Using National Medical Care Survey data to validate examination content on a performance-based clinical skills assessment for osteopathic physicians.
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Patient characteristics, chief complaints, and diagnoses can be used to specify the examination content for performance-based assessments of clinical skills. The purpose of this investigation was to explore osteopathic and allopathic medical practice patterns and to provide summary statistics that can be used to delimit potential assessment content areas for a clinical skills assessment targeted at osteopathic physicians. Analyses of the National Ambulatory Medical Care Survey indicated that the types of patients seen by osteopathic and allopathic physicians in office-based settings are somewhat different. Furthermore, the reasons that patients seek care, and accompanying diagnostic outcomes, can vary by physician type. These differences suggest that from a content perspective, a performance-based clinical skills evaluation targeted at osteopathic physicians should be characteristically different from one designed for allopathic physicians. (+info)
Evaluating the clinical skills of osteopathic medical students.
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Because clinical skills play an important role in health services, many medical credentialing organizations are making performance-based assessments part of the board-certification and licensure processes. While clinical skills are taught and evaluated at colleges of osteopathic medicine, the development and validation of standardized assessment methodologies is far from complete. The purpose of this study was to gather data to support the use of a performance-based assessment of osteopathic clinical skills. A sample of 121 fourth-year osteopathic medical students was tested using the Comprehensive Osteopathic Medical Licensing Examination-USA performance-based clinical skills examination (COMLEX-USA-PE) prototype, a standardized patient performance evaluation that involves a series of 12 simulated encounters. Students were evaluated in a number of domains that included history taking, physical examination, osteopathic manipulative treatment techniques, written communication and clinical problem solving, and physician-patient communication. The analysis of data from 1452 standardized patient encounters suggests that reliable and valid scores can be obtained using the current prototype. The use of COMLEX-USA-PE to assess the readiness of osteopathic medical students to provide patient care in supervised graduate medical education training programs is supported. (+info)
Awareness and use of osteopathic physicians in the United States: results of the Second Osteopathic Survey of Health Care in America (OSTEOSURV-II).
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The Second Osteopathic Survey of Health Care in America (OSTEOSURV-II), a national telephone survey conducted during 2000 using random-digit dialing, was used to address questions about public awareness of the osteopathic medical profession and use of osteopathic physicians. A total of 499 adult, noninstitutionalized, household respondents were surveyed. The main outcomes included prevalence of and multivariate factors associated with awareness and use of osteopathic physicians. The overall response rate was 64%. The prevalence of awareness, lifetime use, and current use of osteopathic physicians among unscreened respondents was 46%, 16%, and 7%, respectively. Among lifetime users, 84% received primary care; 52%, osteopathic manipulative treatment; and 25%, specialty care. The multivariate factors most strongly associated with awareness of osteopathic physicians were college education (rate ratio [RR], 1.86; 95% confidence interval [CI], 1.43-2.40), 60 or more years of age (RR, 1.52; 95% CI, 1.15-2.01), and Midwest residence (RR, 1.39; 95% CI, 1.05-1.84). Nonwhites, including Hispanics, were less likely to be aware of osteopathic physicians (RR, 0.54; 95% CI, 0.38-0.76). Respondents with college education (RR, 2.34; 95% CI, 1.44-3.79), respondents of intermediate age (RR, 1.71; 95% CI, 1.12-2.61), and women (RR, 1.68; 95% CI, 1.12-2.52) were more likely to report lifetime use of osteopathic physicians. Nonwhites were less likely to report lifetime use (RR, 0.25; 95% CI, 0.11-0.57). Greater promotional efforts are needed to increase awareness of osteopathic medicine and to remove barriers to using osteopathic physicians, particularly among nonwhites. (+info)
Emergency medicine resident work productivity and procedural accomplishment.
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The purpose of this study was to assess procedural accomplishment, work productivity, and efficiency for emergency medicine residents in a community-based, osteopathic emergency medicine residency. These data are compared with limited existing data from other training sites. The authors conducted a retrospective analysis of patient-encounter data logged into a computerized main-frame database over 8 years by 19 resident physicians. Only data from residents who had complete logs for all 3 years of residency were included. Procedures and diagnoses were from the core content areas defined in the basic standards for approval of residency training programs in emergency medicine. Approximately 98,000 patient encounters were logged during the study period. First-year emergency medicine residents saw an average of 1.06 patients per hour, second-year emergency medicine residents an average of 1.33 patients per hour, and third-year emergency medicine residents an average of 1.41 patients per hour. Residents performed an average of 65 intubations, 533 adult resuscitations, 144 pediatric resuscitations, 49 central line insertions, 47 lumbar punctures, and 280 laceration repairs. Residents tend to see more patients per hour as their training progresses. Residents in this program get significant experience in some procedures but little or no clinical exposure to other procedures. These results are consistent with the few other published reports attempting to quantify the emergency medicine resident experience. The data may assist in setting clinical objectives and establishing uniform tracking systems and coding terminology. (+info)
Do osteopathic physicians differ in patient interaction from allopathic physicians? An empirically derived approach.
