Volume 120, Issue 6

Context There is no consensus on the correlation between clinical experience and accuracy in diagnosing somatic dysfunctions, which makes it difficult to justify the use of more subjective measures to evaluate this important association. To better understand this relationship, palpatory forces can be observed while diagnosing a somatic dysfunction. Objective To quantify the pressure applied in diagnosing lumbar somatic dysfunction, find a correlation between accuracy of diagnosis and palpation pressure, set the standards for palpation, and develop precise palpatory skills for osteopathic medical students. Methods The palpatory forces were evaluated between participants with varying experience levels (osteopathic medical students and attending physicians from the New York Institute of Technology College of Osteopathic Medicine). Two osteopathic physicians confirmed an L5 somatic dysfunction diagnosis in a volunteer standardized patient (SP), who served as the control. Participants then palpated the lumbar segment of the SP in a prone position with F-Scan System (TekScan) sensors, which recorded the amount of pressure and time used to reach a full diagnosis. Results Participants (11 osteopathic medical students and 10 attending physicians) who diagnosed an L5 somatic dysfunction consistent with the SP's diagnosis had less of a difference in peak force (mean [SD] difference, 62.50 [325.7] g/cm 2 ) between the contact points (right hand vs left hand). In contrast, participants with a dissimilar L5 diagnosis from the SP's had a mean (SD) difference in peak force of 319.38 (703.1) g/cm 2 . Similarly, the difference in the mean (SD) force of palpation between the contact points was lower in participants who made the correct diagnosis (16.81 [117.4] g/cm 2 ) vs those who made an incorrect diagnosis (123.92 [210.3] g/cm 2 ). No statistical significance was found between the diagnostic accuracy of the students and physicians ( P =.387) or the time taken to reach a diagnosis ( P =.199). Conclusion We observed that using equal pressures in both hands while palpating a lumbar segment correlates to more accurate somatic dysfunction diagnoses.

Context The Public Service Loan Forgiveness (PSLF) program is among several repayment programs currently available for recipients of federal student loans. Medical education debt has continued to expand at a rapid pace in the decade since PSLF was created. Proposed changes to the Higher Education Act would substantially transform how future medical trainees finance and repay medical education debt. Objective To better understand relationships between debt and personal stress, as well as between repayment- and forgiveness-program use, in the context of competing legislation. Methods Surveys were sent to all Accreditation Council for Graduate Medical Education−accredited internal medicine residency programs (osteopathic and allopathic). Results From a potential pool of 579 residents, data were obtained from 403 unique respondents (response rate, 69.6%) at 12 residency programs, for a program response rate of 2.2%. Of these respondents, 290 (71.9%) completed the demographic portion of the survey. Median education debt was $225,000. Residents with the top quartile of debt burden were more likely to use PSLF (odds ratio [OR], 3.27; P =.02), more likely to enter loan forbearance (OR, 2.14; P =.03), and indicated a higher level of stress (OR, 5.94; P <.001) compared with those in the second and third quartiles. Conclusion Proposed legislative changes to the Higher Education Act would scale back loan repayment options and also eliminate PSLF for future borrowers. Our data suggest that higher debt burdens are associated with increased debt-related stress. Given program popularity and growing use, along with growing concerns of physician burnout, policy makers should weigh the potential downstream effects of policy change on prospective future physicians.

