DMU's controversial resolution proposed at national SOMA: a recap

[bloodletter]

I’m one of the students from DMU that was at the national SOMA meeting. I was the guy that presented the results of the cranial survey. I’d like to use a public forum (SDN will have to do) to offer my first-hand account of the debate and also to clear a few things up.

At the national SOMA meeting, DMU’s delegates proposed a resolution to encourage schools (and the NBOME) to put more focus on the more-commonly used OMM techniques - the “bread and butter” techniques, if you will – and give less emphasis to those that are technically difficult (to learn as beginner manipulators) or those that are on the fringes of osteopathic medicine. [The resolution is included at the end of this post.] Unlike what one commenter on SDN said, it has nothing to do with the material being “hard.” We are all aware that most of us don’t use OMM after we graduate. Perhaps we aren’t confidently competent enough with the basics – the spine and innominates, maybe the sacrum. The basics are, after all, the treatment modalities we will utilize the most. (The basics are also the treatment modalities slowly gaining support from the literature, unlike Chapman’s points, cranial osteopathy, etc.) Perhaps we, and the osteopathic tradition, would benefit if students were more confident with the spine, ribs, and pelvis, for example. More students might use these treatments. That was our intention.

During discussion on the resolution there was much confusion as to what was being debated, mostly due to unfortunate timing. You see, about 20 minutes prior to the resolutions being introduced, I presented the results of the Assessing Student Attitudes Toward Cranial Osteopathy survey. After that, the two topics couldn’t seem to be separated.

I understand how there might have been some confusion. These two things – the idea for the resolution and the idea for the survey - arose at DMU simultaneously, and two of us in attendance at the meeting had a role in both. That being said, their intentions weren’t related. Think of the resolution as being pro-OMM and the survey results as being anti-cranial. A lot of people never understood that distinction and mistakenly took the resolution to be anti-OMM. Adding to further confusion about if the debate was about the resolution or cranial, we did slip the resolution into the survey to see if it would even have enough of a foothold to make it viable once we got to Washington, DC. We think its inclusion muddied up the resolution’s main message. We regret putting it in there. That being said, I do have to mention that 76% of the 500 students surveyed were in support of the resolution.

Ah, the debate. Some claimed that they hadn’t had time to look over the resolution and prepare materials to argue against it. To that, we say that the resolution was distributed 60 days before the conference. Others stepped up to the microphone and shared anecdotes, appealed to peoples’ osteopathic pride, and tried to steer the debate toward cranial. It’s true that the debate had to be extended by about an hour. It was fairly dramatic, but still inspiring to see all that passion for our profession. These talks need to happen more often. I hope that similar resolutions get proposed and similar debates occur at future SOMA meetings.

The vote was close, but alas, the resolution was defeated. What if it would have passed? It would have been sent on to the AOA on behalf of osteopathic medical students everywhere. It would have been a powerful statement, but not an edict. It would not have limited what can be taught in OMM; schools ultimately decide what is put in their curriculum. Still, it would have surely caught the attention of the AOA. So even though it appears that most students agree with the resolution’s intention, we missed out on a chance to send a powerful message to our governing body.

I say this emphatically: even with the resolution defeated, we left PROUD. Proud of our fellow students at other schools, proud of the fiery debate, proud of the passion shown, and proud to stir things up in the hopes that when the dust settles, regardless of the outcome, osteopathic medicine will be changed for the better. Let’s hope these discussions and debates continue. How else will we progress?



The resolution:

BE IT THEREFORE RESOLVED, that the Student Osteopathic Medical Association (SOMA) will make a recommendation to the 2011 American Osteopathic Association (AOA) House of Delegates that they (the AOA) pursue a course of refinement of OMT curriculum to exclude less commonly used and more technically challenging osteopathic treatment modalities from NBOME licensing examinations and required curriculum at osteopathic medical schools, and BE IT FURTHER RESOLVED THAT, such a change be made in order to put increased emphasis on more basic and frequently used OMT diagnostic techniques and treatment modalities, and BE IT FURTHER RESOLVED, that SOMA encourages more advanced and technically challenging techniques that may be excluded from required curricula continue to be taught at all Osteopathic Medical Schools through the use of non-required elective courses, and BE IT FURTHER RESOLVED, that such action on the part of SOMA should not be viewed by any party as an official stance for or against any particular subset of Osteopathic Manual Therapy, or as a challenge to the tenets of the Osteopathic Philosophy, and BE IT FURTHER RESOLVED, that SOMA believes such action will lead to an increase in student confidence in the more fundamental Osteopathic Manual Therapy techniques, and therefore lead to an increase in the number of Osteopathic medical graduates who go on to use OMT as residents and as attending physicians who may not have otherwise.

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[Pansit]

I’m one of the students from DMU that was at the national SOMA meeting. I was the guy that presented the results of the cranial survey. I’d like to use a public forum (SDN will have to do) to offer my first-hand account of the debate and also to clear a few things up.

At the national SOMA meeting, DMU’s delegates proposed a resolution to encourage schools (and the NBOME) to put more focus on the more-commonly used OMM techniques - the “bread and butter” techniques, if you will – and give less emphasis to those that are technically difficult (to learn as beginner manipulators) or those that are on the fringes of osteopathic medicine. [The resolution is included at the end of this post.] Unlike what one commenter on SDN said, it has nothing to do with the material being “hard.” We are all aware that most of us don’t use OMM after we graduate. Perhaps we aren’t confidently competent enough with the basics – the spine and innominates, maybe the sacrum. The basics are, after all, the treatment modalities we will utilize the most. (The basics are also the treatment modalities slowly gaining support from the literature, unlike Chapman’s points, cranial osteopathy, etc.) Perhaps we, and the osteopathic tradition, would benefit if students were more confident with the spine, ribs, and pelvis, for example. More students might use these treatments. That was our intention.

