How to Develop an Osteopathic

Scholarly Culture

Robert W Hostoffer, DO, LhD, FAAP, FACOP, FACOI, FCCP

Program Director, Allergy/Immunology Fellowship

Michael P Rowane, DO, MS, FAAFP, FAAO

Associate Dean of Clinical Education, LECOM

Brian P Peppers, DO, PhD

Assistant Professor, Allergy/Immunology, WVU

Overview

• ACGME Osteopathic Recognition:

• What it means and what faculty are required

• Curriculum Fundamentals:

• Examples and Ideas

What does ACGME Osteopathic Recognition mean?

• Commitment by a program to teach and assess

Osteopathic Principles and Practices (OPP) at the

graduate medical education level.

• The curriculum incorporates OPP that is relevant to that

specialty

Osteopathic Learning Environment

• Programs with Osteopathic Recognition must create a

learning environment that integrates and promotes the

application of OPP throughout the duration of the

educational program.

Osteopathic Recognition Requirements. ACGME approved focused revision:

February 4, 2018; effective July 1, 2018

Examples and Ideas

OSTEOPATHIC-FOCUSED CURRICULUM AND

REQUIRED EXPERIENCES

• Describe integration of OPP into the curriculum

• Environment that supports scholarly activity that advances

OPP.

• Resources available to support osteopathic-focused education

• Who will provide the formal didactic education in OPP,

including OMT?

• Opportunities for residents to teach OPP

HELP IS ON THE WAY…

Start Aligning for Resources:

People - Educational Materials

• Colleges of Osteopathic Medicine

• OPTI

• Post-OPTI (OPTI-Like…)

• Osteopathic Organizations

•AOA

•AACOM UME-GME ACGME OR Task Force

•AAO

•NBOME

•AOGME

•ACOP

•ACOFP…

Everyone wants success!!!!

No one wants any program seeking

ACGME OR to NOT be successful!

Osteopathic Educational Program

The curriculum for designated osteopathic residents must

integrate OPP into each of the ACGME Competencies

–Patient Care and Procedural Skills

–Medical Knowledge

–Practice-based Learning and Improvement

–Interpersonal and Communication Skills

–Professionalism

–Systems-based Practice

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Integrate OPP into ACGME Competencies

PATIENT CARE: OMT in a clinical setting

–Where – ambulatory clinic

–When – structured OMT clinic vs. longitudinal

EMR

• Add section into EMR with osteopathic focused

evaluation

• Develop quality improvement project to

determine its use over a year

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Add OMT to Billing Sheet

Diagnosis Codes

Diagnosis Codes(ICD-10):

➢ m99.00 segmental and somatic dysfunction of head

➢ m99.01 segmental and somatic dysfunction of neck

➢ m99.02 segmental and somatic dysfunction of thorax

➢ m99.03 segmental and somatic dysfunction of lumbar

➢ m99.04 segmental and somatic dysfunction of sacrum

➢ m99.05 segmental and somatic dysfunction of pelvis

➢ m99.06 segmental and somatic dysfunction of upper extremity

➢ m99.07 segmental and somatic dysfunction of lower extremity

➢ m99.08 segmental and somatic dysfunction of ribs

➢ m99.09 segmental and somatic dysfunction of abdomen/other

Procedure codes

Procedure Codes:

➢ 98925 (1-2 regions)

➢ 98926 (3-4 regions)

➢ 98927 (5-6 regions)

➢ 98928 (7-8 regions)

➢ 98929 (9-10 regions)

Add Modifier

Separate and identifiable evaluation and management service

This code is used when a physician finds it necessary to perform an

evaluation and management code for something above and beyond

the CPD code. Although frequently done, the diagnosis does not

necessarily have to be different

Added to the E/M code when billing to alert the insurance company that

an evaluation AND procedure were done on the same day, and the

E/M was significant and justified.

Example: 99213-25

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Integrate OPP into ACGME Competencies

MEDICAL KNOWLEDGE:

• Journal club monthly

– Join AAO • utilize Osteoblast for articles• Use Google Scholar, OstMED, PubMed and

ScienceDirect

• Lectures every month

– Join AAO• Prerecorded lectures on general osteopathic

topics• Assigned Readings

– OPP/OMM Board Review– Like Harrison club but use FOM

An Osteopathic Perspective of the

Underlying Pathophysiology:

Incorporate REQUIRED reading material here

–Chila, AG (2011). Foundations of Osteopathic Medicine [3rd Edition]

–Nelson , KE & Glonek, T (2015). Somatic Dysfunction in Osteopathic Family

Medicine [2nd Edition]

–Nicholas, AS & Nicholas, EA (2015). Atlas of Osteopathic Techniques. [3rd Ed]

–Rowane, MP, Evans, P. Basic Musculoskeletal Manipulation Skills: The 15

Minute Office Encounter. American Academy of Osteopathy Publishing.