Context Access to primary care (PC) improves health outcomes and decreases health care costs. The shortage of PC physicians and shifting physician workforce makes this an ongoing concern. Osteopathic medical schools are making strides to fill this void. Considering the critical need for PC physicians in the United States, this study aims to identify factors related to choosing a PC specialty. Objective To understand possible motivations of osteopathic medical students pursuing a career in PC specialties by examining the role of sex and the influence of 5 key factors in this decision. Methods Responses from the annual American Association of Colleges of Osteopathic Medicine graduate survey (2007-2016) were analyzed. Self-reported practice decision considerations of 5 key factors, including (1) intellectual and technical content, (2) debt level, (3) lifestyle, (4) prestige/income level, and (5) personal experience and abilities were summarized, and their subjective value was contrasted between osteopathic medicine graduates pursuing PC specialties vs those pursuing non-PC specialties. Results The mean percentage of graduates pursuing PC and non-PC specialties from 2007 to 2016 was 31.3% and 68.7%, respectively. Women were 1.75 times more likely to choose PC than men (95% CI, 1.62-1.89). Regardless of specialty choice, lifestyle was the most important factor each year (1027 for PC [75.3%] vs 320 for non-PC [63.3%] in 2016; P <.0001). Students entering PC were more likely to report prestige and income level to be “no or minor influence” compared with students entering non-PC specialties ( P <.0001). Debt level was more likely to be a “major influence” to students choosing to enter non-PC specialties than to those entering PC ( P <.0001), and the percentage of non-PC students has grown from 383 in 2007 (22.9%) to 833 in 2016 (30.6%). Conclusion Sex was found to significantly influence a graduate's choice of specialty, and female graduates were more likely to enter practice in PC. Each of the 5 survey factors analyzed was significantly different between students entering PC and students entering non-PC specialties. Lifestyle was deemed a major influencing factor, and responses suggested that debt level is a strong influencing factor among students pursuing non-PC specialties.

Context Integral to emotional intelligence (EI), empathy is frequently studied in medical students. While important, given the implications for patient safety and physician well-being, traits such as self-regard may also affect physician efficacy. Emotional intelligence offers a holistic framework from which to study empathy, allowing it to be explored with coexisting traits and offering opportunities to identify related risk factors. Objective To identify trends in osteopathic medical student EI to help mitigate burnout, with specific attention to empathy and self-regard. Methods Eight hundred eighty-five students at Western University of Health Sciences College of Osteopathic Medicine of the Pacific from classes 2014-2016 were offered the Emotional Quotient Inventory 2.0 (EQ-i) at the start of school, completion of their second year, and at graduation. Participants completed all 3 inventories, yielding a response rate of 16.3%. Repeated measurement analysis of variance analyses were conducted using SAS software for Windows version 9.3. Results A total of 144 students participated. The total EI score shifted from mean (SD) 100.2 (12.4) at baseline to 96.1 (12.8) midway to 96.8 (13.3) at graduation ( P =.0161) with significant decreases between baseline and midway ( P <.001) and baseline and final administrations ( P <.001). Empathy declined from 103 (13.1) to 99.9 (12.7) to 99.6 (12.6) ( P =.0481) with significant decreases between baseline and midway ( P <.001) and baseline and final administrations ( P <.001). Self-regard declined from 98.6 (14.1) to 95.8 (15.1) to 95.5 (14.7) ( P =.135) with significant decreases between baseline and midway ( P =.0021) and baseline and final administrations ( P <.001). Conclusion This study's findings support further investigation of potential roles played by EI, empathy, and self-regard in physician burnout.

Context Osteopathic physicians often target the rectus capitis posterior minor (RCPm) and rectus capitis posterior major (RCPM) muscles when using muscle energy or soft tissue cervical techniques to treat patients with head and neck pain. The RCPm and RCPM muscles are located deep within the posterior occipitoatlantal and atlantoaxial interspaces, respectively. Objective To characterize the functional role of RCPm and RCPM muscles by comparing electromyographic (EMG) activation patterns of these muscles with EMG activation patterns of specific flexor and extensor muscles of the head and neck, the sternocleidomastoid (SCM), and the splenius capitis (SC) muscles, respectively. Methods Asymptomatic participants were recruited from the Michigan State University College of Osteopathic Medicine student body. Disposable 25-gauge, bipolar fine - wire intramuscular electrodes were used to collect EMG data from the right and left RCPm and RCPM muscles. Surface electrodes were used to collect EMG data from the right and left SCM and SC muscles. Data were collected as participants performed 4 cycles of flexion and extension with an external 4-lb force applied to the back of the head and the forehead. Results In RCPM muscles, EMG activity was significantly greater ( P< .003) during flexion and extension of the head and neck when an external force was applied to the back of the head. EMG activity in SCM muscles was significantly greater ( P< .0001) during flexion and extension of the head and neck when an external force was applied to the forehead. The authors observed that EMG activity in SC muscles was significantly greater ( P< .015) during flexion and extension of the head and neck when an external force was applied to the back of the head. No significant difference was found in EMG activity in RCPm muscles ( P< .834) during flexion and extension of the head and neck, regardless of whether the external force was applied to the back of the head or the forehead. Conclusion The EMG activation patterns of the RCPm muscles suggest that their functional role may be to stabilize the occipitoatlantal joint by helping maintain congruency of the joint surfaces. In contrast, the EMG activation patterns of the RCPM muscles suggest that their functional role may be to contribute to extension of the head, primarily at the occipitoatlantal and the atlantoaxial joints.

