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GENERAL COMMENTARY...please read :)

Discussion in 'Pre-Medical - DO' started by tennisboy93, Feb 14, 2000.

  1. tennisboy93

    tennisboy93 Junior Member
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    You know, you guys: Before i really started looking at medical and applying and such, I didn't really understand what a DO was. I have sense done some researchh, and LIKE what I have learned. After listening to both the allo- and osteo- boards, I get the general sense that the DO people are a little less fanatical, but endlessly devoted, even more so, to GENUINELY helping people, not just getting a "Dr." in front of their name. The allo- schools (from what I hear) are more constrained, and don't take into account the whole person, yes? DO's just sound more 'people' oriented...is that why some of you chose this?
     
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  3. Smile

    Smile Senior Member
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    tennisboy,

    though you are making some generalizations, i must say i agree w/ what you say. from experience, MD schools have been more concerned w/ my numbers (GPA, MCAT) while DO schools have really looked hard into all my experiences. this has translated directly into how i have fared through the application/interview process. i also found the interviewees at DO schools to be more down-to-earth people and not reflective of the usual cutthroat pre-meds i can remember from my undergraduate days. not to say one group of students is better than the other, but i do believe (and agree with you) in that the types of students MD and DO schools recruit are generally different. they base their selection factors in different criteria as a whole.

    i apologize if these generalizations have offended anyone, but i am only stating personal observations without conferring judgements on anyone.
     
  4. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    TennisBoy,

    There may actually be some evidence to support your perception. In one study of MD versus DO students, DO students were more likely to idenitify as "socioemotionally oriented", whereas MD students were more likely to identify as "technoscientifically oriented." It is important to keep in mind that GROUP data cannot and should not be used to to attempt to explain INDIVIDUAL differences, but if such a difference exists, then the implications for medical education are interesting to consider:

    TITLE: Comparison of osteopathic and allopathic medical Schools' support for primary care.

    AUTHORS: Peters AS; Clark-Chiarelli N; Block SD

    AUTHOR AFFILIATION: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Helath Care, Boston, MA 02215, USA.
    SOURCE: J Gen Intern Med 1999 Dec;14(12):730-9

    OBJECTIVE: To contrast prevailing behaviors and attitudes relative to prJgiary care education and practice in osteopathic and allopathic medical schools. DESIGN: Descriptive study using confidential telephone interviews conducted in 1993-94. Analyses compared responses of osteopaths and allopaths, controlling for prJgiary care orientation. SETTING: United States academic health centers. PARTICIPANTS: National stratified probability samples of first-year and fourth-year medical students, postgraduate year 2 residents, and clinical faculty in osteopathic and allopathic medical schools, a sample of allopathic deans, and a census of deans of osteopathic schools (n = 457 osteopaths; n = 2,045 allopaths). MEASUREMENTS: Survey items assessed personal characteristics, students' reasons for entering medicine, learners' prigiary care educational experiences, community support for prigiary care, and attitudes toward the clinical and academic competence of primary care physicians. MAIN RESULTS: Primary care physicians composed a larger fraction of the faculty in osteopathic schools than in allopathic schools. ***Members of the osteopathic community were significantly more likely than their allopathic peers to describe themselves as socioemotionally oriented rather than technoscientifically oriented.*** Osteopathic learners were more likely than allopathic learners to have educational experiences in primary care venues and with primary care faculty, and to receive encouragement from faculty, including specialists, to enter prJgiary care. Attitudes toward the clinical and academic competence of prJgiary care physicians were consistently negative in both communities. Differences between communities were sustained after controlling for primary care orientation. CONCLUSIONS: In comparison with allopathic schools, the cultural practices and educational structures in osteopathic medical schools better support the production of prJgiary care physicians. However, there is a lack of alignment between attitudes and practices in the osteopathic community.

    It is hard to say how such a difference, if one really exists, might affect the doctor-patient relationship. Still, interventions designed to increase residents' "self-awareness", a hypothetical psychological construct that might overlap with "socioemtionality" have been shown to increase the quality of information doctors are able to illicit during a clinical interview:

    TITLE: Teaching self-awareness enhances learning about patient-centered interviewing.

