Volume 115, Issue 11

Context: Peer tutoring can benefit both tutors and tutored students, but information is lacking regarding establishing and measuring outcomes of such a program at new medical schools. Objective: To examine the outcomes of a pilot peer tutoring initiative and explore the implications for long-term program development. Methods: Fifty-one osteopathic medical students who participated in a pilot peer tutoring program during the 2013-2014 academic year were surveyed regarding satisfaction with the program. Course grade means for the tutors (all courses) and tutored students (specific courses) were analyzed before and after participating in the tutoring experience. Data analyses were performed using frequency distributions, t tests, and qualitative assessment of emergent themes. Results: The survey had a 76% response rate (39 of 51 students). Both tutored students and tutors were satisfied with the tutoring program. Statistically significant changes in course grades for the tutored courses were noted at 3 to 4 and 8 to 9 months among the tutored students who were most at risk for failure ( P =.001). Tutor course grades showed no significant changes for any of the courses in which they were enrolled ( P =.445). Conclusion: Learning gains were realized by the students at greatest academic risk. Additional research is needed to evaluate long-term outcomes.

Context: Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University–Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures. Objectives: To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex. Methods: Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups. Results: Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P =.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; P <.001) and between men and women (34.1 mm vs 39.0 mm; P <.001). The SSD was not significantly different between left and right sides (18.9 mm vs 19.8 mm; P =.08), normal and overweight BMI categories (18.9 mm vs 19.7 mm, P =.21), or men and women (19.7 mm vs 19.0 mm; P =.24). No significant relationship was identified between age and SBP ( P =.46) or SSD ( P =.39); however, the age range was narrow (21-33 years). Conclusion: The study yielded repeatable and reproducible results when establishing SBP and SSD using ultrasonography. The statistically significant relationship between SBP and higher BMI and between SBP and female sex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.

Context: Recent evidence suggests that osteopathic manipulative treatment of somatic dysfunction in newborns may decrease complications and hospital length of stay. Such dysfunction may result from external forces related to the birth process, but its incidence is unknown. Objective: To identify the incidence and patterns of somatic dysfunction in healthy newborns at least 6 hours after birth and to correlate those findings with maternal and labor history, gestational age, and findings of the initial newborn assessment performed immediately after birth. Methods: Healthy newborns aged 6 to 72 hours were physically examined and assessed for somatic dysfunction, including asymmetry and motion restriction of the cranial, cervical, lumbar, and sacral regions. The total somatic dysfunction identified was summarized in a somatic dysfunction severity score (SDSS), calculated by assigning 1 point for each identified finding; the SDSS could range from 0 (no somatic dysfunction) to 34 (all somatic dysfunctions assessed present). Findings were correlated with maternal and newborn characteristics and labor history. Descriptive analyses were performed, and findings were compared between the initial newborn assessment and the research examination. Results: One hundred newborns were examined (mean gestational age, 38.5 weeks). In 99 newborns (99%), at least 1 sphenobasilar synchondrosis strain pattern was present, with sidebending rotations being the most common (present in 63 newborns [63%]). Condylar compression was found in 95 newborns (95%), temporal bone restrictions in 85 (85%), motion restriction of at least 1 cervical vertebral segment in 91 (91%) and at least 1 lumbar vertebral segment in 94 (94%), and a posterior sacral base in 80 (80%). The SDSS was not associated with mode of delivery or labor augmentation ( P =.49 and P =.54, respectively), but it was positively associated with the duration of labor; each 1-hour increase in labor increased the predicted SDSS by 0.12 points ( P =.04). Conclusion: Somatic dysfunction of the cranial, cervical, lumbar, and sacral regions was common in healthy newborns, and the total somatic dysfunction (SDSS) was related to the length of labor. (ClinicalTrials.gov number NCT01496872)

