MEDE 8417 - UNT Health Science Center · The Osteopathic Manipulative Medicine clerkship reinforces...

Texas College of Osteopathic Medicine Our mission: Create solutions for a healthier community by preparing tomorrow’s patient-centered physicians and scientists and advancing the continuum of medical knowledge, discovery, and osteopathic health care.

2019 - 2020

OSTEOPATHIC MANIPULATIVE MEDICINE

CLERKSHIP SYLLABUS

MEDE 8417

CLERKSHIP DIRECTORS

Kendi Hensel, DO, PhD, FAAO

[email protected]

CLERKSHIP COORDINATOR

Cari McTaggart

[email protected]

mailto:[email protected]


Last updated - 20 June 2019 2

Table of Contents

Page 3 Clerkship Purpose

Page 3 Osteopathic Manipulative Medicine Clerkship Description

Page 3 General Clerkship Competencies

Page 4 Clerkship Specific Competencies

Page 5 Interprofessional Education

Page 6 CORE Entrustable Professional Activities (EPA’s) For Entering Residency

Page 7 Clerkship Goals and Learning Objectives

Page 8 Required Didactics and Assignments

Page 9 Evaluation and Grading

Page 15 Rotation Sites

Page 17 General Responsibilities

4 Disclaimer

Page 28 Appendices

• Learning Resources

• Didactic Review Syllabus I

• Didactic Review Syllabus II

• Guidelines for the OMM Case Report


Purpose of the Clinical Clerkship

The clinical clerkships affiliated with the Texas College of Osteopathic Medicine serve to

provide supervised, high quality opportunities for third and fourth year medical students to

apply and transform the declarative medical knowledge and basic clinical skills that they

have acquired into procedural clinical competence, while also functioning as learning

members of health care teams.

The clinical clerkships promote and support TCOM students in developing clinical

competence with emphasis on the core competencies beyond medical knowledge alone.

Clerkships are encouraged to seek opportunities for students to provide Health and

Wellness Counseling, develop improved interpersonal and communication skills,

professionalism, as well as practice-based learning and improvement.

Clerkship Description

The Osteopathic Manipulative Medicine clerkship reinforces the philosophy, principles

and practice of osteopathic medicine for primary care physicians and specialists in a

clinical and hospital setting. This rotation is designed as an opportunity for osteopathic

medical students to develop the clinical skills required for the assessment of health, and

the recognition, diagnosis and treatment of disease, with particular attention to the

Neuromusculoskeletal system. Students will be expected to recall and improve upon

techniques learned in the first two years of the curriculum, and be exposed to additional

osteopathic manipulative techniques. The application of the osteopathic philosophy and

principles in the care of patients will be emphasized. A basic foundation of academic,

research, and clinical experience is included, integrating the basic medical sciences and

osteopathic philosophy and principles with the clinical manifestations of health and

disease.

General Clerkship Competencies

The goals of the Clinical Clerkships are to enable TCOM students to achieve competence

as graduate osteopathic medical students. As such, the goals of the clerkship curriculum

are represented by the AACOM Osteopathic Core Competencies for Medical Students.


For the purposes of the TCOM Clinical Clerkship Competencies, the AACOM 14

Competencies have been condensed into the following 8:

1. Osteopathic Principles and Practices OPP

2. Medical Knowledge MK

3. Patient Care PC

4. Interpersonal and Communication Skills ICS

5. Professionalism P

6. Practice-Based Learning and Improvement PBLI

7. Systems-Based Practice SBP

8. Health Promotion/Disease Prevention HPDP

Clerkship Specific Competencies

The student on OMM service shall be expected to acquire and demonstrate the following

skills during the course of the rotation:

1. Obtain a complete and/or problem oriented history from patients

2. Perform a complete physical examination with particular attention to the osteopathic

structural exam and/or respiratory/circulatory osteopathic exam.

3. Develop increased confidence in the specific tasks of the neurologic and

musculoskeletal examination.

4. Demonstrate professional demeanor and provide compassionate and respectful care to

patients

5. Review and develop a thorough understanding of anatomy, with particular attention to

the musculoskeletal system.

6. Participate in documentation (to an allowable extent) and improve these skills

7. Provide information to patients regarding stretching, aerobic activity, and strength

training


8. Identify urgent and emergent conditions that may present primarily with

musculoskeletal pain

9. Identify urgent and emergent conditions that may present at the time of the office visit

that may require intervention/stabilization with transfer to a hospital facility for further

assessment and management.

10. Understand when steroid injections, viscosupplementation, dry needling or

acupuncture may be appropriate.

11. Confidently and accurately perform, to any appropriate region, Osteopathic

Manipulative Techniques, including: Muscle Energy, Counterstrain, Facilitated Position

Release, Still’s Technique, High-Velocity/Low-Amplitude, Articulatory, Balanced

Ligamentous Tension, Visceral Techniques, and Osteopathic Cranial Techniques.

12. Identify when Physical Therapy referral would be appropriate.

13. Review the Choosing Wisely topics relevant to OMT and understand appropriateness

of certain diagnostics and interventions.

14. Develop an appreciation for the biopsychosocial model and how emotional/social

issues may affect physical complaints.

15. Identify when opioid management is appropriate, its adverse effects, and when to

advise discontinuation.

16. Appropriately identify when OMT may be contraindicated.

17. Develop an appreciation for the appropriate use of imaging and laboratory studies.

Interprofessional Education/Practice

Competency Domain 1: Values/Ethics for Interprofessional Service

Competency Domain 2: Roles/Responsibilities

Competency Domain 3: Interprofessional Communication

Competency Domain 4: Teams and Teamwork


During the course of the clerkship, there will be an opportunity to interact with students

from the Department of Physical Therapy within the School of Health Professions. This

will take the form of an online discussion with prompts from faculty at either or both

schools. You will be required to comment on a question or reply to a comment from a

student from the other program. Professionalism and appropriate netiquette are a must

for this activity. Please see the canvas page for details on this activity.

CORE Entrustable Professional Activities (EPAS) For Entering Residency

These are the skills and behaviors expected of first year residents on day one of their

residencies, as described by the ACGME residency directors and described in detail in

the AAMC document of the above name. It is hoped that clinical clerkship directors and

facilitators will make as much effort as possible to ensure that TCOM students have

opportunities to practice these skills and behaviors on all clinical rotations.