During discussion on the resolution there was much confusion as to what was being debated, mostly due to unfortunate timing. You see, about 20 minutes prior to the resolutions being introduced, I presented the results of the Assessing Student Attitudes Toward Cranial Osteopathy survey. After that, the two topics couldn’t seem to be separated.

I understand how there might have been some confusion. These two things – the idea for the resolution and the idea for the survey - arose at DMU simultaneously, and two of us in attendance at the meeting had a role in both. That being said, their intentions weren’t related. Think of the resolution as being pro-OMM and the survey results as being anti-cranial. A lot of people never understood that distinction and mistakenly took the resolution to be anti-OMM. Adding to further confusion about if the debate was about the resolution or cranial, we did slip the resolution into the survey to see if it would even have enough of a foothold to make it viable once we got to Washington, DC. We think its inclusion muddied up the resolution’s main message. We regret putting it in there. That being said, I do have to mention that 76% of the 500 students surveyed were in support of the resolution.

Ah, the debate. Some claimed that they hadn’t had time to look over the resolution and prepare materials to argue against it. To that, we say that the resolution was distributed 60 days before the conference. Others stepped up to the microphone and shared anecdotes, appealed to peoples’ osteopathic pride, and tried to steer the debate toward cranial. It’s true that the debate had to be extended by about an hour. It was fairly dramatic, but still inspiring to see all that passion for our profession. These talks need to happen more often. I hope that similar resolutions get proposed and similar debates occur at future SOMA meetings.

The vote was close, but alas, the resolution was defeated. What if it would have passed? It would have been sent on to the AOA on behalf of osteopathic medical students everywhere. It would have been a powerful statement, but not an edict. It would not have limited what can be taught in OMM; schools ultimately decide what is put in their curriculum. Still, it would have surely caught the attention of the AOA. So even though it appears that most students agree with the resolution’s intention, we missed out on a chance to send a powerful message to our governing body.

I say this emphatically: even with the resolution defeated, we left PROUD. Proud of our fellow students at other schools, proud of the fiery debate, proud of the passion shown, and proud to stir things up in the hopes that when the dust settles, regardless of the outcome, osteopathic medicine will be changed for the better. Let’s hope these discussions and debates continue. How else will we progress?



The resolution:

BE IT THEREFORE RESOLVED, that the Student Osteopathic Medical Association (SOMA) will make a recommendation to the 2011 American Osteopathic Association (AOA) House of Delegates that they (the AOA) pursue a course of refinement of OMT curriculum to exclude less commonly used and more technically challenging osteopathic treatment modalities from NBOME licensing examinations and required curriculum at osteopathic medical schools, and BE IT FURTHER RESOLVED THAT, such a change be made in order to put increased emphasis on more basic and frequently used OMT diagnostic techniques and treatment modalities, and BE IT FURTHER RESOLVED, that SOMA encourages more advanced and technically challenging techniques that may be excluded from required curricula continue to be taught at all Osteopathic Medical Schools through the use of non-required elective courses, and BE IT FURTHER RESOLVED, that such action on the part of SOMA should not be viewed by any party as an official stance for or against any particular subset of Osteopathic Manual Therapy, or as a challenge to the tenets of the Osteopathic Philosophy, and BE IT FURTHER RESOLVED, that SOMA believes such action will lead to an increase in student confidence in the more fundamental Osteopathic Manual Therapy techniques, and therefore lead to an increase in the number of Osteopathic medical graduates who go on to use OMT as residents and as attending physicians who may not have otherwise.

Thank you DMU...lets get rid of some of this quackery. I once did an OMT rotation once with someone who did cranial and whenever patients questioned what was going on, it was so embarrassing standing there watching him try to explain what was going on, which made NO SENSE, and the patients often just said..."whatever..."

 

[hawkeye pierce]

Wouldn't more schools requiring rotations in OMT also increase the average skill and use of OMT in the real world. I don't think cutting out education is the answer. Obviously as someone who has never taken OMT, i'm speaking only in conjectures. However, is cutting back on knowledge taught really the answer?

 

[Pansit]

Wouldn't more schools requiring rotations in OMT also increase the average skill and use of OMT in the real world. I don't think cutting out education is the answer. Obviously as someone who has never taken OMT, i'm speaking only in conjectures. However, is cutting back on knowledge taught really the answer?

No...should we be required to learn Herbal medicine for the boards? How about homeopathy? Should we be required to learn meridian points and that the left 2nd toe indicates that there is a problem with the liver for boards?...Heck no. The survey clearly shows that the majority of us want to go a different direction. This will change, and I have no doubt that time will change it.

 

[MossPoh]

Wouldn't more schools requiring rotations in OMT also increase the average skill and use of OMT in the real world. I don't think cutting out education is the answer. Obviously as someone who has never taken OMT, i'm speaking only in conjectures. However, is cutting back on knowledge taught really the answer?

You can't force interest in something. It is far more important to have good teachers and a relevant education to bring about interest, rather than trying to ram it down someone's throat.

