Use of a novel assay to measure pre- to posttraining palpatory skills of first-year osteopathic medical students.

CONTEXT: Although palpation is a central skill in the practice of osteopathic medicine, few data are available on factors affecting the development of palpatory skills. OBJECTIVE: To use a novel palpatory skills assay to assess the role of training and practice in the development of palpatory skills in an osteopathic medical student population. METHODS: The palpatory skills of first-year osteopathic medical students were assessed using a simple, objective palpation assay that consisted of locating a dime placed under sheets of copy paper at depths of 50, 100, 150, 200, 300, and 400 sheets. Two trials were performed at each depth. The assay was performed at the beginning and at the end of the students' first term. To determine whether practice with the assay impacted participant performance, a third assay was conducted to compare the performance of students who completed the assays at the beginning and at the end of the term with that of students who had never completed the assay. RESULTS: Sixty-three participants completed the assays at the beginning and end of the term. Fifty-seven of those 63 participants and 192 participants who had not previously completed the assay completed the third assay. A wide variability in number of correct responses per participant was observed at both the beginning (range, 0-11 correct) and the end (range, 2-12 correct) of the term. The mean (SD) number of correct responses per participant increased from the beginning (5.49 [2.78]) to the end (7.17 [2.27]) of the term. Analysis using the generalized estimating equation model demonstrated that both paper depth and experience (ie, beginning vs end of the term) were statistically significant determinants of the number of correct responses (P<.001). The Kaplan-Meier method indicated that the median paper depth at which participants first scored no correct responses increased from 200 sheets (95% CI, 171-229) at the beginning of the term to 300 sheets (95% CI, 232-367) at the end of the term (P<.001). In the third assay, no significant differences were noted in the performance of students who had completed the 2 previous assays vs participants who had not completed the previous assays (P=.136). CONCLUSION: Participants' palpatory skills improved from the beginning to the end of the term. The range of participants' palpatory skills at the beginning of the term suggests that other factors in addition to training influenced participants' palpatory skill level. Additional research is needed to identify and investigate factors that influence the development of palpatory skills.

From "Doctor of Osteopathy" to "Doctor of Osteopathic Medicine": a title change in the push for equality.

Nationally, the California merger created great solidarity among osteopathic members of state and national osteopathic associations. They rebuffed further efforts at amalgamation and championed the continuation of the DO degree. Even after the American Medical Association (AMA) opened its doors to DOs to join local and state medical associations as well as the AMA itself and gave its blessing to them entering allopathic residency programs and becoming MD board certified, the DOs stood fast for their independence. Yet some across the country wanted to become known as MDs. A few osteopathic physicians even went to federal court to claim-unsuccessfully-that state medical boards' refusal to license them or allow them to identify themselves as MDs violated their constitutional rights under the 1st and 14th Amendments. In the mid-1990s, the American Osteopathic Association (AOA) gave individual osteopathic medical colleges the option of indicating on their diplomas that the DO degree signified "Doctor of Osteopathic Medicine" rather than "Doctor of Osteopathy," a change that paralleled previous AOA policy changes regarding appropriate professional language. Nevertheless, some DOs and particularly a sizable number of osteopathic medical students continued to write of their desire for a change in the degree osteopathic medical colleges awarded. However, in July 2008 the AOA House of Delegates unanimously reaffirmed its commitment to continuing the traditional DO degree.

The 'little m.d.' or the 'big D.O.': the path to the California merger.

In the years following the American Osteopathic Association's sanctioning of the broad teaching of chemical and biological agents, osteopathic physicians moved closer to allopathic physicians with respect to diagnosis and treatment. In the 1930s, osteopathic colleges began to adopt standards and improve their basic science and clinical training, which allowed them to produce graduates who did substantially better in passing external examinations to become licensed as physicians and surgeons. Nevertheless, many state legislatures refused to grant DOs unlimited licenses and osteopathic physicians were unable to obtain medical commissions during the Second World War. In California, despite significant accomplishments on the social and legislative fronts, a growing number of osteopathic physicians believed that their DO degree and independent status as a separate medical profession was an impediment to achieving equality with their allopathic counterparts, and they worked toward a merger or amalgamation with their long-time opponents.

The "doctor of osteopathy": expanding the scope of practice.

This article-the third in a 6-part series-examines the status of the DO degree in the first 3 decades of the 20th century. This time was an era when osteopathic practitioners established other colleges, developed state and national organizations, upgraded the length and breadth of curricula, and sought to secure licensure laws commensurate with their expanded education. During this period, osteopathic practitioners debated whether the DO degree was the most appropriate degree for their colleges to award or whether the MD degree alone or in conjunction with the DO degree better signified to lawmakers and the public their expanded academic training. At the end of this period it appeared likely that the DO degree would continue to be the sole designation by which osteopathic physicians would identify themselves in continuing their fight to obtain further legal rights and privileges.

The "diplomate in osteopathy": from "school of bones" to "school of medicine".

This article is the second installment in a series of 6 articles on the history of and controversies related to the DO degree. This article examines how Andrew Taylor Still made the transition from informally training apprentices to launching a formal chartered institution-the American School of Osteopathy. In its first decade of existence, Still expanded both the length and breadth of the curriculum and transformed his college from what he called a "school of bones" to a "school of medicine." As this shift was occurring, J. Martin Littlejohn, then the dean of the American School of Osteopathy, questioned whether the DO degree was the appropriate degree to award its graduates.

A degree of difference: the origins of osteopathy and first use of the "DO" designation.

This article is the first installment in a series of 6 articles on the history of and controversies related to the DO degree. Four questions about the origins of osteopathy and the initial use of the DO designation will be addressed in this particular article. First, did Andrew Taylor Still earn an MD diploma?--he being invariably described as an MD in current osteopathic periodical literature. Second, what was the importance of "magnetic healing" in the evolution of Still's thought? Third, how did the principles and practice of "bonesetting" complete his new system? Finally, when did he originate the term osteopathy and first devise and employ the DO designation? Future articles will examine episodically the history of the DO degree from Still's establishment of the American School of Osteopathy in 1892 up through to the present debate over its significance and value.

Practical divinity and medical ethics: lawful versus unlawful medicine in the writings of William Perkins (1558-1602).

This article examines for the first time the theologically based medical ethics of the late sixteenth-century English Calvinist minister William Perkins. Although Perkins did not write a single focused book on the subject of medical ethics, he addressed a variety of moral issues in medicine in his numerous treatises on how laypeople should conduct themselves in their vocations and in all aspects of their daily lives. Perkins wrote on familiar issues such as the qualities of a good physician, the conduct of sick persons, the role of the minister in healing, and obligations in time of pestilence. His most significant contribution was his distinction between "lawful" and "unlawful" medicine, the latter category including both medical astrology and magic. Perkins's works reached a far greater audience in England and especially New England than did the treatises of contemporary secular medical ethics authors and his writings were influential in guiding the moral thinking of many pious medical practitioners and laypersons.

The transformation of osteopathic medical education.

Osteopathic medical schools and hospital-based postgraduate programs have long constituted small but important sources of physicians and surgeons, particularly for traditionally underserved areas of the United States. Though frequently marginalized in or even left out of standard histories and studies of U.S. medical education, these institutions have become much more difficult to ignore, given the rapid expansion of the number of osteopathic medical students in new and existing colleges and the size of their classes. By 2019, upwards of 25% of all U.S. medical school graduates produced annually will be doctors of osteopathic medicine. The author examines the process through which osteopathy was transformed into osteopathic medicine, how osteopathic medical schools achieved their present status as a significant source of U.S. graduates for residency training, and what challenges osteopathic medical education now faces.