Indianapolis, IN. [2nd Edition] 2019.

Add Board Review to Weekly or Monthly

didactic

Crow, WT. Osteopathic

Manipulative Medicine Review

for Board: A Study Guide for

COMLEX and Osteopathic

Certifying Boards. [3rd Printing]

2016.

An Osteopathic Perspective of the

Underlying Pathophysiology:

Review Structure and Function

–Anatomy review WITH Pics

–Innervation review WITH chart

–Chapman Points of area review WITH pics

–Special Test for Diagnosis Review WITH Pics

Medical knowledge

• General module review quarterly

– Available in specialty colleges (POMT)

• Workshop yearly

– Join AAO– utilize OPTI & COMs– Attend workshops

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Integrate OPP into ACGME Competencies

PRACTICE-BASED LEARNING & IMPROVMENT:

• Quality improvement projects

• Evaluate and investigate patient care

• Appraise and Assimilate Scientific Data

• Apply Continuous Improvement to the Practice of Medicine

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Integrate OPP into ACGME Competencies

INTERPERSONAL AND COMMUNICATION SKILLS:

• Patients, families, and other members of health care team:

•Effectively discuss osteopathic concepts and their role in

patient care

•Appropriate verbal and non-verbal skills, including

appropriate touch

• Give lectures to non-physician groups on OMM

• Give lectures on OMM to non-DO groups

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Integrate OPP into ACGME Competencies

PROFESSIONALISM:

• Demonstrate awareness of and proper attention to issues of culture,

religion, age, gender, sexual orientation, and mental and physical

disabilities as they may influence a patient’s perception of touch within

the context of OPP.

• Maintaining Mind, Body, Spirit interest for:

– Patients

– Family

– Residents

– Fellow physicians

– Staff

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Integrate OPP into ACGME Competencies

SYSTEM-BASED PRACTICE:

• Intergrade OMM/OPP into discussion with other health care

providers

• Utilize OMM/OPP diagnostic interpretations to move

patients to appropriate health care providers

• Cost benefit of OMT, including the concepts of

reimbursement and correct coding and billing processes.

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• Scholar 7

• Series of 7 professionally done lectures

• Available FREE on OOA, AODME, AAO, AOA and LECOM websites

• CME available through AOA website

• Reviews Hypothesis, Introduction, Specific Aims, Preliminary Data,

Conclusions.

• Scholar 4

• Series of 4 professionally done lectures

• Available FREE on OOA, AODME, AAO, AOA and LECOM websites

• Reviews Abstract, poster, oral presentation and manuscript

development

• Scholar Specific: FREE, NEW, NOW!!

Free Advertisement

Scholar Series: Ohio Osteopathic Association:

https://associationdatabase.com/aws/OOSA/pt/sp/scholar7

UH Regional Hospitals

Osteopathic Neuromusculoskeletal Medicine Grand

Rounds Series:

Your Topic

Intern/Resident Presenters: *2-3 medical student AND 2 Interns/residents

Your name (s)Impressive credentials

Faculty Moderators:

Susan Ratay, DO, MSGabrielle Koczab, DOChristopher E. Parnell, DOLauren Walters, DO

Needs & Rationale

• Promoting integration of OPP and OMT

• Advancement of OPP evidence-based practices

• Encourage faculty development and involvement

• Promote common avenues to fulfill ACGME OR

requirements in a community hospital training institution

• Opportunity for osteopathic medical students, interns,

residents and/or fellows to obtain scholarly activities

and develop their professional portfolio

Example:

Osteopathic-focused scholarly project

Review Scholar Series for Osteopathic application

40

Resources available to support and

Osteopathic Learning Environment

• Join AAO

• Align with AOA, State, OPTI, specialty colleges, colleges

• Find resources within these

• Adapt them to create curriculum

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Texts/ Resources for Learners

• Ostmed

•http://ostemed-dr.contentdm.oclc.org/cdm/

• Textbooks

What facilities do I need for OMM/OPP?

What resources are available to support

osteopathic medical education?

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Resources: Physical Plant

• OMT Tables

• Where can I get an OMM table?

• How many?

• Where do I put them?