1. Gather a history and perform a physical examination.

2. Prioritize a differential diagnosis following a clinical encounter.

3. Recommend and interpret common diagnostic and screening tests.

4. Enter and discuss orders and prescriptions.

5. Document a clinical encounter in the patient record.

6. Provide an oral presentation of a clinical encounter.

7. Form clinical questions and retrieve evidence to advance patient care.

8. Give or receive a patient handover to transition care responsibility.

9. Collaborate as a member of an Interprofessional team.

10. Recognize a patient requiring urgent or emergent care and initiate evaluation and

management.

11. Obtain informed consent for tests and/or procedures.

12. Perform general procedures of a physician.

13. Identify system failures and contribute to a culture of safety and improvement.


Clerkship Goals and Learning Objectives

The goal of the Department of Manipulative Medicine rotation is to provide the student

doctor with an opportunity to broaden professional understanding and application of

osteopathic philosophy, principles and practices. During the rotation the student doctor

will develop further by applying his/her skills to patient care and academic activities. The

student doctor is a valued member of the clinical staff and academic department.

The rotation is based in the Manipulative Medicine Clinic (UNTHSC Health Pavilion, 6th

floor) and at each assigned preceptor’s clinic. The student doctor gains exposure to

variations in style approaches to patients, and in the application of osteopathic philosophy

and principles. Student doctors work with residents and department faculty. By the end of

the rotation, the student doctor will be able to:

• Incorporate osteopathic manipulative medicine and, specifically, osteopathic

structural exam, manipulative diagnosis and treatment into the clinical and/or

hospital setting. OPP, MK, PC

• Differentiate and apply appropriate OMT techniques to treat common conditions

that present in the clinical and/or hospital setting. OPP, MK, PC

• Exhibit proficiency in history-taking and physical exam skills. MK, PC, P

• Demonstrate comprehension of material covered in the didactics and clinical

setting by passing the COMAT exam at the completion of the OMM clerkship.

OPP, MK, PC

Treatment opportunities are provided in primary care settings with scheduled clinical

patients and/or hospital patients, where hospital service is established. The student

doctor is expected to see and treat patients in the clinic when assigned and to be

prepared to participate in all patient care responsibilities. These include reviewing patient

case histories and progress notes, locating imaging prior to the patient's office visit and

consulting with the supervising physician or faculty for any questions.

Other responsibilities include:

• Documenting patient care activities in a weekly log. ICS, PBLI


• For student doctors assigned to OMM faculty, attendance and participation as a

teaching assistant in all Year I and II Lab activities and Student Assistant

preparatory sessions. P, PBLI

Required Didactics and Assignments

Working under the supervision of faculty members during the OMM core rotation, student

doctors evaluate and treat private patients in the preceptor’s practice, the OMM Health

Pavilion offices and in a hospital environment. The student observes and, where

appropriate, assists in the interview, examination and treatment of patients. Opportunities

for discussion with the attending physician are available and conducted in private. These

activities are documented in a weekly Procedure Log, submitted by 11:59 p.m. each

Sunday of the rotation.

Resources are delivered digitally to all rotation participants using UNTHSC’s Canvas

platform. These resources augment the Gibson Lewis Library guides, tutorials, collections

and services and support successful completion of the required coursework and the

COMAT exam.

The COMAT exam, covering topics pertinent to the OMM clerkship and Osteopathic

principles generally, is administered online on the last Friday for DFW-based clerkships.

The exam is proctored on campus and taken online. For student doctors in remote

locations, the exam is administered on the last Friday of the rotation by the remote site

coordinator. Failure of a COMAT exam results in a grade of incomplete in the rotation. If

a student fails a core COMAT examination, he/she will be given one opportunity to

remediate the exam. Successful remediation will permit the student to receive a maximum

grade of 70 for this component, pending the successful passing and completion of all

other components of the course requirements will result in a pass for the course. Failure

of any remediation constitutes a failure in the course.


Evaluation and Grading

The final grade of Honors/Pass/Fail for the core rotation is derived from the following

components:

Component Evaluation Tool Minimum Score Required Student Clinical Performance

Clinical Clerkship Evaluation

Upon completion of this clerkship students should perform the behaviors outlined within the “expected” level of each competency rated on the Clinical Clerkship Evaluation and the AACOM Osteopathic Core Competencies for Medical Students. Student evaluations with ratings of below expected for any competency may result in failure.

Standardized Testing

OMM COMAT Exam

Scaled Score of 70

OMM Internal Quizzes

Pre-Rotation, Weekly and Didactic Quizzes

Pre-Rotation Quiz - complete Weekly Quizzes – Score of 85 or above on each Didactic Quiz - Score of 70 or above

IPE – OMM/PT Discussion online Complete

Choosing Wisely

Discussion at 2nd Didactic

Complete

Institute for Healthcare Improvement Patient Safety #105

Completion Certificate

Complete and upload by posted due date

Procedure Log

Weekly procedure records

Score of 70 or above (-10 points per week if not completed by Sunday of each week)


Students must achieve the minimum required score in each component area to pass the

course.

Students may be eligible for “Honors”, designated by the Clerkship Director, if they meet

all expected requirements to pass the clerkship and:

• Score 91 or above on the COMAT exam for that clerkship. The score will be set

and approved on an annual basis by the clerkship director, the assistant dean for

clinical education, and the senior associate dean for academic affairs.

• Achieve an “Exceeds Expectation” on at least one of their clinical evaluation

competency areas.

• Do not have a “Below Expectation” on any clinical evaluation competency area.

• Do not violate any Clinical Education policy or procedure while on the rotation, e.g.

attendance policy.

• The final designation for Honors is at the discretion of the Clerkship Director for

Core clerkships and does not apply to elective rotations.

There is a Pre-Rotation Quiz, three weekly reading quizzes and a Didactic Review Quiz.

All are required. You must complete the Pre-Rotation quiz, pass the weekly quizzes

(score of 85 on each) and Didactic quiz (minimum grade of 70) by the deadline. If

minimum score is not achieved on the weekly quizzes, additional opportunities will be

given. If minimum score is not achieved on the didactic quiz, one opportunity to

remediate may be granted.

