Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?

Abstract

Osteopathic manipulative treatment (OMT) for the allopathic resident is an elective at the University of Minnesota North Memorial Residency that engages the resident in the basic tenants of osteopathic medicine, with exposure to the vast application of OMT with a curricular focus on low back pain management. Implementing an elective curriculum is a feasible way to improve attitudes in OMT for MDs in a Family Medicine residency, and residents can learn OMT in an elective rotation. This article aims to determine if MDs who complete an OMT for the allopathic physician elective rotation have higher comfort caring for patients with back pain compared to those who do not complete the elective. Further, this article is designed to evaluate if these MDs continue to incorporate OMT into the care they provide once they graduate from their residency programs. Graduates from the University of Minnesota North Memorial Family Medicine Residency (2013 to 2019) were sent an email invitation in August 2020 to complete a Qualtrics survey regarding their comfort with caring for patients with back pain, referral patterns for these patients, and the ongoing use of OMT in their practices. Doctor of Osteopathic Medicine (DO) graduates who responded to the survey were removed from the analysis. Among emailed graduates, 61.8% (42/68) completed the survey, with representation from each class ranging from 1 to 7 years postresidency. The five DO graduates who responded were removed from the analysis. Among the remaining 37 respondents, 27 had completed the OMT for the allopathic rotation ("elective participants") during their residency training and 10 had not ("control"). Half (50.0%) of the control group provide OMT care compared to 66.7% of the elective participants, with a comfort score of 22.6 (standard deviation [SD] 32.7) in the control group vs. 34.0 (SD 21.0) in elective participants (on a 0-100 scale; 100 being completely comfortable; p=0.091). Among the control group, 40.0% regularly refer to a DO provider compared to 66.7% of those who completed the elective (p=0.257). The mean comfort score for performing a physical examination on patients presenting with back pain was 78.7 (SD 13.1) and 80.9 (SD 19.3) in the control and elective participants groups, respectively (p=0.198). Allopathic Family Medicine residents who completed an elective rotation in OMT have a slight increase in frequency of referring to DOs. They also have a meaningful increase in comfort performing OMT. With the limited number of DOs being a common barrier to OMT care, more widely implemented training in OMT for allopathic Family Medicine residents may be a reasonable intervention to improve the care of patients with back pain.