I don't know how many friends I have that went to DO schools really excited to learn OMT and then they get to the cranial and other random bits and get totally turned off to the idea. I'm at an MD school and one of the reasons I chose it (aside from 10,000 dollars less a year and proximity to my parents) was that, while I had an interest in the basics of OMT, I did NOT want to have my time wasted with crap I knew I would not use.

 

[hawkeye pierce]

Ok i think my statement about requiring rotations was misunderstood. The reason i was recommending that is that in class you are dealing with (mostly healthy people). You won't see that it works. I'm not saying everyone would become interested. And to the other person, you are going to osteopathic medical school not accupuncture school that makes a big difference between including osteopathy and accupuncture on the boards.

 

[hawkeye pierce]

I should note I actually agree that rarely used things like cranial should only be a very minor part of boards

 

[NewBlood]

"Useless crap" sums OMM up nicely. What a waste of time. I'm so glad I spent my entire summer after MS1 LEARNING molecular bio, genetics and biochem, because otherwise I would have failed the USMLE. It was orders of magnitude more difficult than COMLEX.

But you know what? I had a good feeling when I was taking the USMLE, because I had taken about 300 hours (roughly the amount of time I had to spend learning OMM) over my summer to learn the material and I was well prepared for it. Even though it was difficult, the USMLE could be picked apart with logic and a solid fund of scientific knowledge. The COMLEX, however, gave me a sick feeling in my stomach as I read questions about cranial and OMM.

It's actually very sad that we spend so much time learning about stuff that has no impact on patient care, let alone clinical outcomes or end-points. None of the residents during my 3rd year rotations EVER did OMM or even suggested it. Yet, the AOA expends SO much energy talking about increasing the use of OMM during clerkships and residency, blah blah blah. Even during family med, my preceptor only used it for people who asked for it, and she didn't even diagnose--just cracked their backs.

I applaud DMU for taking this initiative. I have seen their match lists looking better and better each year, and this kind of forward thinking is no doubt part of a culture that values a basic science, EBM-grounded education. ACGME programs directors must have taken notice to the new breed of DO's coming out of DMU. Hopefully, the rest of the osteopathic world will follow suit.

 

[hawkeye pierce]

Des moines is one of the schools with most hours dedicated to omt i believe.

 

[NewBlood]

Des moines is one of the schools with most hours dedicated to omt i believe.

Ok, maybe my opinions about DMU are unfounded in a factual basis. They were merely based on personal observations and a few anecdotes I heard from a few people. I retract what I said about DMU then.

What I will say is that if person A spends 4 hours/week in both OMM lecture and story time...I mean OMM lab...and person B spends 5 hours in OMM, both have effectively shot a solid chunk of time that could have been be used for studying. Even our OMM department chair admitted to a bunch of premeds that DO schools probably spend less time on pathophysiology to make room for OMM.

 

[Pansit]

Ok, maybe my opinions about DMU are unfounded in a factual basis. They were merely based on personal observations and a few anecdotes I heard from a few people. I retract what I said about DMU then.

What I will say is that if person A spends 4 hours/week in both OMM lecture and story time...I mean OMM lab...and person B spends 5 hours in OMM, both have effectively shot a solid chunk of time that could have been be used for studying. Even our OMM department chair admitted to a bunch of premeds that DO schools probably spend less time on pathophysiology to make room for OMM.

I disagree...OMT takes approximately zero studying time. Even for Comlex I studied maybe 2 days of OMT and that was just memorizing viserosamatics and chapman points. It's all hands on stuff and sticks to your head pretty easily.

 

[LesBois88]

I disagree...OMT takes approximately zero studying time. Even for Comlex I studied maybe 2 days of OMT and that was just memorizing viserosamatics and chapman points. It's all hands on stuff and sticks to your head pretty easily.

Not for some of us.

I spend valuable hours studying before OMM exams- hours I could be using for studying other things that I find much more important.

 

[WhitJord85]

DMUs idea of emphasizing the basics of OMM is good. As a student at an osteopathic school other than DMU, my experience is that if you don't understand the basics of OMM you will get lost the more things you learn. So I guess I'm not all that surprised that many students supported this.

I also agree with a lot of the comments regarding the idea that when students leave school, be it for rotations or when they graduate, if they aren't comfortable or confident in their ability to perform OMM, they won't use it.

The comment about OMM being a waste of time... is ridiculous... If you really thought OMM was that much of a waste of time, why did you choose to attend an osteopathic school? Now... of course we have people at our school that don't really like OMM and have already said they won't use it after they graduate, but they also knew they would have to complete courses in it anyway... And have realized that the class can help your GPA somewhat. That being said... for me, OMM doesn't require a great deal of time, nothing like the time required for other classes.... It is more of hands-on, learning by practicing kind of thing.

And as for the person who thinks it really subtracted from their time to study other more important subjects... I think the time you devote by yourself to study... i.e. when and how much time you decide to put towards studying is way more important than having to take a class once in week in OMM.... just my opinion

 

[NewBlood]

The comment about OMM being a waste of time... is ridiculous... If you really thought OMM was that much of a waste of time, why did you choose to attend an osteopathic school? Now... of course we have people at our school that don't really like OMM and have already said they won't use it after they graduate, but they also knew they would have to complete courses in it anyway... And have realized that the class can help your GPA somewhat. That being said... for me, OMM doesn't require a great deal of time, nothing like the time required for other classes.... It is more of hands-on, learning by practicing kind of thing.