The Procedure Log will be graded on timeliness (due weekly on Sunday) and having

entered all procedures. Ten (10) points will be deducted per week for entries not made or

completed by the time due. A minimum score of 70 is required to pass this component.

This is graded as pass or fail.

Students will participate in an IPE discussion on Canvas one week during the rotation with PT students, the Choosing Wisely discussion at the second didactic session and complete Institute for Healthcare Improvement Patient Safety #105. These are scored

complete/incomplete and are a required component to finish the course. Failure to

complete them all may result in a failure of the course.


Clinical Performance and skills are assessed by each attending with which the student

has contact. Professionalism and work habits are a significant portion of the clinical

assessment. These include the student attitude, demeanor, and interaction with

attendings, peers, and staff. Character qualities such as punctuality, honesty, bedside

manner, integrity, etc. are important in your professional development. Each student will

practice case presentations until demonstrating adequate ability to convey relevant

patient presentation, history, physical exam findings, appropriate differential diagnosis

and treatment plan. Preceptor must directly observe student in the collection and

presentation of the above information, give feedback and re-observe until appropriate skill

level is demonstrated. This is graded as pass or fail. Upon completion of this clerkship

students should perform the behaviors outlined within the “expected” level of each

competency rated on the Clinical Clerkship Evaluation and the AACOM Osteopathic Core

Competencies for Medical Students. Student evaluations with ratings of below expected

for any competency may result in failure.

A passing score of at least 70 (scaled) on the OMM COMAT exam is a required

component of this course. Testing and Evaluation Services will notify students of exam

date, location, and start time. Students must be seated in their designated seats prior to

the published exam time. Any student arriving late to the COMAT exam will receive no

additional time to take the exam. They will be required to stop taking the examination at

the published stop time. A student will lose 10 points on the exam for late arrival. If the 10

point reduction results in a score below 70, the student will not be required to remediate

the exam. However, the score will be recorded as is. See also section 4.2.1 of Clinical

Education Policy and Procedure Manual for COMAT exam and remediation procedures.

A written case report, soft tissue clinic or health fair attendance, make up time in the

clinic, or other activities at the discretion of the clerkship director may be assigned as a

remediation requirement. If a case report is assigned, follow the Case Report Guidelines

and Rubric as included in the Appendix 4. Turnitin will be utilized to obtain an originality

report for any Case Report submitted.

If a student fails any of the listed components, he/she may be given one opportunity to

remediate that requirement at the discretion of the course director. Successful

remediation will permit the student to receive a passing grade for that component,


pending the successful passing and completion of all other components of the course

requirements. Failure of any remediation constitutes a failure in the course. Failure and

remediation policy shall be directed by the Vice President for Student Affairs as set forth

in the Uniform Policies.


Rotation Sites

DFW Metroplex

UNT Health – Health Pavilion UNTHSC

Dr. R. Todd Dombroski, Dr. Kendi Hensel, Dr. Yein Lee, Dr. David Mason,

Dr. Dante Paredes, Dr. Ryan Seals, Dr. Sajid Surve

855 Montgomery St, 6th Floor, Fort Worth, TX 76107

Local Private Clinics under the direction of:

Dr. Ade Adedokun

Dr. Ben Dagley

Dr. Mark Dirnberger

Dr. James Irvine

Dr. Samuel Lee

Dr. Joseph Moran

Dr. Chau Pham

Dr. Arthur Speece

Longview, TX

Christus Good Shepherd Medical Center

Dr. John McDonald, Dr. Benjamin Cameron

700 E. Marshall Ave., Longview, TX 75601

Conroe, TX

Lonestar Family Health/ Conroe Family Medicine Residency Program

Dr. Michael Abdelsayed

16902 Southwest Frwy, Physicians Pavilion, Ste 100

Sugar Land, TX 77479


Corpus Christi, TX

Dr. Marian Hendricks

5833 Spohn Dr., Bldg. 601, Corpus Christi, TX 78414

Dr. Jacqueline Phillips

3315 S. Almeda Street, Corpus Christi, TX 78411

Houston, TX

Dr. Adam Weglein

6800 West Loop S., Ste 500, Bellaire, TX 77401

Weatherford, TX

Dr. Ron McDaniel

1710 Santa Fe Drive, Weatherford, TX 76086

Faculty and Staff

University Faculty

• Kendi Hensel, D.O., Ph.D., FAAO, Clerkship Director, Associate Professor

• Ryan Seals, D.O., Interim Chair Family Medicine and Osteopathic Manipulative

Medicine, Associate Professor and Year II Course Director

• R. Todd Dombroski, D.O., Associate Professor

• Yein Lee, D.O., Assistant Professor and Year I OMM Medical Practice Course

Director

• David Mason, D.O., MBA, FACOFP, Interim Senior Associate Dean, FM/ONMM

Residency Director, Associate Professor

• Dante Paredes, D.O., Assistant Professor


• Sajid Surve, D.O., Associate Professor and Performing Arts Medicine Fellowship

Program Director, Year 1 Foundations of Osteopathic Manipulative Medicine

Course Director

• Stuart Williams, D.O. , Associate Professor

Adjunct Clinical Faculty

• Dallas/Fort Worth Metroplex (Listed under rotations sites, local private clinics)

OMM CORE Rotation Staff

• Cari McTaggart, Clerkship Coordinator

MET-552

817-735-0234

UNTHSC Neuromuscular Medicine Clinic Contact

• Lenora Salazar, Supervisor, Clinic Operations

Health Pavilion - 6th Floor

817-735-5160 / 817-735-5003

General Responsibilities

The OMM Rotation Schedule will be posted on Canvas on 3 June 2019; students will

have ten (10) days to make switches of location with another student within the scheduled

period. In order for switches to be accepted, an email from both students requesting the

change, with an explanation for the request is required. Site only change requests will not

be considered without a switch with another student. Once the ten (10) days have

passed, no further changes to the schedule will be allowed for the remainder of the

academic year. The OMM rotation pre-requisites, assignments and assessments are

delivered online via UNTHSC Canvas. The site opens to the student at 5 p.m. on the

Friday before the first day of rotation

• The Pre-Rotation quiz is taken on the first day of the rotation.


• NextGen Instructions and NMM template video are to be reviewed prior to the start

of the rotation if you are assigned to the DFW area

• The Procedure Log is submitted weekly, due each Sunday by 11:59pm .