    AUTHORS: Smith RC; Dorsey AM; Lyles JS; Frankel RM

    AUTHOR AFFILIATION: Department of Medicine, Michigan State University, East Lansing 48824, USA. [email protected]

    SOURCE: Acad Med 1999 Nov;74(11):1242-8
    CITATION IDS: PMID: 10587689 UI: 20055001

    ABSTRACT: PURPOSE: To evaluate the effect of intensive attitudinal training on residents' learning the patient-centered interviewing skills required to establish a healthy provider-patient relationship and to communicate effectively. METHOD: While teaching 53 residents patient-centered interviewing skills, the authors also trained them to recognize previously unrecognized, negative attitudes that interfered with learning the skills. The authors, using an iterative, consensus- building process based on the residents' performances and personality data, identified a spectrum of responses to the educational intervention. Barriers to and facilitators of mastery of skills were analyzed and this information was used to help residents overcome skill deficits. RESULTS: To varying degrees, 44 residents became aware of previously unrecognized attitudes to the extent that they improved their patient-centered interviewing skills. Six residents failed to develop awareness of negative attitudes and showed little learning and clinical use of the interviewing skills being taught. Three residents who rapidly developed superb interviewing skills showed no negative attitude towards using them. CONCLUSIONS: Pending a confirmatory hypothesis-testing study, the authors believe that, as residents learn how to conduct patient-centered interviews, training in awareness of interfering attitudes should accompany training in skills.

    Is "socioemotionality" (a domain in which MD students and DO students appear to diverge) something that is selected for in the admissions process or a consequence of the added emphasis on primary care and/or osteopathic principles and practices to which DO students are exposed? No one knows.

    However, some evidence suggests that these kinds of attitudes might be learned. While numerous studies have supported the assertion that primary care physicians are somehow more "people oriented", a survey of fourth year medical students, revealed no significant difference in psychosocial beliefs among those choosing family medicine versus other specialties.

    TITLE: Psychosocial beliefs of medical students planning to specialize in family medicine.

    AUTHORS: Markham FW; Diamond JJ

    AUTHOR AFFILIATION: Department of Family Medicine, Jefferson Medical College, USA.

    SOURCE: Psychol Rep 1997 Jun;80(3 Pt 1):987-92
    CITATION IDS: PMID: 9198400 UI: 97342314

    ABSTRACT: The psychosocial orientation of fourth-year medical students planning careers in family medicine was compared to those selecting other specialties using the Physician Belief Scale. This scale has shown that practicing family physicians have a greater psychosocial orientation than those in other specialties such as internal medicine. The current study was done to see whether students choosing family medicine already have this greater orientation before they begin training as residents. 664 fourth-year medical students received surveys during their senior year and 378 (57%) returned completed surveys. Female students had a significantly greater psychosocial orientation than their male peers, **but there were no significant differences between students planning residencies in family medicine and those selecting other residencies. The greater orientation of family doctors would appear to be a product of further training and experience either during residency or later during the actual practice of family medicine.**

    There is really very little information to inform the DO versus MD debates on the Internet that preoccupy premeds. Little is known about the efficacy of OMT, although some evidence suggests it might be a cost-effective modality for the conservative care of musculoskeletal injuries. Proponents of osteopathic principles and practices have claimed that exposure to such information contributes to the education of a more holistic physician, however clear data to support that assertion are lacking. As the osteopathic medical profession continues to gain popularity and recognition among the general public, and as venues for training MD's and DO's continue to converge, it might be in the osteopathic profession's best interest to clearly document the neccesity of two medical super-structures (two degrees, two residency processes, two licensing boards, two hospital systems, two application processes, two different sets of schools, etc). Without such documentation there is really no compelling reason for two medical professions to exist.
     
  5. turtleboard

    turtleboard SDN Advisor
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    I was going to go the osteopathic route because I absolutely thought, and still think, OMM is a great tool. It had little to do with the philosophy for me, because as far as I could tell, the philosophies of patient-centered medicine" were essentially shared between both factions.

    As for the types of students each school attracts, I did notice that the guys and gals I interviewed with at NYCOM were INCREDIBLY friendly -- almost too friendly for this cynical-as-hell NYC premed student. [​IMG] And, as it turns out, the NYCOM applicants I interviewed with that day were the nicest of all other applicants I met at all other schools (the others being all allopathic).

    In the end, though, a bunch of things turned me towards the "Dark Side."

    I tend to think that med students are med students, and that they all share the same basic qualities regardless of what school they attend. There are some differences, however, probably owing the region-related issues but for the most part I do think they're all the same.

    I don't think I or any of my allopathic colleagues are in all this $hit for the title of "Doctor," "MD," or even the money. There are easier ways to make that kind of money, and there are titles that are FAR superior to either of those two. And for being "genuinely" interested in helping people, I think you'll have the cynics in both allopathic and osteopathic schools, and I don't think there's any difference in relative proportions across the two schools.

    Can you really not be interested in people and still somehow make it through all this crap? I'd like to see someone try.


    Tim of New York City.
     