And as for the person who thinks it really subtracted from their time to study other more important subjects... I think the time you devote by yourself to study... i.e. when and how much time you decide to put towards studying is way more important than having to take a class once in week in OMM.... just my opinion

The vast majority of people choose an osteopathic school for generally the same reason, because they want to become a physician or surgeon...I am no exception. There is only so much you can learn about a discipline before actually studying it in school, and in the case of OMM I came to decide that it is not valid on the basis of 1) the pathophysiology it claims to treat or 2) the mechanism by which it purports to do so. Luckily, OMM is not a component of western medicine, so I am not obligated to learn it or use it beyond medical school.

As for studying time, I actually studied nearly 100% of my free time. Except for maybe one night every other week to go out with friends, I used nearly every free hour I could to study medicine. If I had 4 or 5 extra hours a week, I would use it to study even more.

We students (and once we are all turned into the fold--we DO's) have an absolute right to dictate how our profession operates and how it practices medicine. Unfortunately for the AOA and the old guard, they have rapidly expanded their very small niche profession into a rather sizable minority in the healthcare sector at the expense of recruiting like-minded individuals into the profession. The vast majority of people who have been entering osteopathic medical schools in the past two decades want to practice western medicine, and that is what most of them do.

There is absolutely nothing wrong with all of this, but the natural progression of things will necessitate that OMM eventually be pared back to whatever has been or can be substantiated by the scientific literature. This has already started. Just last week in the JAOA, there was yet another report that showed that one particular OMM technique was not effective (actually made patients worse).

 

[hawkeye pierce]

Luckily for the profession most of the people who just "wanted to be a physician" are less likely to join the aoa to change this. Do you realize how often drugs are pulled from the market because it is determined that they were more dangerous than beneficial. OMM is a part of western medicine by definition.

 

[Pansit]

Luckily for the profession most of the people who just "wanted to be a physician" are less likely to join the aoa to change this. Do you realize how often drugs are pulled from the market because it is determined that they were more dangerous than beneficial. OMM is a part of western medicine by definition.

Sorry it is not. Western medicine is based on evidence, not anecdotal claims. When OMT gurus start claiming that OMT cures headaches, cures asthma, cures this, helps with that, does this, does that without a SHRED of evidence, they are in my opinion LYING to the patient. And with the AOA, it is only a matter of time. DO's use to only make up only 6% of physicians...now 20% of medical students are DO's, in the next 10-20 years, I suspect there will be a dramatic change as a larger majority will begin to speak out. It is only a matter of time. The best use for OMT is an adjunct to therapy, never substituted as first line therapy, always used with the caveat (and let the patient know) that there is no evidence to it's efficacy but only anecdotally, never make unsubstantiated claims, and let the patient decide if they want it or not. If they do...then go for it. Often times though, these OMT gurus (a very small percentage of DO's) will just start treating patients, make claims about it's efficacy, and sometimes will advise against using standard of care (proven tested with research) for OMT. The patients never question them...well...because they trust the "Doctor". These people in my mind, give us all DO's a bad name because they drag down our degree. Just imagine a patient who finds out later that cranial is baloney. He will forever not trust any DO's...even those of us who practice evidence based medicine.

 

[NewBlood]

Luckily for the profession most of the people who just "wanted to be a physician" are less likely to join the aoa to change this. Do you realize how often drugs are pulled from the market because it is determined that they were more dangerous than beneficial. OMM is a part of western medicine by definition.

Hawkeye, really read and think about what Pansit has to say. Also, I hope whatever medical school you go to has a good ethics course, because it is downright unethical to be using some of the omm techniques in the manner that some docs use them.

If you can somehow get a hold of access to the Journal of the American Osteopathic Association, I would really encourage you to peruse the issues from the last several years. There are already discussions occurring at the highest level within the AOA regarding the use of OMM, how we identify ourselves, whether osteopathic medicine is any different than allopathic medicine, COMLEX to USMLE conversion formulas, ending COMLEX altogether, the farce of COCA accreditation of DO schools, the lack of/lying about use of OMM in DO residency programs. Things have already started to change, it is only a matter of time.

And I would think that most DO students would question why you used quotations around wanting to become a physician. I don't exactly know what you were inferring by putting that in quotations.

Finally, yes I do realize how many drugs have been removed from the market due to dangerous side effects. Do you realize how many there are? The answer is: very few relative to the large number of drugs that have been available to doctors over the past several decades. The FDA drug approval process is very rigorous and few drugs with toxic side effects ever get into the market in the first place. Then again, that is not a very good analogy to use when discussing OMM.

 

[FiremedicMike]

Sorry for poking my head in here, but can someone please describe what cranial is? I've seen it mentioned several times on these boards as being the worst thing since cockroaches, but never defined.

Thanks

 

[Bacchus]

Sorry for poking my head in here, but can someone please describe what cranial is? I've seen it mentioned several times on these boards as being the worst thing since cockroaches, but never defined.

Thanks

http://www.cranialacademy.com/cranial.html

 

[hawkeye pierce]

It is western medicine because it was formed in the west as incorporated in modern western medical schools. Western medicine does not mean evidence based. As i'm sure you are aware some omt has been shown effective. I realize its use is going down (though people on here often quote the incorrect and misleading 5%). the quotations were referencing those who were not good enough to get into the real MD programs they wanted so went to DO schools. Cranial is a skill that everyone on here complains about. Possibly due to not being good at it(pure conjecture).
P.S. Name one drug without toxic side effects please.

