Overview
This osteopathic clinic elective is a half block or full block preceptorial rotation. This elective is open to both osteopathic and allopathic residents.
The rotation occurs at a community office with an osteopathic physician who incorporates osteopathic principles and practices (OPP) into his/her daily appointments. OPP not only includes osteopathic manipulative therapy (OMT) but more broadly includes a holistic approach to each patient, treating the whole person which includes mind, body and spirit. These principles correlate with primary care and are thus able to be modeled and taught in a variety of settings, namely the ambulatory clinic. The teaching of osteopathic principles and practices includes this rotation as well as monthly osteopathic didactics, the noon conference series, and the Osteopathic Manipulative Medicine Self-Directed Online Basic Course offered through the National Center for Osteopathic Principles and Practice Education (NCOPPE).
Definitions
Osteopathic philosophy
This is a concept of health care supported by expanding scientific knowledge that embraces the concept of the unity of the living organism’s structure (anatomy) and function (physiology). It emphasizes the following principles (also known as the osteopathic tenets or the four tenets):
- The human being is a dynamic unit of function,
- The body possesses self-regulatory mechanisms that are self-healing in nature,
- Structure and function are interrelated at all levels, and
- Rational treatment is based on these principles
Osteopathic Manipulative Treatment (OMT)
The therapeutic application of manually guided forces by an osteopathic physician (US usage) to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction.
Osteopathic Principles and Practice (OPP)
The application of the osteopathic philosophy in the care of patients, which may include OMT.
Somatic Dysfunction
Impaired or altered function of related components of the body framework system: skeletal, arthrodial, and myofascial structures, and their related vascular, lymphatic, and neural elements. It is characterized by positional asymmetry, restricted range of motion, tissues texture abnormalities, and/or tenderness. The positional and motion aspects of somatic dysfunction are generally described by:
- The position of a body part as determined by palpation and reference to its defined adjacent structure,
- The directions in which motion is freer, and
- The directions in which motion is restricted.
Somatic dysfunction is treatable using osteopathic manipulative treatment.
Source: Glossary of Osteopathic Terminology
Goals
At the completion of this rotation, the resident will have an understanding of the integration of osteopathic manipulative therapy (OMT) into a routine office visit.
At the completion of this rotation, the resident will be able to explain how osteopathic principles and practices (OPP) are incorporated into almost every primary care office visit.
Objectives
At the completion of this rotation, the resident will have demonstrated to the satisfaction of the osteopathic preceptor:
- Incorporates osteopathic principles and practice (OPP) to promote health and wellness in patients with common conditions. Examples include demonstrating shared decision making when discussing screening guidelines, counseling on nutrition & exercise, incorporating preventative care such as smoking cessation or immunizations into a routine office visit.
- Obtains a history and performs at least one osteopathic examination with direct supervision from the preceptor.
- Attempts at least one treatment of an identified (and confirmed by preceptor) somatic dysfunction with osteopathic manipulative therapy (OMT).
- Creates two or more treatment plans for patients with common conditions that takes into account a patient’s body habitus, availability of resources, and modifications to meet patient where he/she is at physically and emotionally.
- Demonstrates knowledge of cost-effective osteopathic patient care in the health care delivery system, including appropriate documentation of somatic dysfunction. Examples include discussing reimbursement rates for OMT with preceptor and comparing the costs of OMT vs traditional medicine.
- Recognizes barriers to quality osteopathic patient care, including the impact of social determinants of health. Examples include identifying transportation issues as barrier to care and teaching family members OMT for home use.
- Describes the osteopathic philosophy and unique practice of osteopathic physicians to patients and the Interprofessional team. Examples include treating the “whole” patient to include the osteopathic tenet of treating a patient’s mind, body and spirit. This can be demonstrated by addressing the medical concern but also the underlying social/emotional/mental aspect of the medical concern.
- Displays comfort when communicating with patients including when discussing medical, psychosocial and spiritual needs. Examples include incorporating a sexual history into the conversation when needed and clarifying patient’s preferred pronouns.
Implementation
This is a preceptorial rotation so the resident is assigned to a particular osteopathic primary care physician in the Michiana community or a community where a resident may work in the future. The resident will accompany the osteopathic physician during his/her professional activities in the ambulatory clinic setting. In the course of seeing patients, the osteopathic physician will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may see patients independently (and then report back to the preceptor) and may perform procedures with direct supervision from the preceptor.
The resident is responsible for contacting the osteopathic physician prior to the start of the rotation to arrange a schedule for the rotation. The resident must continue to meeting usual residency obligations to his/her Family Medicine Center population including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital, and rounding in the nursing home. The resident is expected to attend noon conferences on week days and abide by duty hour restrictions in keeping with usual program policies. The resident is also strongly encouraged to complete the “Introduction to Osteopathy” course found in the Osteopathic Manipulative Medicine Self-Directed Online Basic Course through the National Center for Osteopathic Principles and Practice Education (NCOPPE).
Upon completion of the rotation, the preceptor will receive an evaluation form electronically to evaluate the resident’s performance during the rotation. The resident will receive a similar electronic evaluation form to evaluate the rotation.
Evaluation
The osteopathic preceptor will complete an evaluation at the end of the rotation. Residents will specifically be evaluated on the following ACGME Osteopathic Recognition Milestones:
- Patient Care 1: Osteopathic Principles and Practice (OPP) for Patient Care
- Patient Care 2: Osteopathic Evaluation and Treatment
- Medical Knowledge: Osteopathic Medical Knowledge (Philosophy and Clinical Anatomic Considerations)
- Osteopathic Principles and Practice for Systems-Based Practice
- Osteopathic Principles for Interpersonal and Communication Skills