• Choosing Wisely to be reviewed and discussed during the second didactic session

• IPE OMM/PT Discussion will occur during one week of the rotation, participation

required

• IHI – Institute for Healthcare Improvement Patient Safety #105

• There are three quizzes, due on Sundays through the rotation.

• The didactic review quiz is due during the last week of the rotation.

• Exit interviews are done via online survey and if requested an in-person

appointment can be scheduled with the clerkship director.

• Two textbooks are provided for students while on rotation. The 5-Minute

Osteopathic Manipulative Medicine Consult and Osteopathic Manipulative

Medicine Review for the Boards, Third Edition. These books must be returned in

good condition at the end of the rotation. Students are responsible for all lost or

damaged books.

• Final clinical evaluation must be completed with your preceptor during the rotation.

It is the student’s responsibility to make an appointment with the preceptor to get

this completed during the rotation; this is completed in eMedley. Additionally this

document may be reviewed at a scheduled meeting with the clerkship director,

should the student request it, at the end of the rotation. The coordinator will advise

of the scheduled time for each requested appointment

• Professional demeanor with patients and colleagues is expected at all times.

• Completion of all site specific online training is required.

• Strict observance to the dress code established at T.C.O.M. is observed in the

clinic, hospital and practice training areas. Clinic jackets and badges are required

and, per clinic policy, the use of perfume or fragrances is not allowed.


• Proper lab attire is required for didactics sessions on the first and third Monday

afternoons of the rotation. Lab attire includes t-shirts (short or long sleeve), yoga

pants, track pants or sweatpants.

• The student doctor is expected to respect the patient's right to privacy with

confidentiality and to respect the physician-patient relationship.

• During the rotation the student doctor will be held responsible for conduct

consistent with the T.C.O.M. Code of Student Conduct.

(http://www.hsc.unt.edu/Departments/StudentAffairs/StudentPolicyHandbook/Stud

entCodeofConductandDiscipline.cfm)

5.2 ATTENDANCE

5.2.1 Absences in 3rd & 4th Year

Absences in 3rd Year

The focus of the clinical experience in years 3 and 4 is patient care. 100% attendance is,

therefore, required to be certain that continuity of care is maintained. Students may not

miss the first day of any clinical rotation. It is understood; however, that certain situations

may arise that will result in absence from required daily participation.

In such instances the following procedures will be observed:

• Students are provided with 5 education days to use during third year to attend

conferences, RAD, workshops, etc. In the event a student requires more than 5

education days, a student may submit for an extension by contacting the Office of

Clinical Education.

• Students are allowed up to 8 absences in each of the fall and spring semesters

total. Any absences beyond that must be made up in period 13 to complete the

third year and before progressing to fourth year. Any combination of time out (excluding PE) that results in a student missing more than 4 days of a 4-week block or 6 days of a 6-week block will result in failure of the clerkship.

http://www.hsc.unt.edu/Departments/StudentAffairs/StudentPolicyHandbook/StudentCodeofConductandDiscipline.cfm

http://www.hsc.unt.edu/Departments/StudentAffairs/StudentPolicyHandbook/StudentCodeofConductandDiscipline.cfm


• All absences shall require submission of the electronic 3rd Year Request for

Absence from Clerkship form a minimum of 10 business days before the start of

the rotation to allow time for schedule adjustments.

• Absences due to emergent reasons such as illness, the absence request is due

immediately with supporting documentation. Students are required to notify their

site/preceptor and clerkship coordinator of all emergent leave.

• Students are allowed up to three days for the COMLEX PE exam- 1 day for travel

to the exam, the test day, and an additional day for return travel. Requests beyond

this may be denied by the Director of Clinical Education. You may not schedule

your COMLEX PE exam on a date which causes you to miss the orientation day

for a rotation. COMLEX PE is not considered part of your absences and must be

requested within 48 hours of scheduling the exam date.

Unapproved absences or absence in excess of the above policy will require remediation

or result in a failing grade at the discretion of the Office of Clinical Education.

Failure to notify the clerkship director, rotation supervisor and Office of Clinical Education of any absence will be considered neglect of duty and may result in a failing grade for the clerkship.

Exposure to Blood Borne Pathogens

Universal Precautions: The term “universal precautions” refers to infection control which

presumes that every direct contact with body fluids is potentially infectious. The

Occupational Safety and Health Administration (OSHA) regulations for health care

professionals who are considered to be at risk of occupational exposure to bloodborne

diseases can be found at https://www.osha.gov/SLTC/bloodbornepathogens/index.html

Bloodborne pathogens refer to pathogenic microorganisms that are present in human

blood and can cause disease in humans (e.g. HBV, HIV, etc.). Exposure Incident means

“a specific eye, mouth, other mucous membranes, non-intact skin, or parenteral contact

with blood or potentially infectious materials.” Contact can occur via a splash, needle stick

(including acupuncture needles), puncture/cut wound from sharp instrument, or human

bite. Other potentially infectious body fluids other than blood include semen; vaginal

https://www.osha.gov/SLTC/bloodbornepathogens/index.html


secretions; pleural, pericardial, synovial, peritoneal, cerebral spinal, amniotic fluid; saliva

during dental procedures; and any other body fluid visibly contaminated with blood.

Policy/Procedure: If a TCOM medical student is exposed to bloodborne pathogens either

by direct contact with blood or other body fluids via the eyes, mucous membranes, human

bite, or sharps (e.g., needle stick, lancet stick, scalpel cut, etc.) while on rotation, it is to

be handled as an EMERGENCY SITUATION.

Post Exposure Protocol

• Immediately wash exposed areas with soap and water.

• If splashed in eyes or mouth, flush with large amounts of water.

• It is critical that you are treated within the first two hours after injury.

• Notify supervisor and follow rotation site exposure protocols (see below for

addresses).

• If facility is not equipped to handle exposure, contact Harris Occupational Health

Clinic (HOH) or appropriate remote site location listed below.

• If HOH or remote listed site is not available, or you are more than 30 minutes from

campus, go to the nearest ER and use your student health insurance.

• You are required to notify Student Health of any care received at another facility.