 

[Bacchus]

Flinging the banner to the wind since 1874. ^

 

[NewBlood]

It is western medicine because it was formed in the west as incorporated in modern western medical schools. Western medicine does not mean evidence based. As i'm sure you are aware some omt has been shown effective. I realize its use is going down (though people on here often quote the incorrect and misleading 5%). the quotations were referencing those who were not good enough to get into the real MD programs they wanted so went to DO schools. Cranial is a skill that everyone on here complains about. Possibly due to not being good at it(pure conjecture).
P.S. Name one drug without toxic side effects please.

P.S. I would have hoped that we could have a discourse where everything does not have to be spelled out in lengthy legal terms, where everyone is on the same basic plane of knowledge and understanding. Obviously that is not the case here. I simply used "toxic side effects" as shorthand for "undesirable side effects that do not outweigh the the benefit of the primary effect."

Also, I don't think you understand what western medicine is, what the term means, or why we use the term. I'm too tired to explain it, but it really should be easy to clear up your concept of it by just doing an internet search.

Lastly, I hope that others and I are not coming across as condescending. You are obviously a premed and you shouldn't be expected to know everything yet. I honestly believe that discussions like this are good and healthy, but the internet often makes it difficult to discern one's tone. If you enter medicine, as either an MD or a DO (or any other degree from other countries), you will need to be prepared to argue and defend your statements and your actions. People (attendings, professors, etc.) are going to challenge things you say and things you do. They will argue with you, and some will not do it in an entirely nice way. There are reasons why they do this. We work with human beings, with people who may live or die based upon what we do. Sometimes what we do or say is wrong, and we must be able to recognize and accept this fact, figure out why we are errant, and correct this.

Sorry to those at DMU for somewhat hijacking this thread. I do, however, believe that what we are talking about is actually related to the resolution that was proposed. We definitely need to continue scrutinizing how we learn and practice OMM. We need to bring more people into this conversation, and conversations about other important issues within the profession.

 

[hawkeye pierce]

I think you need to discern between the concepts of western medicine and evidence based medicine. Believe it or not i've had to argue with medical attending at multiple times during my career some I have won others I have lost. I'm a premed, but i've probably spent more time as a CONTRIBUTING member to a medical team than most anyone here not in 4th year. I do truly believe if you did not want to learn OMM you should have considered another path. Whining is not the answer.

And as far as the toxic side effects thing. I could only read it how it was written. I will be entering as a DO student at DMU actually.

 

[DocEspana]

I just want to interject with this question, and it relates only to cranial (not chapman's points which are a whole different matter). When would you ever need to know cranial? Ever? Its the least asked sub-section of OMM on the COMLEX with exam companies (Kaplan and DiT specifically) saying if you get more than 2 questions on it on any level of COMLEX they'd be shocked. Additionally, its entirely unnecessary (As is everything except rib raising and pedal pump) for Level 2 PE, where the actors never ask for techniques by name and *any* appropriate technique qualifies as doing one.

Cranial is taught so you can answer the 1-3 questions (unless you're the least lucky person around) you'll get on COMLEX I. It's likely the lowest yield topic in all of the COMLEX, and isnt required at all for the practical exam. I get 100% what the resolution was about. I'm just pointing out that you're taking down a spectre that really doesn't exist, and perhaps worse, other people are defending the right to focus on something that has almost zero bearing on their AOA assessments.

and again: just cranial. Chapman points is a whole other bag of questions, cause that is superdy duper high yield.

 

[chet]

I just want to interject with this question, and it relates only to cranial (not chapman's points which are a whole different matter). When would you ever need to know cranial? Ever? Its the least asked sub-section of OMM on the COMLEX with exam companies (Kaplan and DiT specifically) saying if you get more than 2 questions on it on any level of COMLEX they'd be shocked. Additionally, its entirely unnecessary (As is everything except rib raising and pedal pump) for Level 2 PE, where the actors never ask for techniques by name and *any* appropriate technique qualifies as doing one.

Cranial is taught so you can answer the 1-3 questions (unless you're the least lucky person around) you'll get on COMLEX I. It's likely the lowest yield topic in all of the COMLEX, and isnt required at all for the practical exam. I get 100% what the resolution was about. I'm just pointing out that you're taking down a spectre that really doesn't exist, and perhaps worse, other people are defending the right to focus on something that has almost zero bearing on their AOA assessments.

and again: just cranial. Chapman points is a whole other bag of questions, cause that is superdy duper high yield.

I see where you are coming from. I think amongst most people who are primarily concerned with getting through tests and moving on to bigger and better things, cranial and the like present very small obstacles.

However, there are others who are taking more initiative and trying to progress our profession. I'm glad they are around because I certainly don't have the motivation.

 

[NewBlood]

I think you need to discern between the concepts of western medicine and evidence based medicine. Believe it or not i've had to argue with medical attending at multiple times during my career some I have won others I have lost. I'm a premed, but i've probably spent more time as a CONTRIBUTING member to a medical team than most anyone here not in 4th year. I do truly believe if you did not want to learn OMM you should have considered another path. Whining is not the answer.

And as far as the toxic side effects thing. I could only read it how it was written. I will be entering as a DO student at DMU actually.

You make too many assumptions. I wanted to learn OMM, or was at least ambivalent about learning it, just like I was ambivalent about learning embryology. I ended up liking embryology and finding it useful. I ended up disliking OMM and finding it useless. In fact, I found many aspects of it to be so clearly based on pseudo-science that I could never charge a patient for performing these techniques on them, as I find this unethical.

 

[NewBlood]

I see where you are coming from. I think amongst most people who are primarily concerned with getting through tests and moving on to bigger and better things, cranial and the like present very small obstacles.

