix for Quality Enhancement, as developed at Kirksville (Mo) College of Osteopathic Medicine-A.T. Still University. Methods : Application of the Matrix is illustrated using examples selected from our analysis of a set of 16 standardized patient encounters provided as part of a first-year basic science course in medical microbiology. Encounters were developed to improve student understanding of infectious disease entities while also providing a variety of clinical experiences. Feedback on professionalism and humanistic behaviors was also provided. A novel aspect of the Matrix is the inclusion of a component dealing with patient safety. Application : Adding standardized patient encounters to the medical microbiology teaching program at Kirksville College of Osteopathic Medicine was an effective means of integrating educational experiences with the seven core competencies, the requirements of Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-PE (Performance Evaluation), and patient safety issues. Conclusion : The Matrix is a valuable tool for evaluating or developing curricular components that maintain osteopathic integrity while working toward standards for medical education specified by the commission.

Context: Although there is a wealth of information for patients and physicians on the Medicare Prescription Drug, Improvement, and Modernization Act, little research exists related to its impact on osteopathic physicians (DOs). Objective: To examine the impact of Medicare's prescription drug benefit—or Part D —on DOs and their practices. Methods: Two electronic surveys regarding Medicare Part D were e-mailed to DOs randomly selected from the American Osteopathic Association database. The first survey was sent January 31, 2006 (within the first month of Part D implementation), and the second was sent June 1, 2006 (6 months after implementation). Both surveys focused primarily on the challenges experienced by DOs and their staff regarding Part D. Responses were subjected to univariate, bivariate, and Pearson product moment correlation analysis. Results: Of the 10,000 DOs contacted, 603 (6%) responded and met inclusion criteria for the first survey and 343 (3.4%) for the second survey. More than 60% of respondents to the first survey reported challenges such as increased workload, difficulties understanding Part D, difficulties with the physician appeals process, and lack of information and education. These challenges were also reported in the second survey but by approximately 30% fewer respondents. One challenge—changing medications as a result of formulary restrictions—was reported by 17% more respondents to the second survey ( P <.01). Respondents in primary care, solo practice, and rural areas as well as those treating large Medicare populations and those who were their patients' primary source of information about Part D reported more challenges. Conclusion: Considering the numerous challenges respondents faced with Part D, it is important to remember the role of physicians in successfully implementing healthcare programs, particularly as the US healthcare reform debate progresses.

Although the definitions and possible treatments of posttraumatic headache have been discussed in the literature, treatment of this condition is not standardized. In addition, though various reviews and case studies have supported the use of spinal manipulation in the treatment of tension-type headaches and migraines, few describe the use of osteopathic manipulative treatment for patients with posttraumatic headache. In describing a 38-year-old woman with posttraumatic headache, we illustrate a multidisciplinary approach—including the use of osteopathic principles and practice—to treating patients with posttraumatic headache.