OMT use by DO's in Allo PM&R programs?

It all depends on the institution and the number of DOs in the faculty. I personally don't see why a program director would discourage it, but at the same time, may not push for it either.

At Temple, there are quite a few DO faculty and they incorporate it into their practice. On interview day, they even asked me if I practiced it since they are aware that most students do not. Temple is also a well-reputable program.

At UPMC (Pittsburgh), some of the allopathic attendings actually did counterstrain and muscle energy.

Harvard's program teaches courses on OMT for the MDs. Remember manual medicine is a part of PM&R also. I think it is dependent on the program as stated above.

Does PCOM have a student interest group or club for PM&R?

-J

I'm happy to hear that your school's students have a fair amount of exposure to PM&R and physiatrists. I wish our school had something similiar.

I talked to a JD/MD at our school regarding the use of OMT as both a student and resident and it seems that some of the concerns include having a preceptor who is not comfortable enough with OMT to supervise it and liability issues. There were also concerns over time limitations and having proper facilities for practicing OMT.

Granted that DO residents are licensed to practice OMT, they are still practicing/training under the license of an attending who may or may not be knowledgeable/comfortable enough with supervising the use of OMT.

From my discussion with him, the bottom line was that as a DO medical student or resident, it is still the attending's license in a court of law and thus their preference for or against students/residents using OMT while under their supervision. While a program director may be very positive on using OMT, rotation sites would still need knowledgeable attendings (or attendings who are willing to let OMT be used either way) present.

From my rotation experience at UC-Davis, one of the attendings is a former teaching fellow and uses OMT in his various clinics including OMT and spine. There is an MD attending who did a fellowship at Kessler who uses OMT more for diagnosis, but is willing to let residents "run with the ball" as far as OMT is concerned.

UCLA's program also has at least one MD attending who gives lectures on certain modalities of OMT and uses it in clinic although I have never worked with him personally.

PM&R (along with Family Practice) is definitely one of the more favorable specialties to find attendings who are familiar enough with OMT.

Overall, I think that it is "hit or miss" with respect to the autonomy that DO's have perfoming OMT in various PM&R programs. At Mayo there is indeed a policy about this issue (as there is for almost everything!) stating that until a DO resident does the bi-annual PM&R manual medicine course they need supervision before performing OMT. After completing the course and a short conversation with one of the DO faculty, residents can use OMT in their continuity clinics or at the spine center on a case-by-case basis. Some DO residents have wanted to use it while in the hospital, but as you can imagine this may not be as warmly received by all specialties!

The kicker is that PT's and PT students use OMT all the time with no or minimal supervision. Some of us DO residents have done entire one-year pre-doctoral fellowships in OMM and still need "supervision." It can be a little frustrating. On the other hand, I've had the opportunity to observe the hand skills of some DO residents at various manual medicine courses and there is quite a bit variability. As we all know, not *EVERYONE* took OMM part of our medical training that seriously!

drusso,
Although I am taking my OMM seriously in school now, I'm not quite sure if what we learn in these first two years is sufficient enough to be comfortable treating patients with actual problems. As you know, OMM class often falls short as far as emphasis because of all the other hours required to concentrate on other classes...therefore I was wondering if there are any options as far as summer opportunities (I'm a MSI) or as far as further education after graduation and during residency. I don't want to do an OMM residency, but I do want to use it in practice, and am not sure how I can improve my skills.

stretch210 said:

drusso,
Although I am taking my OMM seriously in school now, I'm not quite sure if what we learn in these first two years is sufficient enough to be comfortable treating patients with actual problems. As you know, OMM class often falls short as far as emphasis because of all the other hours required to concentrate on other classes...therefore I was wondering if there are any options as far as summer opportunities (I'm a MSI) or as far as further education after graduation and during residency. I don't want to do an OMM residency, but I do want to use it in practice, and am not sure how I can improve my skills.

Click to expand...

Don't you do an OMM rotation as a MSIII at your school?

stretch210 said:

drusso,
Although I am taking my OMM seriously in school now, I'm not quite sure if what we learn in these first two years is sufficient enough to be comfortable treating patients with actual problems. As you know, OMM class often falls short as far as emphasis because of all the other hours required to concentrate on other classes...therefore I was wondering if there are any options as far as summer opportunities (I'm a MSI) or as far as further education after graduation and during residency. I don't want to do an OMM residency, but I do want to use it in practice, and am not sure how I can improve my skills.

Click to expand...

You could always take additional electives in OMT with some of the big names during your 3rd or 4th years of med school. There is also the +1 OMM/NMM fellowship.

I realize that OMM instruction is variable at different schools. I've felt very comfortable treating *most* appropriate cases in the clinic and a few in the hospital (with my preceptor's permission). I guess a lot of it is practice, practice, and more practice so that you don't lose your skills.

Your mileage may vary...

stretch210 said:

drusso,
Although I am taking my OMM seriously in school now, I'm not quite sure if what we learn in these first two years is sufficient enough to be comfortable treating patients with actual problems. As you know, OMM class often falls short as far as emphasis because of all the other hours required to concentrate on other classes...therefore I was wondering if there are any options as far as summer opportunities (I'm a MSI) or as far as further education after graduation and during residency. I don't want to do an OMM residency, but I do want to use it in practice, and am not sure how I can improve my skills.

Click to expand...

I wouldn't stress to much about OMT at this point in your training. It takes some time to put things together. Besides, as an M1 or 2, you shouldn't feel comfortable treating anyone medically, so OMT is not different. I would recommend requesting a DO that does OMT for your FP rotation 3rd year. I did all my docs OMT and he would clean up anything I didn't get. My school also had a family practice externship in the summer between M1 and M2 and several of the faculty that participated did OMT. Do an OMM elective M3 or M4. Practice on your family, there's always someone with an ache or pain. The other point I'll make is that you have to know your anatomy. Don't memorize treatment positions, learn the concepts. Know the anatomy and basics of direct vs. indirect and you'll be fine.

I'm at the University of Michigan PM&R residency.

I have a weekly clinic of my own. I get referrals from our own PM&R attendings as well as from attendings of various other specialties specifically for OMM (mostly orthopedics and family practice). I do a full OMM treatement on at least two patients per week. By this I mean a complete biomechanical examination and treatmet from the feet up.

I'm even using Dr. Fulford's percussion hammer in my clinic at this time.

Because of the great interventional exposure here, it has allowed me to really create a comprehensive MSK treatment for the patients. All the "interventionalists" are open to OMM.

Have been seeing lots of referrals for rib pain lately. Its great to take a patient with post traumatic intercostal neuralgia, do an intercostal nerve block under flouro in our own department, take their baseline pain down enough so I can touch them, and then mobilize those ribs, t-spine, and muscles that have been locked up for years. Then send them to our PTs that do manual medicine and have them teach some exercises and stretches and get some hands on treatment in between visits with me.

Overall the residency is very open to OMM and with the combination of pain procedures, great PTs, and opportunity to integrate OMM I'm really happy with the service I can provide in this specific regard.

We have a yearly OMM course for all the residents as well. Usually two days long.