Volume 125, Issue 12

Context Following the implementation of the Single Accreditation System (SAS) in 2020, the integration of osteopathic and allopathic residency programs has reshaped access to surgical specialties. Despite these efforts, osteopathic medical graduates remain underrepresented in otolaryngology residencies, with historical concentration in a few Midwestern states and limited access to home residency programs. Objectives The objective of this study was to assess the geographical distribution, training site characteristics, and match patterns of osteopathic otolaryngology residents from 2020 to 2024, including relationships with medical school location and program history (historically AOA-accredited vs. historically allopathic-only). Methods A retrospective cross-sectional analysis was conducted utilizing data on 109 osteopathic otolaryngology residents matched from 2020 to 2024. Data were gathered from National Resident Matching Program (NRMP) results, residency websites, and public sources. Variables included residency location, hospital size, urban/rural status, and medical school affiliation. Statistical methods included descriptive statistics, chi-square tests for trend, Pearson correlation, regression analysis, and a two-sample t  test for geographic mobility. Results Michigan, Pennsylvania, and Ohio accounted for 74.3 % of residents. Geographic distribution trends over the 5-year period (2020–2024) showed no significant year-to-year change (p=0.54). A positive correlation (p=0.014) existed between osteopathic school locations and resident distribution. All residents trained in urban programs; 80.7 % trained in large hospitals (≥400 beds). A two-sample t  test showed that residents who relocated for residency moved significantly farther than those who remained in-state (p=0.014). More osteopathic residents matched into historically AOA-accredited programs than into formerly allopathic-only programs. Conclusions Five years after the SAS merger, osteopathic otolaryngology residents continue to cluster geographically near osteopathic medical schools and train predominantly in large, urban hospitals. Historically AOA-accredited programs remain a primary entry point for osteopathic graduates. Further efforts are needed to expand access and representation across the broader otolaryngology training landscape.

Context As the prevalence of social determinants of health (SDH) continues to have an impact on the management of chronic conditions, it is imperative to expose health professional students to these encounters. Objectives This study investigates the role that virtual interactive modules play on osteopathic medical students and physician assistant (PA) students’ empathy and attitudes toward individuals with diabetes mellitus who are also affected by an array of SDHs. Methods Students from both health professional programs were asked to complete a pre-survey and post-survey that encompassed the Diabetes Attitude Scale, the Jefferson Empathy Scale, and the Assessing Student Competence and Knowledge of Social Determinants of Health (ASCK-SDH) Instrument. Students engaged with virtual interactive modules to follow the life of a patient, Lula Mae, who lives in the Appalachian area with Type 2 diabetes. Results Results from 151 osteopathic medical students concluded significant findings for the Diabetes Attitudes Scale (p<0.001), Jefferson Empathy Scale (p<0.02), and ASCK-SDH (p=0.02). While the matched data pairs for the PA students were too small in number to be significant, the data showed a positive trend pre-module to post-module. Conclusions This interactive module improved health professionals’ awareness, empathy, and attitudes toward SDH affecting those with chronic conditions. This implementation can be a valuable and insightful medical educational tool that can be adapted for other scenarios like various clinical rotations and sensitive healthcare topics to enhance the development of health professional students’ cultural competency and health equity awareness by exposure to various cultural, socioeconomic, and social identities in their future medical decision-making.

Context Asymmetry of bony landmarks, such as the anterior superior iliac spine (ASIS) or posterior superior iliac spine (PSIS), is often utilized to identify somatic dysfunction in the pelvis. However, establishing good accuracy for these assessments can be challenging, so objective training models have been developed to enhance learning and accuracy. Objectives The objective of this study was to determine the effect of training with positional asymmetry models with objective feedback on the improvement and retention of pelvic asymmetry assessment accuracy. Methods First-year osteopathic medical students and undergraduate interns were recruited for model training. After a basic technique demonstration, they completed a 72-question baseline assessment on the ASIS and PSIS models. Subsequent training was conducted for 5 h per week (1 h/day) for two consecutive weeks. Model accuracy was assessed four times at baseline, midpoint, final, and retention. Assessments were scored as a percent of the correctly identified asymmetries, and change scores were calculated by comparison with the previous assessment score (i.e., baseline to midpoint, midpoint to final, final to retention) and overall (baseline to retention). Results Twelve students (age range, 20.3–29.2 years) participated. At baseline, overall scores were 57.6 % for ASIS and 72.9 % for PSIS models. For ASIS models, the change scores improved from baseline to midpoint (+18.9 %, p<0.001) and from midpoint to final (+6.6 %, p=0.01) but decreased from final to retention (−7.2 %, p=0.01). The overall retention scores were higher than baseline (+18.3 %, p<0.001). For PSIS models, the change scores improved from baseline to midpoint (+13.0 %, p<0.001), and the overall retention scores were higher than baseline (+15.0 %, p<0.001). Conclusions Training with positional asymmetry models with objective feedback resulted in significant sustained improvements in ASIS and PSIS positional asymmetry assessment accuracy. Integration of these models into the standard medical curriculum should be considered.