Background The sphenobasilar synchondrosis (SBS; also, sphenobasilar synostosis or sphenooccipital synchondrosis) plays a major role in the concept of osteopathic cranial manipulative medicine (OCMM) and craniosacral therapy. Previous research suggests that many individuals, from newborns to adults, present with single or multiple SBS strain patterns as a result of the birth process and other traumatic forces throughout life. To date, it is unclear whether specific SBS lesion patterns are present in altered health states and disease and how they compare with healthy controls. Objective To identify research that reports on specific SBS strain patterns compared with healthy controls. Methods A literature review of electronic databases and hand-search of publication bibliographies was performed. Observational studies of newborns, children, and adults were included if there was information on the occurrence of cranial strain patterns related to the SBS in individuals with impaired health states and a healthy control group. Results Of 1123 citations, 836 articles were screened after duplicate removal, and 42 articles were evaluated by full-text assessment. Three articles were included in this review, including 1 prospective and 2 retrospective studies. The age ranges of the populations studied were newborns aged 5 days or younger, children aged 4 to 14 years, and adults aged 45 to 90 years. In adults with Parkinson disease, no significant difference in SBS strain patterns between the Parkinson disease group and the age-matched healthy control group were seen. In contrast, different SBS strain patterns were observed between newborns with a range of health impairments, such as jaundice and respiratory and nervous symptoms, and children with learning disabilities compared with their healthy counterparts. However, no statistical analysis was conducted in these 2 studies; hence, results are difficult to interpret. Reporting in all 3 studies was limited; therefore, the methodologic quality of the 3 identified studies was deemed incapable of being judged. Conclusion The study landscape of this review highlights the scarcity of, poor reporting on, and unclear methodologic quality of research on SBS strain patterns in disease and health. It is still unclear whether and to what extent specific SBS strain patterns occur in impaired health states compared with healthy controls. Future studies should seek to improve study methods and reporting and minimize the risk of bias.

In the United States, nearly 40,000 deaths per year are firearm related. Among these fatalities are approximately 1300 children. In addition, there are more than 20,000 unintentional firearm injuries per year. Osteopathic physicians have a unique opportunity to affect this public health concern through patient education. Several evidenced-based recommendations can be incorporated at the bedside to reduce firearm injuries and deaths, including gun education, safe storage, and proper disposal.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic is causing an increased need for mechanical ventilation for a significant percentage of people who present to the hospital for treatment. This increase in demand could surpass the supply of ventilators and lead to an increase in mortality due to a lack of ventilator vacancies. There is significant evidence that osteopathic manipulative medicine (OMM) can alleviate pulmonary symptoms and aid in quicker recoveries from various respiratory ailments. OMM has the potential to play a significant role in helping reduce a patient's need for mechanical ventilation by delaying the onset of acute respiratory distress syndrome stemming from SARS-Cov2 infections.

Hip pain in adults is a common complaint. Secondary processes can often mask underlying conditions, prolonging the course to diagnosis and definitive treatment. In this case, a 74-year-old man presented to an outpatient clinic after 6 weeks of right hip pain that began upon initiation of a rehabilitation program following coronary artery bypass graft surgery. Various imaging and treatment modalities (including radiography, osteopathic manipulative treatment, injection of the greater trochanteric bursa, L2-3 paravertebral block, magnetic resonance imaging, and intra-articular hip injection with 1% lidocaine) ultimately led to the definitive diagnosis of a labral tear. This case report highlights how a comprehensive osteopathic approach was used to evaluate and treat a patient with persistent unilateral hip pain because of an acetabular labral tear, associated psoas syndrome, and trochanteric bursitis, all within 2 months and with a positive clinical outcome.