Potential therapeutic effects of adjunct osteopathic manipulative treatments in SARS-CoV-2 patients.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects various human organ systems, including the lymphatic, pulmonary, gastrointestinal, and neurologic systems. The utilization of osteopathic manipulative treatment (OMT) techniques has been clinically effective in the alleviation of various upper respiratory infection symptoms. Consequently, the use of osteopathic manipulative medicine (OMM) in SARS-CoV-2 patients as adjunct treatment can be beneficial in promoting overall recovery. This paper attempts to address the pathophysiology of SARS-CoV-2 infection at the cellular level and its downstream effects. Subsequently, osteopathic principles were investigated to evaluate potential therapeutic effects, providing a holistic approach in the SARS-CoV-2 treatment. Although the association between the benefits of OMT on clinical improvement during the 1918 Spanish influenza pandemic can be seen, further investigation is required to establish a direct correlation between OMT and symptom management in SARS-CoV-2.

A randomized, controlled study to assess if allopathic-osteopathic collaboration influences stereotypes, interprofessional readiness, and doctor-patient communication.

Despite the growing similarities between allopathic (MD) and osteopathic (DO) medical education, few studies have examined allopathic-osteopathic collaboration. The following study focused on stereotypes and student readiness for interprofessional learning. Patient perceptions were also evaluated. Osteopathic and allopathic students were randomly allocated 1:1:1 to work in pairs (MD/DO, MD/MD, DO/DO) at the start of each shift. A questionnaire evaluating student communication was collected from patients at the end of each encounter. Surveys assessing stereotypes and interprofessional readiness were obtained from students at the end of each workday. Data collection was stopped early due to Coronavirus-related safety measures. In the ITT analysis, there were a total of 126 participants (57 students 69 patients). A per-protocol analysis was performed to account for repeat clinic volunteers. No significant differences were detected between student pairs; however, the sensitivity analysis of the questionnaire assessing interprofessional readiness was 8 points higher in the DO/DO group compared to the MD/MD and MD/DO groups (P = 0.0503). In the content analysis of qualitative responses, the MD/DO group was more likely to respond with themes of enjoyment and less concern about stereotypes than the DO/DO group. The MD/DO group was also less likely to report concerns about differences in expectations, methods, and thinking than the MD/MD group. Early trends from this study suggest that DO students may be better positioned to engage in interprofessional learning than their MD counterparts. Additionally, the findings from our content analysis provide evidence that the collaborative experience improved feelings associated with professional legitimacy and credibility among DO students. Taken in aggregate, this study provides justification for a follow-up investigation, as well as a framework for how such studies could best be executed in the future.

Virtual Residency Interviews during the COVID-19 Pandemic: The Applicant's Perspective.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education at all levels, particularly on applicants applying to residency programs. The objective of the study was to gain a comprehensive understanding of applicants' perspectives on virtual interviews in the setting of the COVID-19 pandemic. METHODS: We conducted a quantitative survey and a qualitative study between March and April 2021. The link to an anonymous online survey was emailed to fourth-year medical students from one allopathic medical school. The survey link also was posted on the social media page of one allopathic medical school and one osteopathic medical school. Participants were then invited to participate in a follow-up 15- to 45-minute qualitative virtual interview. RESULTS: A total of 46 participants completed the survey, with a response rate of approximately 29.1%. The most beneficial aspect of the virtual interview was saving money on travel (31, 78.39%). In contrast, the least beneficial aspect of the virtual interview was the inability to personally explore the culture of the program (16, 34.78%), followed by the inability to explore the city and surrounding area (11, 23.91%). Thematic saturation was reached after interviewing 14 participants over Zoom. Four major themes of the virtual residency interview experience were discussed: virtual interviews offered many advantages, virtual interviews posed unique challenges, residency programs need more organizational improvements, and virtual specific preparations are needed. CONCLUSIONS: Despite the challenges associated with the virtual interview process, applicants rated the overall virtual interview experience positively. Given the continued impact of COVID-19 on medical education, the majority of residency programs will elect to continue virtual interviews for the 2022 Electronic Residency Application Services cycle. We hope that our findings may provide insight into the applicant's perspective on the virtual interview experience and help optimize virtual interviews for future cycles.

The effect of the COVID-19 pandemic on osteopathic education in ACGME-OR residencies from February 2020 to February 2021.