Background: The incidence of melanoma has been rising over the past century. With 37% of patients presenting to their primary care physician with at least 1 skin problem, primary care physicians and other nondermatologist practitioners have substantial opportunity to make an impact at the forefront of the disease process. New diagnostic aids have been developed to augment physician analysis of suspicious pigmented skin lesions (PSLs). Objective: To determine the effects of computer-aided multispectral digital skin lesion analysis (MSDSLA) on dermatologists’ and nondermatologist clinicians’ decisions to biopsy suspicious PSLs after clinical and dermatoscopic evaluation. Methods: Participants were shown 6 images of PSLs. For each PSL, participants were asked 3 times if they would biopsy the lesion: first after reviewing a clinical image of the PSL, again after reviewing a high-resolution dermatoscopic image, and again after reviewing MSDSLA probability findings. An answer was right if a melanoma or high-risk lesion was selected for biopsy or a low-risk lesion was not selected for biopsy. An answer was wrong if a melanoma or high-risk lesion was not selected for biopsy or a low-risk lesion was selected for biopsy. Clinicians’ decisions to biopsy were evaluated using χ 2 analysis for proportions. Results: Data were analyzed from a total of 212 participants, 177 of whom were dermatologists. Overall, sensitivity of clinical image review was 63%; dermatoscopic image review, 5%; and MSDSLA, 83%. Specificity of clinical image review was 59%; dermatoscopic image review, 40%; and MSDSLA, 76%. Biopsy decision accuracy was 61% after review of clinical images, 52% after review of dermatoscopic images, and 80% after review of MSDSLA findings. The number of lesions participants indicated that they would biopsy increased significantly, from 52% after reviewing clinical images to 63% after reviewing dermatoscopic images ( P <.001). However, the overall number of specimens that participants indicated they would biopsy did not change significantly after they reviewed MSDSLA findings (53%). Conclusion: Sensitivity, specificity, and biopsy decision accuracy increased after clinicians reviewed MSDSLA findings. The use of objective, computer-based diagnostic aids such as MSDSLA during clinical evaluations of ambiguous PSLs could aid clinicians’ decisions to biopsy such lesions.

Disorders of the Achilles tendon, the largest tendon in the human body, are common and occur in both active and sedentary persons. A thorough history and physical examination allow primary care physicians to make an accurate diagnosis and to initiate appropriate management. Mismanaged or neglected injuries markedly decrease a patient’s quality of life. A growing body of related literature is the basis for current therapeutic regimens, which use a multimodal conservative approach, including osteopathic manipulative treatment. Although primary care physicians can manage most cases of Achilles tendon disorders, specialty care may be needed in certain instances. Procedural intervention should consider any comorbid conditions in addition to patients’ lifestyle to help guide decision making. When appropriately managed, Achilles tendon disorders generally carry a favorable prognosis.

Context: The value of reflective practices has gained momentum in osteopathic medical education. However, the use of reflective pedagogies has not been explored in the larger context of medical course delivery and design, to the authors’ knowledge. Objective: To determine the types of reflection demonstrated by osteopathic medical students on an online discussion board and to explore differences in discussion engagement caused by the use of a reflective learning self-assessment tool. Methods: Using a mixed-method approach, reflection processes in an osteopathic surgery clinical clerkship online module were investigated in third-year osteopathic medical students. Discussion board messages were captured and coded. Both manual coding techniques and automated interrogation using NVivo9 (a computer program) for qualitative data were applied. Correlations of scores across 4 case-based discussion tasks and scores for self-reflection were computed as quantitative data. Results: Twenty-eight students were included. Four main types of reflection (ie, content, contextual, dialogic, and personal) along with corresponding differentiated subthemes for each type of case-based discussion board group message were identified. Group collaboration revealed insights about the reflection process itself and also about the evidence of collective efforts, group engagements, and intragroup support among students. Student preparation revealed that students’ metacognition was triggered when they judged their own contributions to group work. Challenges in completing readings and meeting deadlines were related to the students’ long work hours. Conclusion: Reflective practices are essential to the practice of osteopathic medicine and medical education. Curricula can promote the development of reflective skills by integrating these deliberate practices in educational activities.