Band 119, Heft 4

Context Osteopathic medicine emphasizes partnering with patients to help them attain or maintain health. This philosophy encourages physicians to practice primary care and a mission of improving community health. However, there is currently a shortage of primary care physicians in many areas of the United States. Objective To determine whether intended practice patterns of recent graduates of colleges of osteopathic medicine favor primary care and whether practice patterns correlate with medical education debt. Methods Responses were analyzed from the American Association of Colleges of Osteopathic Medicine survey of pending medical school graduates from 2007 through 2016 regarding indebtedness and specialty selection. Results The percentage of graduating osteopathic medical students who chose a primary care specialty increased from 28.1% (676 students) in 2007 to 33.2% (1377 students) in 2016. Among graduates, those above the 75th percentile of debt had a general move toward more non–primary care positions, with a value of 74.4% in 2007 and 79.9% in 2016. Graduates below the 25th percentile had a gradual increase in primary care representation, moving from 24.6% in 2007 to 29.4% in 2016. In 2007, graduates with a loan forgiveness/repayment program were more likely to choose primary care over graduates without such a program (OR, 0.681 [95% CI, 0.505-0.920]; P =.02). Analysis of subsequent years showed a declining OR with increasing significance. Conclusions Results of this analysis indicated that increased educational debt loan directly influenced physician practice choice. Graduates with high debt burden were more likely to enter primary care fields and use loan forgiveness/repayment programs. Graduates with high debt burden who did not use loan forgiveness/repayment programs were more likely to enter non–primary care specialty fields, with this trend increasing as mean medical school debt increased. This association has implications for policies that could affect choice of primary care. However, further research is needed to fully understand the primary care choice by graduates of colleges of osteopathic medicine.

Context Given the importance of emotional intelligence (EI) in physician leadership and success, the possible decline of EI over the course of training is a concern in medical education. Objectives To assess the EI of osteopathic medical students as they progress through the preclinical years of medical school, to discover the course of EI over time, and to identify specific core EI competencies to be enhanced or coached. Methods This exploratory, longitudinal study used survey data to assess the course and competencies of EI in the incoming 2019 class of medical students at a college of osteopathic medicine. Changes in EI overall scores and the 8 core competency scale scores were assessed, and additional demographic data were collected for use in analysis. Methods of analysis included paired samples t test, independent samples t test, Pearson product moment correlation, and multiple regression analysis. Statistical significance was defined as P <.05. Results Sixty-two participants completed the Six Seconds Emotional Intelligence Assessment survey at orientation and again after their second year. Overall EI scores declined over the course of the preclinical training for men and women ( t 6 1 =4.24, P< .001), although no differences were noted by gender when independent-samples t tests were run. However, 2 of the 8 competency scales of the composite EI scores did not decline over time—Enhanced Emotional Literacy and Pursue Noble Goals. A weak negative correlation was found between Medical College Admission Test scores and the scale of Apply Consequential Thinking ( r =−0.3, P< .05). A weak positive correlation was found between grade point average and intrinsic motivation ( r =0.3, P <.05) and optimism ( r =0.3, P <.05), and a moderate positive correlation existed between preboard examination scores and intrinsic motivation ( r =0.5, P <.001) and optimism ( r =0.4, P <.01). None of the chosen independent variables (academic grades, test scores, age, or gender) contributed to overall EI scores. Conclusions During the preclinical training, osteopathic medical students’ overall EI scores, as well as 6 of the 8 core competency scales, declined. Therefore, EI coaching is warranted to address specific core competencies needed to build, enhance, and prevent the decline of EI through preclinical training.

Context Comprehensive Medical College Admission Test (MCAT) preparatory courses could potentially promote interest among premedical students to pursue careers in osteopathic medicine in underserved areas. Objective To determine whether a comprehensive 16-week course centered on MCAT preparation and exposure to an osteopathic medical school setting will promote interest among premedical students to become osteopathic physicians in the rural Southwest. Methods At the Burrell College of Osteopathic Medicine in Las Cruces, New Mexico, undergraduate premedical students from the surrounding rural and urban areas completed an all-inclusive 16-week MCAT preparation course. Students were required to have completed medical school prerequisite courses and have a minimum 3.0 grade point average. The program included interactive instructional sessions for teaching material pertinent to the MCAT, an introduction to osteopathic philosophy, workshops for application preparation, a tour of the medical school facilities, full-length practice tests, and mock interviews. After course completion with at least 80% attendance, a survey was conducted to identify effectiveness and outcomes of the course. The survey used a Likert scale that ranged from 1 (strongly disagree) to 5 (strongly agree). Results Of the 170 student participants, 163 completed the survey. After completing the course, participants felt more knowledgeable about the true nature of medical school and osteopathic medicine (weighted averages, 4.26-4.40) than before the course. Compared with attitudes before taking the course, participants were more inclined to attend an osteopathic medical school and practice rural medicine in the southwestern United States (weighted averages, 4.16-4.45). Participants who completed the course also felt that they were better prepared to take the MCAT (weighted average, 4.37). Conclusion Participant knowledge and attitudes about practicing osteopathic medicine were enhanced after they completed the comprehensive MCAT preparatory course. These results suggest that offering similar courses in osteopathic medical schools throughout the country may improve the outlook of creating a diverse physician workforce that provides health care in rural areas.

At the Edward Via College of Osteopathic Medicine (VCOM), students are taught through a systems-based block education process organized according to separate organ systems. The block education lectures provide instruction on these various organ systems and their associated diseases and potential for diagnosis and treatment. A curricular initiative implemented at VCOM incorporates International Classification of Diseases, 10th Revision (ICD-10) codes into the preclinical curriculum to enhance student learning and recall of basic science information and to prepare them for patient encounters during clinical rotations. In constructing this curricular initiative, diseases and procedures mentioned in all lectures during the first 2 years were evaluated and matched with their corresponding ICD-10 diagnostic and procedural codes to illustrate to students how this information would be used in a clinical setting. Of 994 lectures with 36,105 slides, 4331 opportunities to associate ICD-10 codes were identified. Information was given to instructors to update their future lectures. This initiative aims to enhance the preclinical educational experience and prepare preclinical students for documenting patient care. After students have been fully exposed to this new learning component, a study is planned to analyze the effects of the curriculum.

In 2014, the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education agreed to establish a new, single accreditation system for graduate medical education in the United States. This article focuses on recent policy enhancements and modifications to facilitate the transition to the single accreditation system and concludes with a discussion of the current transition planning after the end of the transition period on June 30, 2020.

Postvasectomy pain syndrome (PVPS) can be debilitating and is notoriously difficult to treat, often requiring a multidisciplinary approach. In this case report, osteopathic manipulative treatment (OMT) was used to treat a patient with PVPS. After vasectomy, an otherwise-healthy man experienced chronic right testicular pain, aggravated by exercise, touch, and sexual intercourse, resulting in marital strain and an inability to perform routine fitness activities. Symptoms persisted for 8 years, despite lifestyle modifications, orally administered pain regimens, pelvic floor physical therapy, nerve blocks, steroid injections, epididymectomy, spermatic cord denervation, and counseling. After the patient's urologist suggested orchiectomy, his family medicine physician referred him for OMT. The OMT interventions, applied over a 4-month period, were directed at the lumbar spine, pelvis, pelvic floor, and lower abdomen. After treatment, the patient reported absence of testicular pain most of the time and described his quality of life as “10 times better.” Literature review revealed no reports of OMT used to manage PVPS.