Education Columns

Julie Dahl-Smith, DO, DABMA, Department of Family Medicine, Medical College of Georgia, Georgia Health Sciences University

The Georgia Health Sciences University Department of Family Medicine is one of three dually accredited American College of Graduate Medical education (ACGME) and American Osteopathic Association (AOA) residency programs in Georgia. Our Intern AOA program started in 1992, and in 2003 we transitioned to a fully accredited 3-year AOA family medicine program. Our program accepts two new osteopathic and six allopathic residents each year. Our dual program has two osteopathic and 20 allopathic physicians on faculty. The osteopathic program curriculum has evolved over the past 10 years, based on feedback from our osteopathic and allopathic residents and graduates, establishing a dynamic curriculum that meets AOA program requirements.

All AOA residency programs must be affiliated with an osteopathic school. The schools provide oversight of each osteopathic program and assist with educational resources. For many programs, the school's osteopathic manipulative medicine faculty help meet core Osteopathic Manipulative Therapy (OMT) competencies by providing lectures and clinical opportunities. Because our program is geographically distant from our affiliated school, we have had to develop the clinical hands-on osteopathic education here at our site. Additionally, the challenge of having fewer osteopathic faculty to provide didactics has compelled the program to challenge residents to participate in creation of new lectures, lead a monthly Journal Club from osteopathic literature, and be directly involved in teaching.

The osteopathic curriculum starts during the July Orientation month. All new family medicine residents receive 3 hours of lectures that include OMT Structural Review, Review of OMT Techniques, Physical Exam for the Lumbar Spine, OMT Coding, and Teaching to Teach. During that month the osteopathic interns are required to complete a lumbar objective structured clinical examination (OSCE) for competency. During the 3 years of residency, monthly 1-hour lectures are given in the department, and all residents are required to attend. Each osteopathic resident is required to give one osteopathic lecture per year as part of this lecture series, and osteopathic residents are required to complete a quiz for each lecture. Each year, specific areas covered include OMT for the cervical and thoracic spine; osteopathic residents are required to complete OSCEs on each of these areas during their second year of residency. Each month there is an additional osteopathic noon conference where OMT techniques and structural exam can be reviewed and practiced. This is a hands-on session, and all residents in the department are welcome to participate. This forum allows the residents to learn from each other and finesse their skills.

Interns are required to work a minimum of four clinics with the osteopathic program director in her OMT clinic so the resident's skills can be assessed and areas of decreased competency improved. During their second and third years of residency, the osteopathic residents are required to work in the OMT Resident Clinic, which is precepted by AOA or ACGME faculty who are competent in OMT. The PGY-2 is required to participate in 12 clinics per year, and the PGY-3 is required to participate in 16 clinics per year. Each osteopathic resident is required to integrate OMT into their continuity clinics. They are required to perform structural exams and OMT on two patients per month. These must be precepted by DO faculty or allopathic faculty who feel comfortable precepting OMT. Each osteopathic resident is also required to perform structural exams and OMT on a minimum of six patients in the hospital setting. A minimum of two of these must be precepted by DO faculty. All of these clinic and hospital procedures are required to be documented in the patient's chart, signed off by the faculty who attests to the procedure, and recorded in the resident's electronic procedure log. These clinic and hospital interactions are recorded on our monthly advisor report sheet by the resident for review with their advisor and the program director.

The osteopathic curriculum is accessible as well to the allopathic residents. The allopathic residents can obtain competency in OMT procedures during their residency. Over the past 2 years, two of our allopathic residents have been credentialed in OMT procedures. A 1-month OMT elective is open to all residents in the Department of Family Medicine as well as other residents at our institution and from outside residency programs. For the allopathic residents to gain and demonstrate competency, they are required to do a 1-month elective in OMT, attend the OMT lectures throughout the 3 years of residency, integrate OMT in their continuity clinics, and pass osteopathic OSCEs for the cervical, thoracic, and lumbar areas. These residents who obtain competency get an OMT Competency Certificate at graduation. Allopathic medical students rotating at Georgia Health Sciences University Family Medicine Center on the Family Medicine Clerkship Rotation or Procedure Elective are assigned to faculty or resident OMT clinics for exposure to OMT.

Our approach to teaching osteopathic medicine in a dually accredited family medicine program continues to evolve with input from our osteopathic and allopathic residents and students. This curriculum challenges the residents to not only finesse their osteopathic skills but also develop new curricular materials shared department wide through OMT lectures, hands-on activities, and educating other learners in our program.