Osteopathic Medical Training Revisited: Developing Tomorrow's Physicians
http://www.100md.com
《美国整骨期刊》
I would like to thank Dr Smith and Dr Bledsoe for using this forum to boldly address some controversial issues within the osteopathic medical profession (J Am Osteopath Assoc. 2004;104[6]: 230–231, and J Am Osteopath Assoc. 2004;104[10]:405–406, respectively).
When I began medical school, I was excited about using osteopathic manipulative treatment (OMT) as a treatment modality. However, over the past 3 years, I've been underwhelmed by its clinical applicability and unimpressed with the science and research used to support its use among those in the profession.
As a scientist and future osteopathic physician, I have been trained to evaluate all the options for my patients critically and to utilize the most appropriate and effective treatment available.
Because I generally have neither the data to support the use of OMT in the clinical setting nor the ability to explain its mechanisms, I feel ethically compelled to limit my use of this treatment modality. In fact, I cannot even say with confidence that it "does no harm," as a recent study by Licciardone et al demonstrated.1
Other researchers have concluded that the majority of DOs rarely or never use OMT.2 Although the reasons for this are multifactoral, a serious disconnect seems to exist between what DOs are "supposed" to do, and how we actually practice medicine.
Juxtapose these research findings2 with the examination questions used in the second part of the Comprehensive Osteopathic Medical Licensing Examination, which I recently completed. The emphasis on OMT-specific questions—such as Chapman reflex points, craniosacral manipulation, and assorted viscerosomatic reflexes—surprised me. I found it troubling that a substantial portion of my medical licensing examination was dedicated to concepts lacking broad-based support even among osteopathic physicians, let alone the rest of the medical community. I think this disconnect is part of the "elephant in the room" syndrome that Dr Bledsoe was referring to in his aforementioned letter to the editor.
Dr Clark, in his November 2004 response to Dr Smith ("Osteopathic Medical Training: Developing the Seasoned Osteopathic Physician." J Am Osteopath Assoc. 2004;104[11]:452–454), made a reasonable suggestion when he proposed that osteopathic medical students and residents who have concerns gain more experience and clinical competence before proposing changes to the profession they have just joined.
The main problem I see in following Dr Clark's well-intentioned advice is that those with concerns might just become exasperated—or worse, apathetic—while waiting for "their turn" to speak up. In fact, they may begin looking for satisfaction in Accreditation Council for Graduate Medical Education (ACGME) residency programs, curtailing all future participation and discussion within the osteopathic community.
With the majority of new DOs currently accepting ACGME residencies, is it not plausible that only the "unconcerned" DOs might remain in the system to eventually assume positions of influence within the profession I doubt this self-selected body would have any strong motivation to examine more closely a system that has worked just fine for them. Surrounded only by fellow osteopathic patriots, one could well imagine that they would feel no compelling reason to change anything at all.
I've worked hard during my medical training. I feel confident I've prepared myself to become a competent, caring, "people-not-just-symptoms" – treating resident and physician. However, I'll be truthful and admit that, like the majority of current DOs, OMT is not likely to be a meaningful part of my clinical practice.
My future participation as an active member of the American Osteopathic Association (AOA) is less clear. As proud as I am of my medical training and pending degree, I am not sure that the AOA adequately represents who I want to be as a physician. I believe the AOA is most concerned with its own survival. The AOA adamantly maintains that osteopathic medicine is distinct from allopathic medicine, but it seems far less interested in the research and training programs necessary to justify that distinction.
As evidenced by the increasing numbers of osteopathic medical students selecting ACGME residency training, until the osteopathic profession and the AOA tackle some issues soberly and head on, I am afraid that the elephants in the room will continue to crowd many of us out of the tent.