• Conference Room

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Osteopathic Culture and Philosophy

• How do we use this in our training?

• AT’s words:

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Mind, Body, Spirit

• “First the material body, second the

spiritual being, third a being of mind which

is far superior to all vital motions and

material forms, whose duty is to wisely

manage this great engine of life”

» AT Still, MD, DO,

Philosophy of Osteopathy

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REFLECTION EXERCISE

• Have residents or fellows write a 1 page reflection and place in

portfolio

48

Find Health-Wellness

• “To find health should be the object of the doctor.

Anyone can find disease”

» AT Still, MD, DO, Philosophy of Osteopathy

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Reflection

• Have resident or fellows write a 1 page reflection

• Portfolio development

50

Let us write a short reflection on the tenets.

1. The body is a unit; the person is a unit of body, mind, and

spirit.

2. The body is capable of self-regulation, self-healing, and

health maintenance.

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of the

basic principles of body unity, self-regulation, and the

interrelationship of structure and function.

Didactics

• Perform didactics regularly

• Expectations must be high

• Integrate OMM didactic into schedule

• Incorporate Mind, Body Spirit into all didactics

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ACGME Osteopathic Recognition Faculty

• Select and appoint faculty members committed to the

success of the osteopathic curriculum.

• Director of Osteopathic Education: Responsible for

leading the osteopathic education in the program

Osteopathic Recognition Requirements. ACGME approved focused revision:

February 4, 2018; effective July 1, 2018

Faculty

• Director of Osteopathic Education

• Develop Osteopathic-Focused faculty

• Community physicians

• OR Residents – Junior faculty

57

Faculty training

• Faculty attend all OMM didactics

• Faculty attend OMM workshops

• Faculty Development: “Scholar Teacher”

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Faculty development

• Do this Scholar Series for CME credit

• Have faculty attend OMM workshops

• Faculty Development: “Scholar Teacher”

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Opportunities for residents to teach OPP

• Have residents lecture at local CME, college, and/or hospital

on OMM that involves their specialty

• OMM Grand Rounds

• Presentations

• Journal Clubs

• Table Trainers

• Patient care opportunities with student learners

Summary: Developing an Innovative ACGME

Osteopathic Recognition Curriculum

• ACGME Osteopathic Recognition:

•What it means

•What faculty are required

• Curriculum Fundamentals

• Examples and Ideas

References1. Osteopathic Recognition Requirements. ACGME approved focused revision:

February 4, 2018; effective July 1, 2018.

2. Ostmed-DR: http://ostemed-dr.contentdm.oclc.org/cdm/

3. Ratay, SM, Rowane, MP. “Osteopathic-Focused Grand Rounds: Supporting an

Osteopathic Learning Environment” Webinar: Association of Osteopathic

Directors and Medical Educators-American Academy of Osteopathy. December

13, 2017.

4. Crow, WT. Osteopathic Manipulative Medicine Review for Board: A Study Guide

for COMLEX and Osteopathic Certifying Boards. [3rd Edition] 2016.

5. Nelson , KE & Glonek, T. Somatic Dysfunction in Osteopathic Family Medicine

[2nd Edition] 2015.

6. Chila, AG (Ed). Foundations of Osteopathic Medicine [3rd Edition] 2011.

References

7. Nicholas, AS & Nicholas, EA. Atlas of Osteopathic Techniques. [3rd Ed] 2015.

8. Rowane, MP, Evans, P. Basic Musculoskeletal Manipulation Skills: The 15

Minute Office Encounter. American Academy of Osteopathy Publishing.

Indianapolis, IN. [2nd Edition] 2019.

9. Rowane, MP. Approaches to Building your Osteopathic Recognition

Curriculum: Fundamentals and Innovations. Osteopathic Recognition: Intensive

Peer-to-Peer Workshop. AACOM Pre-Conference Program. Tuesday, April 17,

2018

10. Scholar Series: Ohio Osteopathic Association:

https://associationdatabase.com/aws/OOSA/pt/sp/scholar7

Free Advertisement• Scholar 7

– Series of 7 professionally done lectures– Available FREE on OOA, AODME, AAO, AOA and

LECOM websites– CME available through AOA website– Reviews Hypothesis, Introduction, Specific Aims,

Preliminary Data, Conclusions.• Scholar 4

– Series of 4 professionally done lectures– Available FREE on OOA, AODME, AAO, AOA and

LECOM websites– Reviews Abstract, poster, oral presentation and

manuscript development• Scholar Specific: FREE, NEW, NOW!!

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