CONTEXT: It remains to be determined exactly how the COVID-19 pandemic has and will continue to impact osteopathic resident education, in particular as it pertains to treatment with osteopathic manipulative medicine (OMM). Although the long-term effects of the pandemic cannot be determined yet, changes in current resident education can be analyzed. OBJECTIVES: Here, we describe how the format, frequency, and environment of OMM training have changed in residency programs from prior to February 2020 to the "lockdown" period of February 2020 to June 2020, and then to the "recovery" period of July 2020 to February 2021. METHODS: A 19-question survey inquiring about the above three categories was emailed via SurveyMonkey to 282 Accreditation Council for Graduate Medical Education (ACGME) residency programs with osteopathic recognition at the end of January 2021. RESULTS: Of the 282 programs surveyed, 24.5% (69) responded. Osteopathic neuromusculoskeletal medicine (ONMM) programs were excluded from the data analysis, resulting in a modified sample size of n=60. Responses indicated that residency programs dramatically decreased the frequency of OMM didactic education sessions (100.0% [60] reported offering OMM didactic education before the lockdown period; compared to 73.3% [44] during the lockdown period) and shifted their educational programs from an in-person-only environment (88.3% [53] before lockdown; 8.3% [5] during lockdown) to either a combined in-person/virtual platform (6.7% [4] before lockdown; 31.7% [19] during lockdown) or to a virtual-only platform (0.0% [0] before lockdown; 46.7% [28] during lockdown). During the recovery period, 91.7% (55) programs reported giving some form of OMM didactic education. The percentage of programs reporting in-person-only, combined in-person/virtual platform, and virtual-only didactic education were 3.3% (2), 53.3% (32), and 41.7% (25), respectively, during the recovery period. The preferred method of instruction changed from a combination of resident and attending lectures with a hands-on component (55.0%; 33) before lockdown, to the same but without a hands-on component (28.3%; 17) during lockdown, and back to the same but with a hands-on component (36.7%; 22) during the recovery period. Furthermore, the number of programs offering OMM didactic education [OMM patient care] at least once a month decreased from 70.0% (42) [78.3% (47)] before the lockdown period to 46.7% (28) [48.3% (29)] during the lockdown period. It then increased to 55.0% (33) [73.3% (44)] during the recovery period. Finally, before the lockdown period, programs offered OMM patient care predominantly in a combination of an inpatient/outpatient environment (63.3%; 38). The preferred patient care setting changed to an outpatient-only environment (43.3%; 26) during the lockdown period and then back to a combination of an inpatient/outpatient environment (45.0%; 27) during the recovery period. CONCLUSIONS: This study demonstrates that programs have been dramatically impacted by the COVID-19 pandemic, by the augmentation of the osteopathic learning environment, and by the delivery of OMM to patient care within the training programs. These impacts were still present 1 year after the start of the pandemic. It will be imperative for ACGME Osteopathic Recognition (ACGME-OR) programs to continue an assessment of these impacts on resident physicians' learning and preparedness.

The pandemic silver lining: preparing osteopathic learners to address healthcare needs using telehealth.

CONTEXT: During the COVID-19 pandemic, many clinicians quickly adapted their way of practicing patient care by offering telehealth and virtual office visits while simultaneously having to minimize direct patient care. The shift in direct clinical learning opportunities provided to third- and fourth-year medical students required a shift in the educational curriculum to develop learner skills around the appropriate use of telehealth in patient care. OBJECTIVES: The aim of this project was to provide exposure to students so they could learn the telemedicine equipment and best practices, and how to identify infectious diseases to improve access to care and meet the needs of the patient. METHODS: In July and August of 2020, the Indiana Area Health Education Centers Program partnered with Marian University College of Osteopathic Medicine (MUCOM) to support a 1 day telehealth simulation (online curriculum, group lecture, and two standardized patient encounters) into their clerkship curriculum. We utilized a retrospective pretest-posttest to assess changes in learner knowledge around telehealth after the program. At the conclusion of the telehealth training program, students were asked to complete a retrospective pretest-posttest assessing their level of preparedness to utilize telehealth equipment, their preparedness to demonstrate "telehealth best practices" in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. RESULTS: A total of 96 learners completed the program in 2020. Posttest results demonstrate a statistically significant (p<0.05) improvement for learners' self-reported level of preparedness to utilize telehealth equipment, their preparedness to demonstrate "telehealth best practices" in a manner consistent with protecting patient (and data) privacy, their confidence to utilize telehealth for identification of infectious diseases, and their confidence to utilize telehealth to identify proper treatment plans. CONCLUSIONS: Our telehealth curriculum involving a video, interactive learning session, and two standardized patient experiences provided osteopathic medical learners with realistic simulated case scenarios to work through in effort to improve their knowledge and self-efficacy around the utilization of telehealth in practice.

Termination of the USMLE Step 2 CS: Perspectives of Surgical Residents with Diverse Medical Backgrounds.