  6. Mayqswet

    Mayqswet Senior Member
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    My personal experience has been similar to Smile's. I have been treated just a little bit nicer at the DO schools than the MD schools I interviewed at. As a non-traditional applicant with less than stellar grades, OK MCATs, but great letters, a master's degree, 8 years hospital exerience, publications, etc, the DO schools were much more interested in me. The MD schools were cordial, but I left with a "don't call us" impression.

    However, I do agree with Tim. I have always believed (and still do) that there is usually more variation within a group than between groups. Also, all 5 schools I interviewed at had students that loved being there and were very nice to me. They will all turn out lots of great docs who are genuinely interested in helping people. You either have it or you don't. A school can't give it to you or take it away.


     
  7. Sheon

    Sheon Senior Member
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    I think Tim made a good point, people are going to be people wherever they go. No matter which school, state, country, or philosophy you choose you are going to have the "scientists" and the "artists" in your class.

    The study that drusso posted (in my opinion) shows that those in the DO camp indentify more with the art of medicine (the people side), and those in the MD camp identify more with the science of medicine (the labratory side).

    Perhaps the reason that the DO "philosophy" appeals to someone is because of their own personal "artsy" orientations.

    My personal opinion is that the DO philosophy appeals to a great number of pre-meds (perhaps half). Many don't know it because they never bothered to look, others deny their true orientation because they want to fit in, and still others get lost in the prestige that they associate with the "elite" MD schools (i.e., Harvard, JHU, etc.).

    Regardless of what happens you will always have both camps. Even if the MD/DO thing dissovles the age old art vs science will exist in medicine for all time.
     
  8. Matthew T Perry

    Matthew T Perry Junior Member
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    You know I never pass an opportunity to give my opinion. I would like to draw your attention to the article in the January 5, 2000 edition of JAMA (volume 283, no 1, pages 59-68). I will not insult your intelligence summarizing it for you. First, I will find it hard to agree that there is a very significant difference between the osteo pre-med and allo pre-med. Most people who apply to medical schools apply to both and generally go wherever they are accepted. To say there is a difference would imply an intrinsic personality conflict in the population of medical students in schools today, because the decision to go osteo or allo is usually not up to most students but rather up to an arbitrary panel at the different medical schools. It follows that if student A gets accepted to only an allo school, and B to an osteo school, A and B?s personality will be the same even if the acceptances were reversed. I think that you would agree that far fewer people today attend osteopathic medical schools for genuine "osteopathic" reasons. I know in our class (2003), the most popular reason for accepting the invitation to study here (TCOM) is the desire to "just practice medicine." I have no problem with this. I enjoy this answer. But this poses a problem for the die-hard osteopaths who want students to emulate Andrew Still and create alters in his honor, and have sacrificial lamb slaughtering over his burial sight (yes I exaggerate, but only slightly). I do not, as you probably know, believe we need two systems of medicine. We have one (only one) facet of our profession that we can use that our colleagues in the allopathic field do not and cannot easily get. And that's manip. This one cornerstone of our profession, however, is so poorly understood, poorly researched, and rarely practiced to make it the bases of a totally different system of medicine is irresponsible. Oh, you mention, "holistic medicine." To say that an osteopathic doctor practices holistic medicine and an allopathic doctor doesn't is not only inaccurate, but also just as irresponsible. How do we as a collective group of intelligent people make such grandiose statements? My father's cardiologist (M.D) who treated him through out his recent heart attack practiced the most holistic and caring style of medicine I have ever seen in either profession. With over sixty percent of the graduates of osteo schools doing the USMLE and going into ?allo? residencies, where they are trained in allo-hospitals, with allo-doctors and allo-minded patients, and with this being the most popular avenue of training for osteo students today, how can we say that there is absolutely any difference at all. Compound this with the realization that the so much of medical school is forgotten, outdated, or never used post medical school graduation anyway and you have an even stronger argument for integrating the two professions. The general public and the majority of the profession have failed to embrace us as an equal part of the system because we fail to play by the same rules we expect them to bestow on us. We get wrapped up in little communities of osteophytes and its only when we travel out of this safety zone do we get reminded of the effects of our isolationist and proprietary policies. We cannot approach medicine with the same mentality as a widget salesman. We have no patent, nor should we, on the art or science of medicine. We, in our arrogant fashion of self-righteousness, have forgotten the single most important part of medicine: the patient. We preach holistic medicine and patient care, but we don?t practice it. We tell others of the great benefit of manip, but again we don?t do it and we refuse to allow allopaths the opportunity to easily learn it. Why, because we are afraid that we will lose our identity. I think for all of us who said, ?we don?t care whether we are DOs or MDs? this will be our chance to prove it. I thought I didn?t care, but I really do.
     

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