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Colleges of osteopathic medicine teach osteopathic principles, which provide a different approach to and interaction with patients than principles taught in allopathic medical schools. The authors examined whether osteopathic primary care physicians' interactions with patients reflect the principles of osteopathic medicine when compared with allopathic physicians' interactions. The principles of osteopathic medicine were adapted to elements that could be measured from an audio recording. This 26-item index was refined with two focus groups of practicing osteopathic physicians. Fifty-four patient visits to 11 osteopathic and 7 allopathic primary care physicians in Maine for screening physicals, headache, low back pain, and hypertension were recorded on audiotape and were dual-abstracted. When the 26-item index of osteopathic principles was summed, the osteopathic physicians had consistently higher scores (11 vs. 6.9; P = .01) than allopathic physicians, and visit length was similar (22 minutes vs. 20 minutes, respectively). Twenty-three of the 26 items were used more commonly by the osteopathic physicians. Osteopathic physicians were more likely than allopathic physicians to use patients' first names; explain etiologic factors to patients; and discuss social, family, and emotional impact of illnesses. In this study, osteopathic physicians were easily distinguishable from allopathic physicians by their verbal interactions with patients. Future studies should replicate this finding as well as determine whether it correlates with patient outcomes and satisfaction. (+info)
Treating patients in primary care: the impact of mood, behavior, and thought disturbances.
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Patients with symptoms of mood, behavior, and thought disturbances are regularly treated in the primary care setting. More often than not, the disorders associated with these symptoms are overlooked or misdiagnosed by physicians, in part because these patients present symptomatic complaints that are seemingly unrelated to the underlying disorder. Recognition of comorbid psychiatric symptoms allows physicians to treat the whole person more effectively. Furthermore, patients and their caregivers benefit greatly from the early intervention and treatment that is frequently provided in the primary care setting. With the appropriate training so that they may readily recognize these symptoms, osteopathic physicians can help prevent the further progression of--or potential unfavorable outcomes from--otherwise untreated or inadequately treated illnesses. (+info)
Relationship between academic achievement and student performance on the Comprehensive Osteopathic Medical Licensing Examination-USA level 2.
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The Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) is a three-part examination used for licensing osteopathic physicians. The relationship between performance on this examination and prior student academic performance has been unclear. This study explores the relationship between COMLEX-USA level 2 scores and student academic performance at Oklahoma State University College of Osteopathic Medicine (OSU-COM). All first-time examination candidates from OSU-COM had a formal, weeklong board review in March 2000, and all passed the examination. Predictions about COMLEX-USA scores generated by the academic dean's office at OSU-COM underestimated student examination performance; results suggest a significant correlation between level 2 performance with (1) level 1 performance (.751); (2) grade point average (GPA) in basic science (.659); (3) total GPA (.672); and (4) Medical College Admission Test (MCAT) scores (.406). The correlation of level 2 scores to clinical GPA (.269) was lower but still significant. Results of this study suggest that performance on COMLEX-USA level 2 is strongly correlated with prior student academic performance in this population. (+info)
Predictive validity of osteopathic medical licensing examinations for osteopathic medical knowledge measured by graduate written examinations.
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The purpose of this study was to evaluate the predictive validity of osteopathic medical licensing examinations for osteopathic medical knowledge measured by graduate written medical examinations. Performances on the three osteopathic initial licensing examinations, the three osteopathic internal medicine in-service examinations, and the osteopathic internal medicine board certification examinations were analyzed for a cohort of the most recent osteopathic internal medicine board certification examination candidates (N = 82). Multiple regressions were performed for the predictive value of licensing examination scores for the late examination scores. Logistic regressions were used for the prediction of pass/fail status on the licensing examinations for that on the board certification. A longitudinal performance profile was constructed to assess the rank changes in decile on the examinations at different times. All correlation coefficients between the licensing examinations and other examinations were significant and higher than .70. The licensing examinations together predicted at least 60% of the variance of any of the other examination scores. The pass/fail status on the licensing examinations predicted 89% of the pass/fail status on the certification examination. Decile ranks since the first licensing examination were consistent and stable over at least 5 years. The osteopathic licensing examinations had high predictive validity for the late written osteopathic internal medicine examinations. Generalization of the findings to other disciplines needs a caution, as a specialty bias may exist for these types of studies. (+info)