However, there are others who are taking more initiative and trying to progress our profession. I'm glad they are around because I certainly don't have the motivation.

I agree with you 100%--these are indeed small obstacles. What others might not get is that the purpose of removing things like cranial and chapman's points from our OMM courses is not to make people's lives easier, it is to exclude from our curricula anything that cannot be supported by scientific evidence.

 

[Pansit]

I think you need to discern between the concepts of western medicine and evidence based medicine. Believe it or not i've had to argue with medical attending at multiple times during my career some I have won others I have lost. I'm a premed, but i've probably spent more time as a CONTRIBUTING member to a medical team than most anyone here not in 4th year. I do truly believe if you did not want to learn OMM you should have considered another path. Whining is not the answer.

And as far as the toxic side effects thing. I could only read it how it was written. I will be entering as a DO student at DMU actually.

Good...one of the required courses you will have to take at DMU is evidence based medicine. Maybe you will learn something in that course. And second...Osteopathic medicine is not defined by OMT. You are confusing it with osteopathy, practiced by other countries. Osteopathic medicine is based on EVIDENCED BASED MEDICINE, along with EXTRA study on manual medicine (OMT). OMT is taught AT DMU as a adjunct to current, evidence based therapies. It is never suppose to replace or become the primary mode of treatment for anything. You will see that once you are ACTUALLY IN Medical school. The DO's who use solely OMT and claim it should be used as the primary treatment for illness are quacks, and should practice osteopathy NOT osteopathic medicine. We are in medical school to be PHYSICIANS not osteopaths. If you want to practice osteopathy, then go to europe and attend DO school there. Otherwise we in osteopathic medicine will like to keep our profession along the evidenced based side of things...and that includes those OMT techniques proven through research to have positive effects. Those are what we should be learning and focused on...not things like cranial and chapmans points.

 

[ShyRem]

I just want to interject with this question, and it relates only to cranial (not chapman's points which are a whole different matter). When would you ever need to know cranial? Ever? Its the least asked sub-section of OMM on the COMLEX with exam companies (Kaplan and DiT specifically) saying if you get more than 2 questions on it on any level of COMLEX they'd be shocked. Additionally, its entirely unnecessary (As is everything except rib raising and pedal pump) for Level 2 PE, where the actors never ask for techniques by name and *any* appropriate technique qualifies as doing one.

Cranial is taught so you can answer the 1-3 questions (unless you're the least lucky person around) you'll get on COMLEX I. It's likely the lowest yield topic in all of the COMLEX, and isnt required at all for the practical exam. I get 100% what the resolution was about. I'm just pointing out that you're taking down a spectre that really doesn't exist, and perhaps worse, other people are defending the right to focus on something that has almost zero bearing on their AOA assessments.

and again: just cranial. Chapman points is a whole other bag of questions, cause that is superdy duper high yield.

Well, I must be the least lucky person around then. My comlex 1 had no less than 15 questions on cranial. I kid you not. I had about 3 on sacral diagnosis, one on ribs, and the rest were cranial.

Regarding OMM questions on COMLEX, I found level 1 questions to be the hardest. Level 2 OMM quesitons were much much easier and more like what you indicate above. I'll let you know how level 3 goes in July.

 

[hawkeye pierce]

Ok, first of all, I have take classes in evidence based medicine. Second of all OMT is not the total definition of osteopathic medicine, but it is what makes its definition different than allopathic. I chose DO school because i wanted to learn these skills yes, but I plan to practice an evidence based practice. I would note that large portions of what physicians do is NOT supported by large amounts of formal studies. Nearly half of all prescriptions are written for off label indications. I personally find cranial hard to believe myself. Some patients claim it as a near miracle (i know this is poor evidence). Sorry if I came off as supporting these (chapman's points I'm not sure of). Honestly, most of my training is in the drug side of things. While cranial and possibly chapmans seem to make no sense, I'm not going to complain about the few hours spent on them.

 

[DocEspana]

Well, I must be the least lucky person around then. My comlex 1 had no less than 15 questions on cranial. I kid you not. I had about 3 on sacral diagnosis, one on ribs, and the rest were cranial.

Regarding OMM questions on COMLEX, I found level 1 questions to be the hardest. Level 2 OMM quesitons were much much easier and more like what you indicate above. I'll let you know how level 3 goes in July.

I do have to admit that I can only speak to current administrations of the exam and the testimony of the Kaplan and DiT (and to some degree my pre-clinical dean who tries to use stat analysis to figure out the concentration per-topic on the comlex) test prep people. There may be a backing away from it in the last few years (cause I had heard it was big in the past, but all the current info I find disagrees with that). So that's my assumption of the difference in experiences, that you may have caught the tail end of the last few "high cranial" exams.

 

[Shinken]

...and give less emphasis to those that are technically difficult (to learn as beginner manipulators) or those that are on the fringes of osteopathic medicine....it has nothing to do with the material being “hard.” ...Perhaps we aren’t confidently competent enough with the basics – the spine and innominates, maybe the sacrum. ...

...

BE IT THEREFORE RESOLVED, ...course of refinement of OMT curriculum to exclude ...more technically challenging osteopathic treatment modalities from NBOME licensing examinations and required curriculum at osteopathic medical schools, ...and BE IT FURTHER RESOLVED, that SOMA encourages more advanced and technically challenging techniques that may be excluded from required curricula continue to be taught at all Osteopathic Medical Schools through the use of non-required elective courses, ...