As the decision to permanently suspend the USMLE Step 2 Clinical Skills exam resonates across the medical education landscape, it has different implications for the graduates of American allopathic (US-MD), osteopathic (DO) medical schools and international medical graduates (IMGs). Through this perspective, we as authors who represent each of these three diverse cohorts highlight the changes that resulted from the COVID-19 pandemic and delve into the multitude of ramifications that could ensue as a result of this decision. Our propositions are geared towards a standardized objective structured clinical examination for evaluating US-MDs and DOs, and a call for novel evaluation strategies to assure the minimum clinical standards of IMGs.

20/20 Vision.

In this essay, the author offers a poem constructed in a COVID-19 themed narrative medicine seminar at the Ohio University Heritage College of Osteopathic Medicine. The poem is situated within reflections about what came into focus during a global pandemic and its accomplices of social unrest. The author concludes by emphasizing the importance of self-care in broader efforts toward healing and social justice.

Predictors of emotional wellbeing in osteopathic medical students in a COVID-19 world.

CONTEXT: In March 2020, the World Health Organization declared the novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Due to the rapid spread, strong contagion, high incidence of lethality in severe cases, and the lack of a pharmaceutical prevention or cure, COVID-19 has posed a serious threat to human life and health. It has also had a tremendous impact on mental health, including fear and worry, difficulty sleeping or concentrating, and increased use of poor coping mechanisms. Osteopathic medical students have had additional concerns regarding the interruption of their studies, closing of clinical rotations, and postponed licensing exams. To date, few reports have focused on osteopathic medical students and their reactions to the outbreak. OBJECTIVES: To assess resilience, coping, health behaviors, and emotional wellbeing of osteopathic medical students during the onset of the COVID-19 pandemic. METHODS: In this cross-sectional study, we distributed an anonymous online survey to all medical students enrolled at Nova Southeastern University in May 2020 (n=1,310) via an e-mail invitation using the institution's student listservs. Our major study variables were based on published reports and anecdotal evidence; we subsequently developed the Emotional Wellbeing in Healthcare Professions Students Questionnaire (EWB-Q). This EWB-Q contained validated scales to assess the contribution of levels of coping strategies used, personal resilience, and health behaviors on the emotional wellbeing of osteopathic medical students. Multiple linear regression and other statistical analyses were conducted using SPSS v0.26. RESULTS: Of the 1,310 students invited to participate, 335 (25.5%) surveys were returned. Of those, 133 had more than 33% of the necessary data missing and were removed, resulting in 202 (15.4%) completed questionnaires. The mean age of the participants was 26.7 years. About half (n=92; 45.5%) were in the clinical phase (years 3 and 4) of their medical school training (in rotations). A significant regression equation was found (F[4,171]=17.481, p<0.000, R2 =0.290, R2adjusted=0.274), indicating that levels of coping, personal resilience, and health behaviors (i.e., not sleeping more than usual, not exercising less than usual) accounted for a significant amount of the variance in emotional wellbeing scores in osteopathic medical students. Higher levels of resilience, greater use of coping strategies, not sleeping more than usual, and not exercising less than usual were predictors of emotional wellbeing. CONCLUSIONS: Cultivating positive mental health should be a high priority for medical educators as they develop and implement curriculum-based initiatives to help medical students bolster their personal resilience and to encourage healthy coping behaviors during times of crisis and beyond. A proactive position that assists with building personal resilience and developing stress management habits is paramount in assisting students who are grappling not only with the challenges of rigorous medical training, but also with the uncertainty and stress that exists during any major global health or socioeconomic crisis.

The flipped classroom: a novel approach to physical examination skills for osteopathic medical students.

CONTEXT: Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic. OBJECTIVES: To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students. METHODS: A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment. RESULTS: The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom. CONCLUSIONS: The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.

Transforming a clerkship with telemedicine.

The coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on both clinical practices and learning environments. On March 17th, 2020, the American Association of Colleges of Osteopathic Medicine and Commission on Osteopathic College Accreditation issued a statement recommending a "pause" in medical student participation in-person at clinical sites. In response, the Family Medicine Department at the Rowan University School of Osteopathic Medicine recognized the need to evolve the traditional curriculum and quickly transitioned to an online format, incorporating telemedicine into the clerkship. This new model enabled 44 third-year medical students to obtain high-quality, offsite, virtual education and learn new skills.

Promoting Access of Osteopathic Medical Students to Surgical Residency Training Programs.

The COVID-19 pandemic has uncovered disparities for allopathic and osteopathic surgical applicants for the upcoming 2021 residency application cycle. It has provided an opportunity for change to the current paradigm in surgical resident selection. This study seeks to quantify the disproportionality of opportunities between allopathic and osteopathic students and provides solutions to level the playing field for all applicants.