Dallas Fort Worth & Weatherford Area students with exposures to bloodborne pathogens which occur M-F, 8-5 should report to:

Harris Occupational Health 1651 W. Rosedale, Ste. 105

Fort Worth, TX 76104 T: 817-250-4840 F: 817-878-5250

For exposures occurring afterhours, students should report to the nearest emergency room and use your student health insurance. Conroe remote site students with exposures to bloodborne pathogens which occur M-F, 8-5, should report to the Nurse Manager at:

Lone Star Family Health Center 605 S. Conroe Medical Dr.

Conroe, TX 77304 936-539-4004.


For exposures occurring afterhours, students should report to :

Emergency Department Conroe Regional Medical Center

504 Medical Center Dr. Conroe, TX 77304

936-539-1111 Longview remote site students with exposures to bloodborne pathogens which occur M-

F, 8-5, should report to:

CHRISTUS Good Shepherd Medical Center Employee Health 1621 N 4th St, Suite 1 Longview, TX 75601

903-315-5154

For exposures occurring afterhours, students should report to:

Emergency Department CHRISTUS Good Shepherd Medical Center

700 E Marshall Ave. Longview, TX 75601

903-315-2000 Corpus remote site students with exposures to bloodborne pathogens should report to:

Christus Spohn OCC Health Nurse at Christus Spohn

also immediately report to your attending and Dr Hinojosa

Bay Area report to charge nurse and medical education office proceed directly to emergency room for treatment

Patient Care Supervision

Cross Listed as TCOM Procedure 5.4 Patient Care Supervision TCOM students and

residents engaged in patient care at UNTHSC operated facilities or as participants in

UNTHSC affiliated training programs shall do so under the supervision of a licensed

health care provider who has been credentialed to provide that scope of care. Visiting

students and residents working in UNTHSC facilities or with UNTHSC employed faculty

shall be similarly supervised.

1. TCOM students and residents engaged in patient care activities shall at all

times be supervised by a duly licensed member of the clinical faculty who

https://www.unthsc.edu/texas-college-of-osteopathic-medicine/wp-content/uploads/sites/9/TCOM-Procedures-2018.1.pdf


retains privileges for the scope of care being provided. Faculty or a similarly

credentialed designee (resident or fellow with approved privileges) must be

immediately available in the facility where the activity is taking place. Students

who have demonstrated competence to the faculty may perform patient

histories and physical examinations without immediate supervision if directed to

do so by faculty.

2. TCOM students and residents may form such additional tasks as may be

directed by supervising faculty upon demonstrating competence to perform

those tasks. In most instances, the provision of patient care shall require the

immediate presence of a duly credentialed supervising provider who has

ascertained the trainees’ level of proficiency.

3. TCOM shall assure distribution of this procedure to students, residents and

faculty as part of the orientation plan for clinical training.

4. Students or residents who fail to follow procedures for clinical supervision may

be removed from patient care activities at the discretion of the dean or her/his

designee pending a disciplinary review.

5. Faculty who fail to observe supervision procedures may be removed from

participation in TCOM training programs and may be further subject to

disciplinary action.

Medical Student Use of Chaperones While on rotations, it is important for you to make your position clear to patients by

introducing yourself as a “medical student”. All students should review with their

preceptor and site all chaperone policies to ensure they are in compliance on this rotation.

Without question, any portion of an exam that involves breast, pelvic or rectal exams, and

even during certain portions of an interview that can involve sexual history, should not be

done alone with the patient.

Health Services Students in the DFW & Weatherford area may access health services at the UNTHSC Student Health Clinic.

UNTHSC Student Health Clinic

855 Montgomery St 3rd Floor North


Fort Worth, TX 76107 817-735-5051

[email protected]

Students in the Conroe area may access health services at Lone Star Family Health Center’s Spring Location.

Lone Star Family Health Center- Spring 440 Rayford Rd. Spring, TX 77386

936-539-4004

Students in the Longview area may access health services at CHRISTUS Trinity Clinical Internal Medicine.

CHRISTUS Trinity Clinical Internal Medicine 703 E. Marshall Ave

Suite 1001 Medical Plaza II

Longview, TX 75601 903-753-7291

Students in the Corpus Christi area may access health services at Prompt Immediate Care.

Promptu Immediate Care 5638 Saratoga Blvd

Corpus Christi, TX 78414 361-444-5280

Promptu Immediate Care 4938 S Staples

Ste E-8 Corpus Christi, TX 78411

361-452-9620

Disclaimer

The OMM clinical clerkship is operated in accordance with the policies and procedures of

the academic programs of Texas College of Osteopathic Medicine as presented in the

class Clerkship Protocol, Student Handbook and College Catalog.

The provisions contained herein do not constitute a contract between the student and the

College. These provisions may be changed at any time for any reason at the discretion of

the clerkship director. When necessary, in the view of the College, appropriate notice of

such change will be given to the student.

Applicable Policies



All policies of the UNTHSC/Texas College of Osteopathic Medicine will be observed in

the MEDE 8417 course. Students are expected to be familiar with those policies as

presented in the Student Handbook and College Catalog. In general, course policies are

contained within the body of this syllabus. You are responsible for reading and

understanding the contents of this syllabus. Any questions regarding this document

should be directed to the Course Director for clarification.

http://www.hsc.unt.edu/policies/PoliciesList.cfm

Policy Statement

Each student enrolled at UNT Health Science Center is responsible for knowing current

academic policies and scholastic regulations, general and specific requirements, and

operational policies that apply to registration and instruction.