I'm sorry, but after reading your message it seems to me that it would be more convincing to change the wording.

Although I understand what you're trying to accomplish, the way I interpreted this at first was "these techniques are too hard to learn, therefore not too many people use them, therefore let's get rid of them and make them elective." Yikes! Good attitude for medical school (I know that's not what you were saying, that's how the message came across to me with the wording of the resolution).

What's next? Biochem and neuroanatomy are too difficult and people after med school do not become biochemists and neuroanatomists so let's get rid of them and make them elective curriculum? How about in the clinical years? Surgery and Ob/Gyn rotations are hard, let's get rid of them and make them electives only?

(I know that's not what you meant, but when I first read the resolution that's what I understood the resolution to mean).

Bottom line: change the wording. Perhaps instead of saying 'technically challenging' (translation: hard to learn) or 'less commonly used', change it to 'evidence-based' or something like that. Just because a technique or a subject is technically challenging or less commonly used does not mean it should be stricken from the curriculum. Otherwise medical school would be two years in length.

Just my opinion. Carry on.

 

[NewBlood]

Ok, first of all, I have take classes in evidence based medicine. Second of all OMT is not the total definition of osteopathic medicine, but it is what makes its definition different than allopathic. I chose DO school because i wanted to learn these skills yes, but I plan to practice an evidence based practice. I would note that large portions of what physicians do is NOT supported by large amounts of formal studies. Nearly half of all prescriptions are written for off label indications. I personally find cranial hard to believe myself. Some patients claim it as a near miracle (i know this is poor evidence). Sorry if I came off as supporting these (chapman's points I'm not sure of). Honestly, most of my training is in the drug side of things. While cranial and possibly chapmans seem to make no sense, I'm not going to complain about the few hours spent on them.

Just because there may be other areas of medical practice that need to be reformed and brought up to snuff in terms of evidence-based-practice does not give a free ticket to osteopaths to go around using cranial to "treat" autism.

That being said, I don't know where you are getting your numbers here, because almost everything I have ever seen shows around 20% of prescriptions are for off-label uses. Regardless of what the true number is, much of off-label usage is indeed based on scientific evidence. I'm surprised you wouldn't know this if you took a full course in EBM. Drug companies get FDA approval to market a drug for a specific indication. If it is approved, others may do research and show validity for slightly different conditions, different patient populations, and so on. Actually, many times drug companies have scientific evidence that their drug will be effective for several indications or patient populations, but they know it is economically more sound to seek approval for the single indication that will be easiest to meet end points in clinical trials. As an example, if you prescribe any SSRI (other than fluoxetine) to a 17 year old for depression, that is an off label use. Now if you want to take up the argument that there is NO scientific basis for the use of SSRI's in 17 year olds, be my guest. And yes, I specifically chose SSRIs to use as an example. We don't know exactly how they work, yet there is a preponderance of evidence to support their use. Nevertheless, there is an ongoing debate about the use of SSRIs in various circumstances, as there should be. The problem with many OMM techniques is that we don't know how they work, yet there is NOT sufficient statistically significant data to indicate that they even have any effect. Therefore, it is our ethical duty as members and future members of the medical community to initiate debate about their use by physicians.

 

[NewBlood]

Bottom line: change the wording. Perhaps instead of saying 'technically challenging' (translation: hard to learn) or 'less commonly used', change it to 'evidence-based' or something like that. Just because a technique or a subject is technically challenging or less commonly used does not mean it should be stricken from the curriculum. Otherwise medical school would be two years in length.

Just my opinion. Carry on.

You have a good point here. I still think the big challenge is will be getting past some of the super old school osteopath-types who are difficult to reason with. There have been PhD faculty at DO schools who have demonstrated (INTEREXAMINER RELIABILITY AND CRANIAL OSTEOPATHY, The Scientific Review of Alternative Medicine Vol6.,N 1, Winter 2002) that many published studies regarding palpation of CRI actually had inter-examiner reliability coefficients that were NEGATIVE (yes, that is possible!), yet the OMM departments just refused to to acknowledge hard data. So if PhDs on faculty at DO schools cannot get these schools to tweak their curriculum, it will be difficult to effect change as students, residents, and young practicing DOs not in leadership positions. But it certainly is possible and the efforts started at DMU should continue. I have no doubt that they will, and no doubt that they will eventually succeed.

 

[hawkeye pierce]

We could argue if any drug that increases suicide risk in teenagers is ever a good thing to treat depression. I realize many of the off label uses have data backing them up. I know i've seen some wierd things prescribed that when i questioned them I was given this is how this drug works, nothing else has worked so i'm gonna try this and hope it works type answer. Drug companies usually try to avoid doing studies in children. Those number i quoted were from a continuing education class i took (honestly the exact number isn't that important). It wasn't even until the 60's that drug companies had to show any efficacy whatsoever. Did you actually read the studies on the inter-reliability (i havn't), but is it possible that the people doing it were largely students who did not get it?

 

[hawkeye pierce]

At what point would there be "sufficient" significant studies? Just an honest question.

 

[NewBlood]

Did you actually read the studies on the inter-reliability (i havn't), but is it possible that the people doing it were largely students who did not get it?

Yes I did, the authors looked at studies where the examiners were either DO's, PTs, RNs, or PT students. There was no statistically significant difference in the ability of anyone to palpate the frequency of the CRI.

My mini vacation was supposed to be over this morning, so I must return the the real world now and resume my studies.

Keep up the fiery debate, it is a beautiful thing!