Midwestern University–Arizona College of Osteopathic
Medicine
Glendale, Ariz
References
2. Spaeth DG, Pheley AM. Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties. J Am Osteopath Assoc. 2003;103:16–26. Available at: http://www.jaoa.org/cgi/reprint/103/1/16. Accessed March 18, 2005.(Kevin Innes, MSIV)
When I began medical school, I was excited about using osteopathic manipulative treatment (OMT) as a treatment modality. However, over the past 3 years, I've been underwhelmed by its clinical applicability and unimpressed with the science and research used to support its use among those in the profession.
As a scientist and future osteopathic physician, I have been trained to evaluate all the options for my patients critically and to utilize the most appropriate and effective treatment available.
Because I generally have neither the data to support the use of OMT in the clinical setting nor the ability to explain its mechanisms, I feel ethically compelled to limit my use of this treatment modality. In fact, I cannot even say with confidence that it "does no harm," as a recent study by Licciardone et al demonstrated.1
Other researchers have concluded that the majority of DOs rarely or never use OMT.2 Although the reasons for this are multifactoral, a serious disconnect seems to exist between what DOs are "supposed" to do, and how we actually practice medicine.
Juxtapose these research findings2 with the examination questions used in the second part of the Comprehensive Osteopathic Medical Licensing Examination, which I recently completed. The emphasis on OMT-specific questions—such as Chapman reflex points, craniosacral manipulation, and assorted viscerosomatic reflexes—surprised me. I found it troubling that a substantial portion of my medical licensing examination was dedicated to concepts lacking broad-based support even among osteopathic physicians, let alone the rest of the medical community. I think this disconnect is part of the "elephant in the room" syndrome that Dr Bledsoe was referring to in his aforementioned letter to the editor.
Dr Clark, in his November 2004 response to Dr Smith ("Osteopathic Medical Training: Developing the Seasoned Osteopathic Physician." J Am Osteopath Assoc. 2004;104[11]:452–454), made a reasonable suggestion when he proposed that osteopathic medical students and residents who have concerns gain more experience and clinical competence before proposing changes to the profession they have just joined.
The main problem I see in following Dr Clark's well-intentioned advice is that those with concerns might just become exasperated—or worse, apathetic—while waiting for "their turn" to speak up. In fact, they may begin looking for satisfaction in Accreditation Council for Graduate Medical Education (ACGME) residency programs, curtailing all future participation and discussion within the osteopathic community.
With the majority of new DOs currently accepting ACGME residencies, is it not plausible that only the "unconcerned" DOs might remain in the system to eventually assume positions of influence within the profession I doubt this self-selected body would have any strong motivation to examine more closely a system that has worked just fine for them. Surrounded only by fellow osteopathic patriots, one could well imagine that they would feel no compelling reason to change anything at all.
I've worked hard during my medical training. I feel confident I've prepared myself to become a competent, caring, "people-not-just-symptoms" – treating resident and physician. However, I'll be truthful and admit that, like the majority of current DOs, OMT is not likely to be a meaningful part of my clinical practice.
My future participation as an active member of the American Osteopathic Association (AOA) is less clear. As proud as I am of my medical training and pending degree, I am not sure that the AOA adequately represents who I want to be as a physician. I believe the AOA is most concerned with its own survival. The AOA adamantly maintains that osteopathic medicine is distinct from allopathic medicine, but it seems far less interested in the research and training programs necessary to justify that distinction.
As evidenced by the increasing numbers of osteopathic medical students selecting ACGME residency training, until the osteopathic profession and the AOA tackle some issues soberly and head on, I am afraid that the elephants in the room will continue to crowd many of us out of the tent.
Midwestern University–Arizona College of Osteopathic
Medicine
Glendale, Ariz
References
2. Spaeth DG, Pheley AM. Use of osteopathic manipulative treatment by Ohio osteopathic physicians in various specialties. J Am Osteopath Assoc. 2003;103:16–26. Available at: http://www.jaoa.org/cgi/reprint/103/1/16. Accessed March 18, 2005.(Kevin Innes, MSIV)