At a social event a number of years ago, an engaging young man introduced himself to me as a student from an allopathic medical school and began to talk about an osteopathic resident he had encountered in his training. During a core rotation in medicine, he interacted daily and intensely with his teaching resident, one of only two DO residents at a large Accreditation Council for Graduate Medical Education (ACGME) program with exclusive core affiliation to the student’s medical school. The student lauded the resident’s mastery of the subject matter, his efficient yet compassionate bedside manner, and his overall professional comportment. He was particularly intrigued by the way the resident did not cling to the chart but laid it aside to use his hands to connect personally and therapeutically with the patient. This particular resident went on to receive the top resident teaching honors awarded by his program as well as the adulation of colleagues and students who wished to emulate his level of medical practice. I was obviously proud of this resident’s accomplishment and generosity, but I was also greatly sad that he, being in the ACGME residency program, was now essentially out of reach to the osteopathic students who are currently in the formative stages of their own professional careers. This particular teaching hospital, although open to the recruitment of DO graduates as residents, was not accessible to osteopathic students.
Much of the osteopathic identity, values, and culture derive from the genesis of the profession. The founder, having earned an MD degree of the times, postulated an approach to the patient that gave the musculoskeletal system a focus into diagnosis and treatment. To distinguish this skill set, he eschewed the MD designation in favor of bestowing a doctor of osteopathy degree to those trained in this singular approach. The profession has rightfully developed in accord with proven scientific principles of pharmacology, surgery, and other modern medical advances. Although the applied science behind osteopathic manipulative medicine (OMM) is rightfully in need of continuing and sustained research, the modality remains a critical and intense component of the osteopathic curriculum. It has never been abandoned. Other tenets of osteopathic philosophy, such as the holistic approach to patient care, the ability of the body for self-healing, and respect for the mind, body, and spirit of the patient, are implicitly and explicitly expressed throughout the curriculum, even as they have been incorporated into the practice of other health professions.
When does a student become osteopathic? For many, it begins with a mentor relationship with the primary care osteopathic physician who guides the potential student through the application process, providing the required osteopathic reference. For others, the inculcation begins with the acceptance letter. Together as such, these students arrive for orientation, share a table in the intensity of the gross anatomy lab, and become partners in the mandated hands-on approach of the OMM lab. All do not necessarily see their future in an exclusive osteopathic manipulative practice, but respect for the modality and subtle appreciation of hands as a diagnostic, treatment, and communication tool become integrated into their clinical thought process. When these students in their clerkship years encounter residents who exemplify these values, their formation as osteopathic physicians receives a veritable booster shot, to be procured in no other way.
At graduation, the students recite the Osteopathic Oath to mark their commitment to professional responsibilities. Notably, the graduates pledge to
look with respect and esteem upon all those who have taught me my art. To my college I will be loyal and strive always for the best interests of the students who will come after me.
Therein lies the osteopathic dilemma. The “best interest of the students that come after me” is engaging actively, especially as residents, with the continuum of osteopathic education. When osteopathic graduates earn a place in an exclusive ACGME-approved residency program, they become potentially inaccessible during these important years to osteopathic students who follow. The continuum of the osteopathic heritage suffers even as others find it inspiring.
Since my encounter with the allopathic student mentioned above, the teaching hospital that functioned exclusively with one medical school began participating in osteopathic-accredited graduate medical education. With this successful comingling of ACGME and American Osteopathic Association accreditation, osteopathic residents and leaders now participate in the teaching and role modeling of both MD and DO students. Likewise, core distinctive activity, such as OMM education, is now standard-based with both MDs and DOs participating. Cultural identity is not hidden but, instead, is recognized and validated.
Both professions bring to the table unique resources and rich histories of physician education and formation. Hopefully, with increasing understanding, the parallel movement of both professions can be enhanced and sustained, especially within the critical and challenging world of graduate medical education.
Kenneth J. Veit, DO, MBA
Dr. Veit is senior vice president for academic affairs and dean, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania; (firstname.lastname@example.org).