Context Osteopathic assessment and osteopathic manipulative treatment (OMT) have been utilized in managing chronic neck pain (CNP) and neck somatic dysfunction. However, osteopathic assessments lack quantitative measures to detect muscle abnormalities and evaluate the effect of OMT. Objectives This study aims to investigate the feasibility of utilizing ultrasound shear wave velocity (SWV) and shear wave relative anisotropy coefficient (SWRAC) to assess neck somatic dysfunction and the effect of OMT. Methods After receiving Institutional Review Board (IRB) approval and informed consent, we measured upper trapezius muscle (UTM) SWV in both longitudinal and transverse planes. We calculated SWRAC utilizing the formula: (SWV longitudinal  – SWV transverse )/SWV transverse . We analyzed differences in muscle SWV and SWRAC between different age groups utilizing one-way analysis of variance (ANOVA). For the comparison in SWV and SWRAC between UTMs with and without neck somatic dysfunction, we utilized an unpaired t -test, although we examined the changes in SWV and SWRAC before and after OMT utilizing a paired t -test. We also evaluated correlations between SWV and muscle somatic dysfunction utilizing Spearman correlation. The diagnostic performance of SWV in identifying neck somatic dysfunction was assessed utilizing the area under receiver operating characteristic curve (AUC). Inter- and intra-observer reliability in measuring muscle SWV was analyzed utilizing intraclass correlation coefficient (ICC). Results From November 2022 to August 2024, we measured muscle SWV in 158 adults (68 men, 90 women, mean age 49 years) without (51) and with (107) neck somatic dysfunction. We observed significant differences in SWV and SWRAC between UTMs with and without somatic dysfunction, and before and after OMT (p<0.01). Longitudinal muscle SWV was high in elderly subjects and those with neck somatic dysfunction. Longitudinal SWV positively correlated to neck somatic dysfunction ( R 2 =0.69). AUC of SWV for determining neck somatic dysfunction was 0.86. ICCs for measuring SWV ranged from 0.80 to 0.99. Conclusions The SWV in longitudinal muscles shows a positive correlation with neck somatic dysfunction, demonstrating moderate diagnostic accuracy and strong observer reliability. Application of OMT significantly decreases muscle stiffness measured by SWV, providing an objective and quantitative method to assess the effectiveness of OMT.

Context Cesarean sections (CSs) can reduce maternal and fetal risk in medically necessary cases. However, studies show that CSs are associated with negative fetal outcomes, including birth defects, low birth weight, delayed fetal resuscitation, neonatal acidosis, and even infant mortality. Maternal comorbidities play a role in determining if a CS is necessary and may contribute to negative fetal outcomes following a CS. Objectives The primary objective of this study was to determine the prevalence of negative fetal outcomes such as low birth weight, birth defects, prolonged hospital stay, and infant mortality in CS deliveries and their increased risk of occurrence among mothers with comorbidities. Methods We conducted a cross-sectional study of the Phase 8 (2016–2019) Pregnancy Risk Assessment Monitoring System (PRAMS) to assess the associations of the aforementioned birth outcomes with pre-existing conditions such as high blood pressure (HBP), depression, and type II diabetes mellitus, as well as demographic factors in the United States (US). Results Our findings showed that mothers who delivered via CS with pre-existing or gestational HBP, or gestational diabetes, were less likely to experience infant mortality (adjusted odds ratio [AOR]: 0.4; confidence interval [CI]: 0.17–0.92, AOR: 0.2; CI: 0.09–0.44, and AOR: 0.09; CI: 0.03–0.33, respectively). However, mothers who delivered via CS with pre-existing or gestational diabetes, pre-existing or gestational HBP, or pre-existing or gestational depression had higher rates of prolonged infant hospital stay (AOR: 1.73; CI: 1.41–2.11, AOR: 1.21; CI: 1.05–1.39, AOR: 1.77; CI: 1.5–2.09, AOR: 2.58; CI: 2.31–2.88, AOR: 1.25; CI: 1.09–1.43 and AOR: 1.33; CI: 1.16–1.52, respectively). Likewise, mothers who delivered via CS with pre-existing or gestational HBP, or pre-existing or gestational depression, were more likely to deliver an infant with low birth weight (AOR: 1.88; CI: 1.62–2.19, AOR: 2.7; CI: 2.45–2.98, AOR: 1.24; CI: 1.09–1.41, and OR: 1.28; CI: 1.14–1.42, respectively). Conclusions Our study revealed a lower incidence of infant mortality following CS deliveries among mothers with pre-existing or gestational HBP, or gestational diabetes. This suggests a potential benefit in antenatal testing in mothers experiencing depression or those with no comorbidities. Additionally, infants born to mothers with these comorbidities experienced longer hospital stays, and infants of mothers with pre-existing or gestational HBP and depression had a higher incidence of low birth weight. Given the increasing rates of diabetes, HBP, and depression in the US, it is crucial to provide healthcare professionals with the necessary guidance to prevent and manage these comorbidities and improve fetal outcomes following CS deliveries.