J Am Osteopath Assoc. 2020 May 1;120(5):293-302. doi: 10.7556/jaoa.2020.048.
Colleges of osteopathic medicine (COMs) are required to provide hands-on osteopathic manipulative medicine (OMM) training during clerkship years, but this can be challenging given that students are in a variety of clinical sites and often train with allopathic physicians.
To identify student OMM practice patterns documented on required OMM practice logs detailing 10 OMM treatments each semester as part of a 3-semester third- and fourth-year clerkship curriculum and to determine whether these practice patterns varied by supervisor type (osteopathic vs allopathic) and semester.
The OMM practice logs from 2 class years were retrospectively reviewed for patient and supervisor characteristics and OMM treatment details. Semesters included 2 third-year semesters and an extended fourth-year semester.
Between July 2015 and March 2018, 1018 OMM practice logs were submitted detailing 10,150 treatments involving 4655 clinical (45.9%) and 5474 volunteer (53.9%) patients. Logs contained up to 10 treatments per log; 26.0% included only clinical patients, 17.4% included only volunteer patients, and 56.6% included both. Significantly more clinical patients (1708 [36.7%]) were treated during the first semester of the third year than the other 2 semesters (P<.001). The supervisor's credentials were identified as an osteopathic physician for 6639 treatments (65.4%) and an allopathic physician for 768 (7.6%). No difference was found in the proportion of clinical to volunteer patients supervised by osteopathic or allopathic physicians (P=.34). Neuromusculoskeletal complaints accounted for 10,847 (90.7%) chief complaints, and nonneuromusculoskeletal complaints accounted for 1115 (9.3%). The most commonly treated body regions were the thoracic (6255 [61.4%]), cervical (4932 [48.4%]), and lumbar (4249 [41.7%]). More body regions were treated on clinical patients than on volunteer patients (mean, 2.7 vs 2.6, respectively; P=.04). Commonly used techniques were muscle energy (6570 [64.5%]); high-velocity, low-amplitude (4054 [39.8%]); soft tissue (3615 [35.5%]); balanced ligamentous tension/indirect techniques (2700 [26.5%]); and myofascial release (1944 [19.2%]).
More than 80% of students documented OMM practice on clinical patients for their required OMM practice logs. Both osteopathic and allopathic physicians provided supervision. Chief complaints and types of osteopathic manipulative treatment used were consistent with current clinical practice. Areas identified for enhanced didactic education included OMM for nonneuromusculoskeletal complaints.
骨医学院（COMs）被要求在实习期间提供实践的整骨医学（OMM）培训，但鉴于学生在各种临床场所并且经常与全科学医生一起接受培训，这可能具有挑战性。
确定学生在第三年和第四年实习课程的三个学期中，每个学期在规定的 OMM 实践日志中记录的 10 次 OMM 治疗的实践模式，并确定这些实践模式是否因监督类型（整骨与全科学）和学期而异。
回顾性审查了 2 个年级的 OMM 实践日志，以了解患者和监督者的特征以及 OMM 治疗的详细信息。学期包括 2 个三年级学期和一个延长的四年级学期。
2015 年 7 月至 2018 年 3 月期间，共提交了 1018 份 OMM 实践日志，详细记录了涉及 4655 名临床（45.9%）和 5474 名志愿者（53.9%）患者的 10150 次治疗。日志中最多可包含 10 次治疗；26.0%的日志仅包含临床患者，17.4%的日志仅包含志愿者患者，而 56.6%的日志包含两者。在第三年的第一个学期中，接受治疗的临床患者（1708 [36.7%]）明显多于其他两个学期（P<.001）。对于 6639 次治疗（65.4%），监督者的证书被认定为整骨医生，对于 768 次治疗（7.6%）则被认定为全科学医生。整骨医生和全科学医生监督的临床患者与志愿者患者的比例没有差异（P=.34）。神经肌肉骨骼投诉占 10847 次（90.7%）主要投诉，非神经肌肉骨骼投诉占 1115 次（9.3%）。最常治疗的身体部位是胸部（6255 [61.4%]），颈部（4932 [48.4%]）和腰部（4249 [41.7%]）。在临床患者上治疗的身体部位多于志愿者患者（平均分别为 2.7 次和 2.6 次，P=.04）。常用的技术包括肌肉能量（6570 [64.5%]）；高速度，低幅度（4054 [39.8%]）；软组织（3615 [35.5%]）；平衡韧带张力/间接技术（2700 [26.5%]）；和肌筋膜释放（1944 [19.2%]）。
超过 80%的学生在其规定的 OMM 实践日志中记录了对临床患者的 OMM 实践。整骨医生和全科学医生都提供了监督。主要投诉和使用的整骨手法治疗与当前的临床实践一致。确定需要加强教学的领域包括非神经肌肉骨骼投诉的 OMM。