The Health Science Center reserves the right to amend or add to the academic policies

and improves the quality of education and is introduced in a fair and deliberate manner

with appropriate notice provided to all students affected by the changes. For a detailed

view of all UNTHSC policies, see: http://www.hsc.unt.edu/policies/

Academic Integrity/Honor Code

Enrollment is considered implicit acceptance of the rules, regulations, and guidelines

governing student behavior at UNT Health Science Center. It the responsibility of the

student to be familiar with all policies governing academic conduct which can be found in

the UNTHSC Student Catalog, Student Policy Handbook and the Student Code of

Conduct and Discipline which are located on the UNTHSC Internet at http://www.hsc.unt.edu/Sites/DivisionofStudentAffairs/

Academic Assistance

Students may schedule one-on-one academic assistance with faculty through in-person

appointments, telephone calls or e-mail communication. Academic assistance is also

available through the UNTHSC Center for Academic Performance (CAP).

http://www.hsc.unt.edu/CAP

Americans with Disabilities Act



http://www.hsc.unt.edu/Sites/DivisionofStudentAffairs/

http://www.hsc.unt.edu/CAP


The University of North Texas Health Science Center does not discriminate on the basis

of an individual’s disability and complies with Section 504 and Public Law 101-336

(American with Disabilities Act) in its admissions, accessibility, treatment and employment

of individuals in its programs and activities. UNTHSC provides academic adjustments and

auxiliary aids to individuals with disabilities, as defined under the law, who are otherwise

qualified to meet the institution's academic and employment requirements. For assistance

contact the Equal Employment Opportunity Office at the health science center. Reference

Policy 7.105 Americans with Disabilities Act Protocol in the Student Policy Handbook and

online at: http://www.hsc.unt.edu/policies/

Course and Instructor Evaluation

It is a requirement of all students that they are responsible for evaluating each of their

courses and instructors as defined in UNTHSC Policy 7.120 Student Evaluation of

Courses and Instruction. Please adhere to all guidelines established in the policy.

http://www.hsc.unt.edu/policies/

Course Assessment

In some instances, courses will have a course assessment that will provide immediate

feedback to the course director regarding progress of the course identifying potential

problems and determining if student learning objectives are being achieved.

(Provide all pertinent information regarding the specifics of the groups in the syllabus as

defined in UNTHSC Policy 7.120 Student Evaluation of Courses and Instruction.)

Social Media Policy Statement

Social media has created unique opportunities for interaction, communication, and

networking. Students are expected to abide by the Student Code of Conduct & Discipline

and the Health Insurance Portability and Accountability Act (HIPAA) when using social

media by not revealing patient/client/research subject information, private content, or

proprietary information regarding patients/clients/research subjects of the institution.

The purpose of this policy is to provide students with guidelines and regulations for

appropriate social media use in order to uphold confidentiality and privacy laws and

agreements.

https://app.unthsc.edu/policies/Home/GetFile?policyNumber=07.115



https://app.unthsc.edu/policies/Home/GetFile?policyNumber=07.115


Syllabus Revision

The syllabus is a guide for this class but is subject to change. Students will be informed of

any change content or exam/assignment dates.

Turnitin and the Family Education Rights and Privacy Act (FERPA)-If applicable

NOTE: UNTHSC has contracted with Turnitin.com for plagiarism detection services.

Use of Turnitin.com is entirely in the discretion of the instructor, but use of such a service

requires that you provide notice (via syllabus) to your students that you are using such

services. In addition, instructors who use Turnitin should be sure to remove student

identifiable information from the work before sending to Turnitin or receive written

permission from the student. There are two methods for using Turnitin for written

assignments. Please refer to the wording guidelines and consent form located on the

Faculty Affairs website at

http://www.hsc.unt.edu/Sites/OfficeofFacultyAffairs/index.cfm?pageName=Turnitin

Zero Tolerance for Sexual Violence and Harassment

All students should be able to study in an atmosphere free of harassment, sexual violence

and gender discrimination. Title IX makes it clear that violence and harassment based on

sex and gender is a Civil Rights offense subject to the same kinds of accountability and

the same kinds of support applied to offenses against other protected categories such as

race, national origin, etc. If you or someone you know has been harassed or assaulted,

you can find the appropriate resources on the UNT Health Science Center’s website:

http://web.unthsc.edu/info/200304/student_affairs/355/title_ix_reporting

The Texas College of Osteopathic Medicine shall not discriminate on the basis of race, ethnicity, color, sex, sexual orientation, gender, gender identity, religion, national origin, age or disabilities.

We reserve the right to make clinical assignments based on needs and availability.

http://www.hsc.unt.edu/Sites/OfficeofFacultyAffairs/index.cfm?pageName=Turnitin

http://web.unthsc.edu/info/200304/student_affairs/355/title_ix_reporting


Appendix 1

Learning Resources Required Textbooks

American Osteopathic Association. (2011). Foundations for Osteopathic Medicine.

Philadelphia: Seffinger, Michael A. Wolters Kluwer.

Foundations for Osteopathic Medicine 4th ed., 2018

Recommended Reading

DiGiovanna, Eileen L.; Schiowitz, Stanley; Dowling, Dennis J. (Eds.). (2005). An

Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Philadelphia: Lippincott

Williams & Wilkins.

An Osteopathic Approach to Diagnosis and Treatment

The Pocket Manual of OMT: Osteopathic Treatment for Physicians (Book with Access

Code). (2010) Beatty, David R.; Li, To Shan; Steele, Karen M., Lippincott, Williams and

Wilkins. 2nd Edition.

The Pocket Manual of OMT: Osteopathic Treatment for Physicians 3rd ed., 2016

Nicholas, Alexander, & Nicholas, Evan A. (2016). Atlas of Osteopathic Techniques (3rd

Edition). Philadelphia: Wolters Kluwer.

Atlas of Osteopathic Techniques

Magoun, Harold. (Ed.). (1976). Osteopathy in the Cranial Field (3rd ed.). Kirksville, MO;

Journal Printing Co.

Osteopathy in the Cranial Field

Hoppenfeld, Stanley, & Hutton, Richard. (1976). Physical Examination of the Spine and

Extremities. New York: Appleton-Century-Crofts.

Physical Examination of the Spine and Extremities

Greenman, Philip E. (2003). Principles of Manual Medicine, (3rd ed.). Philadelphia:

Lippincott Williams & Wilkins.

Principles of Manual Medicine

https://www.amazon.com/Foundations-Osteopathic-Medicine-Philosophy-Applications-dp-1496368320/dp/1496368320/ref=mt_hardcover?_encoding=UTF8&me=&qid=1556738699

http://unthsc.sirsi.net/uhtbin/cgisirsi/x/0/0/57/5/3?searchdata1=19820%7bCKEY%7d&searchfield1=GENERAL%5eSUBJECT%5eGENERAL%5e%5e&user_id=WEBSERVER


https://www.amazon.com/Atlas-Osteopathic-Techniques-Alexander-Nicholas/dp/1451193416/ref=asc_df_1451193416/?tag=hyprod-20&linkCode=df0&hvadid=312519927002&hvpos=1o3&hvnetw=g&hvrand=12082543114280534363&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9060281&hvtargid=pla-477325041975&psc=1





Nelson, Kenneth E., & Glonek, Thomas. (Ed.) (2007). Somatic Dysfunction in Osteopathic

Family Medicine. Philadelphia: Lippincott Williams & Wilkins.

