Volume 125, Issue 10

Context Clinically based performance assessments, including those employing standardized patients (SPs), have been utilized to educate and assess medical students and graduates. Starting in the 1990s, demonstrating competency on these types of assessments became part of the medical licensure pathway in some countries, and was re-added to the licensure pathway in the United States in 2004. Studies have been published to support the validity of the scores and associated pass/fail decisions obtained from SP assessments. With the onset of the COVID-19 pandemic, testing organizations were forced to suspend many of their in-person clinical skills assessments. There is widespread recognition that clinical skills are necessary for high-quality patient care. Nevertheless, there has been disparate interest in reestablishing national assessments of these skills. Objectives Based on the recommendations of the Special Commission on Osteopathic Medical Licensure Assessment, the National Board of Osteopathic Medical Examiners (NBOME) established the Core Competency Capstone for Doctors of Osteopathic Medicine (C3DO). The objectives of this study were to describe the assessment and to ascertain the feasibility of administering it at multiple colleges of osteopathic medicine (COMs). Methods Surveys of osteopathic medical school personnel and students taking the assessment were conducted to gather data on the feasibility of administering the C3DO, the challenges associated with a distributed model, and the educational value of the assessment. Reports submitted by the medical schools provided information on the cost of the assessment. Some psychometrics analyses of Phase 1 C3DO pilot data were conducted, including the quantification of measurement errors. Results The NBOME, in collaboration of the COMs, was able to administer the C3DO to almost the entire class at four osteopathic medical schools. Although there were challenges, including data transfer from the schools, summary scores were derived for a total of 811 students, including nine repeat test takers. Medical students across sites indicated that the C3DO was a valuable educational assessment activity. The reliability of the ratings derived from the checklists (history building [HB], physical examination [PE]) and Communication and Respectfulness Evaluation (CARE) tool were adequate. Based on a variance components analysis, there was some evidence to suggest that at a given school, the choice of an SP portraying and scoring the case could have an impact on the student scores. Conclusions The C3DO-distributed site model, which includes centrally developed cases, standardized training of SPs, and independent scoring of osteopathic manipulative treatment (OMT), provides the means to assess the clinical skills of osteoapthic medical students at different testing sites. The implementation of a distributed, school-based model for the assessment of osteopathic clinical skills is feasible, potentially economically advantageous, and if rigorously developed and administered, should provide for comparable student scores and associated competency decisions. Additional Phase 2 (2024-2025) and Phase 3 (2025-2026) studies are underway to establish the psychometric rigor of the assessment more fully.

Context Medical error is cited as a leading cause of preventable harm and death. Medical education in the United States must be restructured to enhance the development of skills, behaviors, and attitudes that medical students will need upon graduation, including the crucial ability to manage clinical and scientific information, understanding the basic concepts of human dynamics, patient safety, systems theory, and the development of basic management, communication, and teamwork skills. To accomplish this goal, it will be necessary for medical schools to balance their current, intensive focus on basic and clinical services with patient safety science. Although many examples exist of incorporating patient safety awareness into medical school courses, there are no recognized and accepted models related to incorporating mandatory patient safety education into medical school curricula that provide comprehensive measures of competence. This study evaluates the quantitative and qualitative outcomes of an intensive, mandatory patient safety course implemented during the third year of undergraduate medical education. Objectives The objective of this study was to determine if the implementation of an advanced mandatory 2-week patient safety course, leading to the attainment of the Certified Professional in Patient Safety (CPPS™) credential, can yield a measurable impact on medical students’ patient safety knowledge entering into residency. Methods Data were gathered from 12 cohorts of students in each of two consecutive third-year classes. Utilizing mixed-methods analyses, this study followed a total of 430 students to measure the change in their knowledge and perceptions before and after taking the course. The study also assessed what factors were associated with first-time passing of the CPPS™ Certification Examination. These factors included grade point average (GPA), positive perceptions about the course, and class year. Results There was significant improvement in the knowledge scores of all five patient safety domains. Similarly, there was a significant improvement in the perceived importance of receiving patient safety education in undergraduate medical education, attaining certification, and the value for students when applying for residency positions. Students’ GPA was the only reliable predictor of passing the CPPS™ Certification Examination. Themes from qualitative data analysis reveal student perceptions of the course and certification to be extremely important to understanding the magnitude of the preventable harm problem and highlighting tools to address patient safety issues in the future. Most students reported that the course was essential to preparing for the comprehensive CPPS™ Certification Examination. Conclusions Patient safety science subject matter can be successfully integrated into a formal course for third-year medical students, creating competent patient safety–focused providers and change agents of the future. Incorporating CPPS™ Certification into the curriculum provides a tangible, quantitative academic achievement while equipping students with critical knowledge to systematically improve healthcare quality and safety.

