Maintaining Distinctiveness and Affordability of Osteopathic Medical Education

To the Editor:

I value the merits of osteopathic manipulative medicine (OMM) and the high quality of osteopathic medical education, which presents students with a holistic approach to patient care using unique diagnostic and therapeutic tools.

Unfortunately, most osteopathic medical students currently obtain only about 200 hours of preclinical experience in OMM at colleges of osteopathic medicine (COMs),¹ and this training must be provided for hundreds of students by relatively few faculty members. This is definitely not enough exposure to OMM for osteopathic medical students.

In the words of Norman Gevitz, PhD,² “it appears that OPP [osteopathic principles and practice] have moved from the center toward the periphery of the osteopathic medical profession.”

I do not advocate that osteopathic medicine start and end with OMM. However, I do believe that our profession must deliver on the “distinctiveness” that it claims so that osteopathic physicians can—to again quote Dr Gevitz³—“make [the] leap from being regarded only as a medical minority to becoming broadly recognized as medical elite.” Thus, OMM and OPP need to be more emphasized and fully integrated into undergraduate and postdoctoral osteopathic medical training.

Our students need more exposure to OMM to acquire an understanding of the uniqueness of osteopathic medicine's holistic approach to patient care, while still having sufficient time to learn the tremendous amount of basic sciences taught during the first 2 years of medical school. I believe that additional time should be allocated in the undergraduate COM curriculum to OMM, as well as to disease prevention, nutrition, spirituality, and other approaches to medicine beyond conventional medical treatments so that our graduates are equipped to provide the best-informed healthcare to their patients.

Therefore, I propose that the COM academic year start slightly earlier—in June instead of August—and that an additional 300 to 400 hours of instruction compressed into the preclinical years provide our students with needed holistic and OMM skills.

If we claim to offer something unique and more integrative in healthcare, compared with our allopathic counterparts, this uniqueness should be reflected in our COMs' curricula.

Sufficient numbers of OMM faculty members and exposure to basic research related to OMM are crucial to communicate the merits of OMM and the distinctiveness of OPP to osteopathic medical students. Furthermore, formal hands-on rotations in OMM and complementary and alternative medicine (CAM), as well as a dissertation on OPP or CAM, should be instituted as requirements for graduation.

In this “information age,” patients can easily obtain information about the education and qualifications of osteopathic physicians. By emphasizing the uniqueness and distinctiveness of our profession in education and clinical practice, we can help patients realize that our profession is a special brand. However, this can happen only if we live up to the tenets of OPP. The survival of our profession depends on the full incorporation of OPP into osteopathic medical education and practice.

Along with extending the content of our undergraduate medical curriculum, we need to find ways to shorten the total expense and length of medical training. According to a study⁴ published in Health Affairs, median tuition and fees for students in public medical schools increased by 312%—and in private medical schools by 165%—between 1984 and 2004. Median medical student debt increased by more than 150% during this same period.⁴ The Association of American Medical Colleges⁵ reported that the average debt load of graduates from public medical schools and private medical schools were $120,000 and $160,000, respectively, in 2006. Only six of the nation's 25 COMs are public schools.⁶

Colleges of osteopathic medicine should actively partner with various undergraduate universities to offer accelerated 6- to 7-year BS/DO medical programs to as many qualified students as possible. Lake Erie College of Osteopathic Medicine in Pennsylvania has designed a 3-year accelerated curriculum designed to encourage osteopathic medical students to choose primary care careers—and also to save students the cost of 1 year of medical education.⁷ This curriculum can serve as a model for other COMs.

The American Osteopathic Association has restructured the traditional osteopathic internship into three options, allowing each specialty college to choose its own preferred model for osteopathic graduate medical education (OGME).⁸ This restructuring, which went into effect last year, is a positive step forward. At the very least, it helps osteopathic medical students match or track to their chosen specialties in their senior year, instead of at the end of their internship year.

However, the duration of postdoctoral training for some osteopathic medical specialties is still longer than that of our allopathic counterparts—potentially making OGME a less attractive option to trainees. Approximately 60% of COM graduates are presently being trained in Accreditation Council for Graduate Medical Education–accredited training programs.⁹ We need to make OGME a more attractive training option.

One incentive for graduates to pursue OGME would be to redefine the role of and requirements for a traditional rotating osteopathic internship—so that the osteopathic internship mirrors that of the preliminary internship in allopathic training programs. This change would help reduce the length of training for osteopathic medical students. Furthermore, additional training opportunities in nonprimary care specialties need to be developed to attract and meet the career aspirations of COM graduates.