Somatic Dysfunction in Osteopathic Family Medicine

Kuchera, Michael L. & Kuchera, William A. (1991). Osteopathic Considerations in

Systemic Dysfunction (2nd ed.). Kirksville, MO: Kirksville College of Osteopathic Medicine.

Osteopathic Considerations is Systemic Dysfunction

Kuchera, William. (1992). Osteopathic Principles in Practice (2nd ed.). Kirksville, MO:

Kirksville College of Osteopathic Medicine.

Osteopathic Principles in Practice

Channell, Millicent King & Mason, David C (2009), The 5-Minute Osteopathic

Manipulative Medicine Consult, Lippincott Williams & Wilkins

The 5-Minute Osteopathic Manipulative Medicine Consult

Schuenke, Michael; Schulte, Erick; Schumacher, Udo.(Eds.). (2010).Thieme Atlas of

Anatomy; General Anatomy and Musculoskeletal System. Stuttgart; New York: Thieme.

Thieme Atlas of Anatomy; General Anatomy and Musculoskeletal System

Jones, Lawrence H.; Kusunose, Randall S., Goering, Edward K. (1995). Strain and

Counterstrain (2nd ed.). Boise, Idaho: Jones Strain-CounterStrain, Inc.

Strain and Counterstrain

Board Review Books

Crow, William Thomas. (2016). Osteopathic Manipulative Medicine Review for Boards A

Study Guide for COMLEX and Osteopathic Certifying Boards.

Osteopathic Manipulative Medicine Review for Boards

Savarese, Robert G.; Adesina, Adeleke T.; Capocianco, John; Reed, Grant. (2018). OMT

Review; A Comprehensive Review in Osteopathic Medicine. S.I: Savarese.

OMT Review; A Comprehensive Review in Osteopathic Medicine







https://www.createspace.com/6215963

https://www.createspace.com/6215963

https://www.amazon.com/OMT-Review-Comprehensive-Osteopathic-Medicine/dp/0692157565/ref=sr_1_1?keywords=savarese&qid=1556739035&s=gateway&sr=8-1


Appendix 2

Didactic Review Syllabus I

Orientation Lecture: 3rd Year OMM Review

This lecture provides students with general Osteopathic Principles and Practices.

Upon completion, the student should be able to:

• Explain the basic principles of the Osteopathic Concept. OPP

• Identify anatomical landmarks. OPP, PC

• Perform a neuromusculoskeletal examination. OPP, MK

• Describe the barrier concept and perform motion on a patient. OPP, MK, PC

• Define Somatic Dysfunction. OPP, PC

• Use the proper terminology in describing somatic dysfunction. OPP

• Recognize tissue texture (T) changes, physiologic asymmetry (A) and deficiencies

in ranges (R) of motion as well as elicit areas of tenderness (T) on a patient in the

cervical, thoracic, lumbar, sacral, pelvic and upper and lower extremities (TART).

OPP

• List and describe the performance of three direct methods and three indirect

method used to treat somatic dysfunction. OPP, MK

• Describe the physiology of each region as it applies to normal motion and somatic

dysfunction. OPP, PC

• Treat somatic dysfunction of each region with direct and indirect methods utilizing

a variety of activating forces. OPP, MK

• Describe how somatic dysfunction of each region can effect or be affected by other

structures or organ systems in the body (somato-visceral/viscero-somatic

dysfunction). OPP, MK, PC, P


Appendix 3

Didactic Review Syllabus II

Clinical Applications

1. Ear, Nose, Throat

The student should be able to list and perform key history, physical examination,

structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as

it relates to common ENT. These include otitis media, sinusitis, vertigo rhinitis,

pharyngitis, tonsillitis and allergies (OPP, MK, PC).

The student should be able to identify the major elements of the ENT anatomy and

physiology. These include: ear, nose & throat structures and related sympathetic and

parasympathetic innervation and lymphatic drainage (OPP, MK).

2. Cardiovascular



it relates to common cardiovascular problems. These include: Hypertension, Congestive

heart failure, Arrhythmia, and Edema (OPP, MK, PC).

The student should be able to identify the major elements of the cardiovascular anatomy

and physiology. These include: Coronary arteries, myocardium, pericardium, valves,

large arteries and veins, lymphatic drainage and nerve supply (MK).

3. Pulmonary



it relates to common pulmonary problems. These include: Asthma, COPD, Restrictive

Lung Disease, Pneumonia, and Acute Bronchitis (OPP, MK, PC).

The student should be able to identify the major elements of the pulmonary anatomy and

physiology. These include: Sibson’s fascia, diaphragm, central tendon, thoracic wall

(ribs, sternum, vertebrae, and musculature), lungs, bronchi, pulmonary arteries and veins,

lymphatic drainage, pleura, pulmonary ligaments, and nerve supply (MK).

33

4. Gastrointestinal



it relates to common gastrointestinal. These include gastritis and peptic ulcer disease,

irritable bowel syndrome and postoperative ileus (OPP, MK, PC).

The student should be able to identify the major elements of the gastrointestinal anatomy

and physiology. These include: abdominal wall, esophagus, stomach, small and large

intestine, pancreas, liver, spleen, abdominal aorta, inferior vena cava, portal venous

system, lymphatic drainage and innervation (OPP, MK).

5. Genitourinary



it relates to common genitourinary problems. These include pyelonephritis, cystitis, dysmenorrhea, pelvic pain, prostate and BPH, low back pain, short leg syndrome (OPP,

MK, PC).

The student should be able to identify the major elements of the genitourinary anatomy

and physiology. These include kidney, bladder, ureter, male/female reproductive system,

sacrum/pelvis, psoas/piriformis/pelvic floor muscles and fascia, iliolumbar ligament,

diaphragms and ribs, lymphatic drainage and innervation (OPP, MK).