 

[hawkeye pierce]

DO's, PTs, RNs, or PT students. So some of them were students. Some were RN's (i believe that is a major part of their studies right???). Were the DO's all NMM/omt board certified? While I too find it far fetched. Would you accept the validity of study on hernia surgery success rates completed by m2's on some and by nurses on others. One thing in evidence based medicine is to look at how the study was set up (correct?). This study seems like a set up to failure based on info given.
By the way hope you enjoyed your mini vacation.

 

[Pansit]

DO's, PTs, RNs, or PT students. So some of them were students. Some were RN's (i believe that is a major part of their studies right???). Were the DO's all NMM/omt board certified? While I too find it far fetched. Would you accept the validity of study on hernia surgery success rates completed by m2's on some and by nurses on others. One thing in evidence based medicine is to look at how the study was set up (correct?). This study seems like a set up to failure based on info given.
By the way hope you enjoyed your mini vacation.

You definitely are not in medical school...lol...just wait till you have a practical on cranial. You will realize that you feel NOTHING, make up some random CRI number, the OMT fellow/attending will check, and say "wow...right on!". And you just know in the back of your mind it's BS.

 

[Bacchus]

You definitely are not in medical school...lol...just wait till you have a practical on cranial. You will realize that you feel NOTHING, make up some random CRI number, the OMT fellow/attending will check, and say "wow...right on!". And you just know in the back of your mind it's BS.

The only cranial lab we had all year was just to palpate the CRI. I never felt anything. How to treat? I dunno.

 

[hawkeye pierce]

I was just commenting on the study is all.

 

[DocEspana]

The only cranial lab we had all year was just to palpate the CRI. I never felt anything. How to treat? I dunno.

Palpation is treating (there are some special techniques, but this is mostly true). You just simply will yourself to apply the most minute amount of additional pressure to the cranial bones into a restriction and see if they free up. All from the vault hold. And never with your thumbs resting on the patient. (never understood why they were so anal about that)

 

[chet]

DO's, PTs, RNs, or PT students. So some of them were students. Some were RN's (i believe that is a major part of their studies right???). Were the DO's all NMM/omt board certified? While I too find it far fetched. Would you accept the validity of study on hernia surgery success rates completed by m2's on some and by nurses on others. One thing in evidence based medicine is to look at how the study was set up (correct?). This study seems like a set up to failure based on info given.
By the way hope you enjoyed your mini vacation.

The reason why they use non-DO's in studies like this is to remove bias.

In lab next year you will be sitting their, with your hands on your partners head, feeling foolish because, well you are in a dark room groping someones head. Then, your OMM Doc will come over and start moving your hands in an effort to get you to appreciate the motion.

What they are really doing, in my opinion, is using powerful suggestion to get you to feel something that may not be there. So, you use non-DO's in a study, because if CRI is real, anyone with the sense of touch should be able to feel it.

That is all just purely my opinion, nothing more.

 

[hawkeye pierce]

The reason for the thumbs issue is most likely due to your own pulse being so noticable in your thumb when you put pressure on something (same reason you don't use your thumb to take a pulse (this is just speculation as well).
The problem with using not do's in study about OMT would be the same as using a nurse to get results from a brainsurgery provided by a nurse... the experts are necessary( if it doesn't work it doesn't work, but a study using nurses shows nothing of the such.

 

[NewBlood]

The problem with using not do's in study about OMT would be the same as using a nurse to get results from a brainsurgery provided by a nurse... the experts are necessary( if it doesn't work it doesn't work, but a study using nurses shows nothing of the such.

If I took a bunch of carpenters and had them slap their hands down on an oak table--no, lets make this nice--a rich mahogany table, and then I asked them to count the number of "Wood Respiratory Impulses" that they felt in a minute, I could record their individual findings and calculate an inter-examiner correlation coefficient to determine how well their findings for WRI correlated with each other. If I then took a bunch of bakers and candlestick makers and had them do the same thing, I could record similar statistics for all of them. If I then compared the inter-rater correlation coefficients for all three groups, I would not expect the carpenters, despite the fact that they work with wood all day, to have coefficients any closer to 1 than the bakers or candlestick makers. In fact, I would expect all three numbers to be very close to ZERO, because the Wood Respiratory Impulse does not exist.

If I took a groups of hepatologists, a group of PT students, and the cast of Diff'rent Strokes and had all of them palpate for the inferior border of the liver, the inter-examiner reliability coefficients would not be the same. The hepatologists' coefficient would be very close to 1, the PT students might be close to .2 or .3 if they were lucky, and the cast of Diff'rent Strokes would likely be close to 0.

 

[Bacchus]

 

[hawkeye pierce]

Why are you knockin' on the different strokes cast?

 

[DocEspana]

Todd bridges is a master of liver palpation. Zombie Gary Coleman... not so much.

 

[hawkeye pierce]

Zombies are usually slow at liver palpation, but if they get their hands on the liver they plapate it quite thoroughly starting with hands, then teeth , then....

 

[LSU Alex]

In lab next year you will be sitting their, with your hands on your partners head, feeling foolish because, well you are in a dark room groping someones head.

Com'on, brother. Don't feel foolish... you're palpating the human soul. Thems mad skillz you got there! I'm sorry. I read this argument with the pre-med and laughed. Please re-visit this 12 to 18 months from now. I really want to see if there is a change in attitude towards cranial. I will be simply shocked if there isn't. I'd spend more time studying Repro and Development if I were you. More points there on Step 1 than cranial.