Context Sarcopenia is a disease characterized by low muscle mass and function that places individuals at greater risk of disability, loss of independence, and death. Current therapies include addressing underlying performance issues, resistance training, and/or nutritional strategies. However, these approaches have significant limitations, and chronic inflammation associated with sarcopenia may blunt the anabolic response to exercise and nutrition. This presents an unmet need for treatment strategies that promote gains in muscle function. One such possibility is soft tissue manipulation (STM), which is a noninvasive, nonpharmacological mechanotherapy employed by osteopathic physicians, physiotherapists, and massage therapists, wherein soft tissues are subjected to mechanical forces delivered by hand or by an instrument. However, the molecular effects of STM in sarcopenia remain largely unknown. Objectives In the present study, we utilized a rat model of sarcopenia due to disuse atrophy and examined the effects of STM on recovery of muscle mass and regulation of pro-/anti-inflammatory cytokines. Methods Ten-week-old male Brown Norway rats were subjected to 2-week hindlimb suspension (HLS) and then allowed to re-ambulate for 8 days with or without instrument-assisted soft tissue manipulation (IASTM) applied to the right hindlimb. Muscle weights were determined for treated and nontreated hindlimbs, and membrane-based cytokine arrays were performed on treated tissue and serum. Results Following suspension, IASTM enhanced the effectiveness of re-ambulation (Re-A) on muscle mass recovery in both treated and contralateral limbs. This was associated with changes in numerous cytokines in treated skeletal muscle and sera. Several factors we observe to be regulated were also shown to be regulated by STM in other studies, including ciliary neurotrophic factor (CNTF), IL-1β, IL-2, IL-3, IL-13, ICAM-1, and tumor necrosis factor alpha (TNF-α), whereas others are reported for the first time. Conclusions Our study adds further support for the role of manual therapy in musculoskeletal health and details molecular-level effects in both target tissue and circulation. STM may hold promise for recovering muscle mass and function related in conditions of atrophy such as age-related sarcopenia.

Context Osteopathic manipulative treatment (OMT) is an emerging nonpharmacological intervention utilized to address various health conditions, particularly among the elderly population. This scoping review aims to examine the available evidence regarding the effectiveness of OMT in improving pain, balance, and quality of life in geriatric patients, identifying gaps in the current research and suggesting future directions. Objectives This scoping review aims to evaluate the efficacy of OMT in elderly patients by analyzing selected studies that specifically explore its effects on balance, quality of life, and pain management. Additionally, this review will assess the current quality of evidence regarding these outcomes. Methods Selected articles from December 2012 to September 2024 focused on OMT in individuals aged 65 and older. We conducted a systematic literature search utilizing Medical Subject Headings (MeSH) and free-text terms combined with the Boolean operator “AND,” including: OMT, osteopathic manipulative treatment, osteopathic medicine, aging, older adult, elderly, aged, and geriatric people. Databases, including PubMed, SCOPUS, Cochrane Library, and others, were searched from June 3, 2024 to September 3, 2024 following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Three authors (L.M., E.N., L.M.) reviewed the titles, abstracts, and full texts to determine eligibility. Disagreements were resolved through discussion. Filters included studies involving human subjects and studies published in English, Spanish, or Italian. Exclusions were made for literature reviews, protocols, commentaries, and nonosteopathic manual techniques. Results A total of 2,478 articles were identified; then, after removing 1,564 duplicates, 917 articles remained for screening. These articles were assessed based on their titles and abstracts, leading to the exclusion of 873 articles according to the established exclusion criteria. In the final phase, the remaining 44 articles underwent a full-text evaluation. This process resulted in the exclusion of 21 articles that were not randomized controlled trials (RCTs) and 14 articles that did not meet the required outcome measures. Ultimately, a total of nine articles were included in the systematic review. Conclusions This study highlights the effectiveness of OMT in improving pain, balance, and quality of life in geriatric patients. The findings underscore the value of OMT as a personalized therapeutic approach, promoting healthier aging and enhancing overall well-being in the elderly population. Further research is encouraged to explore the full potential of OMT, supporting its integration as a key component of osteopathic care for geriatric patients.

Context Pediatric lymphedema is a progressive condition of chronic swelling and soft-tissue damage, caused by impaired lymphatic function. It affects nearly 1 in 100,000 children in the United States, raising challenges of clinical management and strategies for preventing disease progression. Traditional therapies, such as complex decongestive therapy (CDT), provide limited value due to a lack of research on the pediatric population and low compliance in adolescents, highlighting the need to seek alternative approaches. Multiple osteopathic manipulative treatment (OMT) modalities, such as myofascial release (MFR) and lymphatic pump, enhance lymphatic flow and have emerged as promising adjunctive therapies. Objectives The objective of this study was to systematically review and evaluate the evidence supporting the effectiveness of OMT in managing pediatric lymphedema and compare it to traditional therapies such as CDT. Methods A systematic review was conducted from July 2024 to October 2024 across PubMed, DynaMed, and Google Scholar databases. Searches followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with the following Medical Subject Headings (MeSH) terms: “pediatric lymphedema,” “primary lymphedema,” “osteopathic manipulative treatment,” and “lymphatic drainage techniques.” Inclusion criteria involved peer-reviewed articles published in English between 2015 and 2024 with full-text access, focusing on lymphedema management and pediatric cases. Grey literature and non-English studies were excluded. A total of four authors conducted independent screenings, resolving disagreements through consensus. Data on outcomes, patient demographics, and treatment efficacy were extracted and analyzed to compare OMT with CDT. Results Out of 7,261 records identified, 7,153 were excluded (duplicates and nonrelevant studies). Thus, 108 full texts were assessed, with 18 studies meeting the eligibility criteria. Findings indicated that OMT techniques, such as lymphatic pump treatment (LPT), may help with limb volume reduction and wound closure. In a pediatric cohort, OMT demonstrated significant patient compliance and satisfaction due to its noninvasive nature and reduced session times compared to other therapeutic counterparts. Moreover, studies on fibroblast morphology suggest cellular benefits of OMT in reducing chronic inflammatory markers, promoting tissue repair, and improving lymphatic flow. Conclusions OMT shows promise as an adjunctive therapy for pediatric lymphedema, offering advantages of enhanced lymphatic drainage, reduced edema, and prompt wound healing with better patient tolerance. Further large-scale trials are needed to validate the clinical utility of OMT, aiming to establish comprehensive management protocols for pediatric lymphedema.