6. Geriatrics


structural diagnostic and Osteopathic Manipulative Techniques in the care of a geriatric

patient as it relates to common problems within this population. These include low back pain, gait and balance issues, Parkinsonism, and dementia (OPP, MK, PC)

7. Neurology



it relates to common neurologic problems. These include: headache/migraine, CVA,

34

Parkinsonism, neuromuscular weakness, sciatica, myelopathy, and autonomic disorders

(OPP, MK, PC).

The student should be able to identify the major elements of the genitourinary anatomy

and physiology. These include brain, spinal cord, autonomic nervous system,

somatosensory nervous system, lymphatics and glymphatics (OPP, MK).

8. Pediatrics


structural diagnostic and Osteopathic Manipulative Techniques in the care of a pediatric

patient as it relates to common problems within this population. These include otitis

media, sinusitis, pneumonia, pharyngitis and asthma (OPP, MK, PC).

9. Hospitalized

The student will learn to perform key history, physical examination, structural diagnostic and Osteopathic Manipulative Techniques in hospitalized patient (OPP, MK, PC).

35

Appendix 4 (For Reference if needed as remediation assignment only)

Guidelines for the OMM Case Report

An Introduction to the Case Report and Medical Writing

The OMM Case Report illustrates current practice and treatment issues for the osteopathic physician and medical student. The development and honing of medical writing skills, informed by current and foundational medical literature, supports the exploration of patient care and outcomes, and influences practice within the medical community. A case report is a means of communicating something new that been learnt from clinical practice. Case reports provide essential sources of information for the optimum care of patients because case reports can describe important scientific observations that are missed or are undetectable in clinical trials, provide insightful information that expands our knowledge and spawns new research, and provide information that strays from the classical textbook case and leads to better and safer patient care.

Your OMM rotation emphasizes the application of manipulative treatment across a broad landscape of specialties – in family practice, physical medicine and rehabilitation, geriatrics, pain management and others. The case report allows you to focus deeply on the medical history of single patient, investigate the history, course of treatment, literature and test findings, discuss failings and best practices – and draw your own conclusions.

It is the expectation of the OMM Department that your training, education and unique OMM rotation experience will have prepared you to craft a case report worthy of consideration for submission to a peer-reviewed osteopathic journal. Student and faculty work is submitted for publication to educate, inform, develop and support manipulative medicine practices in the osteopathic community.

The Organization of the Writing

Scientific writing protocol generally requires writing in the third-person perspective and the use of AMA style for format and citation. Your paper should be at least 750 words, but no greater than 1,500 words (not including citation page), double spaced, in 12 pt. Times Roman font, formatted with 1’ margin on all sides, with a running header after the title page. You must save and submit your work/documents as YourLastName.doc or YourLastName.docx by the date/time due.

36

The paper is divided into five discrete sections (Title page and Reference pages not included) Incorporate the sections of the paper into your report as subheadings. Each section is weighted and important to the successful construction of the paper as a whole

37

The Grading Rubric - This is a guideline on how to begin your paper, for a more definitive guideline see the JAOA link below.

A. A Title Page containing the date of submission. The title page should list the full names of all authors according to the author’s preferred usage. Authors’ names should include all doctoral and master degrees in the order in which they were earned. For authors without doctoral or masters degrees, their highest earned academic degrees should be listed. In addition, the full professional titles and affiliations of all of the manuscript’s authors should be included on the title page.

B. A Brief Narrative Abstract that delivers a brief, concise description – the essentials- of the article. Should consist of four distinct sections. Case Presentation Intro, Literature Review, Discussion and Conclusions/Summary. This abstracted is limited to 150 words.

C. An Introduction to the topic which includes the literature review of relevant publications. Literature review should include osteopathic sources. Introductions should end with a brief objective statement that clearly identifies the purpose of the case report or study.

D. Case Report “Patient Presentation & Findings” This should be in two parts: HPI should include a description of the patient’s chief complaint, age, gender, medical history both past and present, (past medical history, past surgical history, past social history, past family history) past and present medications, past treatments, current treatment plan, review of systems. Physical portion: vital statistics, physical exam, osteopathic structural exam with proper nomenclature as indicated in the Glossary of Osteopathic Terminology, osteopathic treatment plan and outcome. OMT Techniques used or recommended may be added here or included in the Discussion of the case.

E. Comment “Discussion” of the case in the context of relevant medical literature reviewed that shows an exploration and deep understanding of current literature for the pathology regarding best practices, impediments to recovery, other testing, methods of treatment and approaches to improving quality of health/life. This is where you bring it all together. Elaboration of unique techniques, types and goals of treatment and expected outcomes are discussed as related to your case.

Title of Paper

Student Name

UNTHSC/Texas College of Osteopathic Medicine

Preceptor

Attending

Period # and Date

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F. Conclusion that identifies the study’s major findings as they relate to the study’s purpose and the clinical applications of those findings, if appropriate. They should not consist of a summary of the study. This conclusion should be limited to 1 paragraph.

G. Acknowledgements – Authors should limit acknowledgements to people who substantially contributed to either the study or the preparation of the manuscript (optional). Make sure no patient names are included.

H. References - References are required for all material derived from the work of others and should follow the guidelines described in the 10th edition of AMA Manual of Style: A Guide for Authors and Editors (2007). References should include direct, open-access URLs (uniform resource locators) to full-text versions of the reference articles. A URL to an abstract in the National Library of Medicine’s PubMed database does NOT meet this requirement. References should reflect recent or current works as well as from osteopathic sources/journals.

Generally speaking the “A” paper has logical flow from point to point and section to section; the information is credible, take from primary (patient interview, records and test results) and authoritative sources (Such as JAOA, JAMA, and the International Journal of Osteopathic Medicine); all quotes, images, tables and graphs included in the report are given full attribution and in-text citations, used when paraphrasing, acknowledged the original source of information.

Resources

JAOA Information for Authors http://www.jaoa.org/site/misc/ifora.xhtml

AMA Manual of Style: A Guide for Authors and Editors (2007) http://www.amamanualofstyle.com/view/10.1093/jama/9780195176339.001.0001/med-9780195176339

http://www.jaoa.org/site/misc/ifora.xhtml

http://www.amamanualofstyle.com/view/10.1093/jama/9780195176339.001.0001/med-9780195176339

http://www.amamanualofstyle.com/view/10.1093/jama/9780195176339.001.0001/med-9780195176339

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