Kirksville college of osteopathic medicine A T Still University of health sciences

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Kirksville college of osteopathic medicineA T
Still University of health sciences
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A Matrix forQuality EnhancementBased upon the
Seven Core Competencies of the
Osteopathic Profession

• Michael Lockwood, DO, FCA
• AACOM June 2007

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The Matrix for quality enhancement Comprised of
five submatrixes

• The Seven Core Competencies of the Osteopathic
  Profession
• Expectations for COMLEX-USA, Dimension I and II
• Domains of COMLEX-USA-PE
• Physician behavior based Patient Safety concerns
• The Stillian Paradigm as enunciated in the Four
  Tenets of Osteopathic Medicine

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(No Transcript)
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The Matrix for Quality enhancement

• Allows for tracking of core competencies
• Provides basis for curriculum development
• Can be applied to Standardized Patient and other
  case based formats
• Can track First and Second year encounters
• Can be employed by preceptors
• Regional Deans could track undergraduate programs
• Can be applied to OPTIK programs

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Modified Blooms Hierarchy of Learning and the
Use of the Expanded Matrix
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Seven Core Competencies

• Individual competencies were analyzed for
  expectations and requirements
• Each competency or required element was
  subdivided according to expectations
• Subdivided expectations were made into the
  interogative form
• Responses were imposed upon the MATRIX grid for
  analysis

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AN example subdivided as to individual
expectaTions

• CORE COMPETENCY 1
• Osteopathic Philosophy and Osteopathic
  Manipulative Medicine
• Students are expected to demonstrate and apply
  knowledge of accepted standards in Osteopathic
  Manipulative Treatment (OMT). The educational
  goal is to train a skilled and competent
  osteopathic practitioner who remains dedicated to
  life-long learning and to practice habits in
  osteopathic philosophy and manipulative medicine.

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AN Example OF the Three expectations
Changed to the interogative

• CORE COMPETENCY 1
  Osteopathic Philosophy and Osteopathic
  Manipulative Medicine
• DOES THE LEARNING ACTIVITY HELP, ALLOW OR
• REQUIRE THE STUDENT TO
• Demonstrate and apply knowledge of accepted
  standards in OMT?
• Train a skilled and competent osteopathic
  practitioner who remains dedicated to life-long
  learning?
• Train a skilled and competent osteopathic
  practitioner who remains dedicated to practice
  habits of manipulative medicine?

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Required elements ARE ALSO CHANGED PUT INTO A
QUERY FORMAT

• REQUIRED ELEMENT ONE
• Does it demonstrate competency in the
  understanding and application of Osteopathic
  Manipulative Treatment (OMT)?
• Does it integrate Osteopathic Concepts and OMT
  into the medical care provided to patients?
• Does it advance integrating Osteopathic
  Principles and Philosophy into all clinical and
  patient care activities?

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Matrix for Quality Enhancement Seven Core
Competencies of the Osteopathic Profession
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Comlex-usa
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COMLEX - USA

• The NBOME examinations are the primary pathway by
  which osteopathic physicians apply for licensure
  to practice osteopathic medicine and surgery
• A passing score on these examinations ensures
  that the candidates medical knowledge and
  clinical skills have met a national standard
• The COMLEX-USA examination sequence is accepted
  for licensure in 50 states
• The Osteopathic Medical Board in seven states
  require COMLEX for licensure

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COMLEX - USA

• COMLEX USA examination sequence uses a primary
  care approach to patient care
• Distinctiveness of osteopathic medicine fully
  integrated throughout the examination
• Approximately 20 of questions have a
• distinct component of Osteopathic
• philosophy, principles, and practice

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Submatrix for COMLEX USA

• CLINICAL PRESENTATION
• Dimension I lists patient presentations in case
  history format.
• PHYSCIAN TASKS
• Dimension II ensures adequate demonstration of
  physician tasks.

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Dimension I Patient Presentation TypesWITH
DESIGNATOR ABBREVIATION
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Dimension II Physician Tasks with Designator
Abbreviation
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COMLEX-USA-Level 2-PE

• COMLEX USA Level 2 PE is a clinical skills
  examination with an examination blueprint
  designed to assess osteopathic students
• The blueprint reflects the distinctive practice
  of osteopathic medicine
• All encounters are expected to reflect
  Osteopathic Principles and Philosophy
• Additionally, from 25 to 50 of the encounters,
  the student is expected to perform appropriate
  osteopathic manipulative treatment
• There is an emphasis on manipulative treatment
  and the neuromusculoskeletal system as
  appropriate for osteopathic medicine

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COMLEX -USA- PE biomechanical/boimedical domain

• B

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COMLEX-USA-PE humanistic domains
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medica safety issues with designator abbreviation
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Consider Medical Safety Errors

• Never Never Use Abbreviations- Examples

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Structure and Function Are reciprocally
interrelated. Normal structure is essential to
normal function.
The body is a unit. Mind, body,
spirit inseparable.
The Four Tenets of Osteopathy
The Four Tenets of Osteopathy
Rational therapy based upon understanding
of body and integration of other three tenets
The body possesses healing and
self-regulating mechanisms.
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Stillian paradigm requirements

• A scientific knowledge of anatomy and physiology
  in the hands of a person of intelligence and
  skill
• Masterful adherence to the process of astute,
  systematic observations
• Development of advanced palpatory skills
• Apply all skills and knowledge base for
  enhancement and promotion of health

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KCOM/ATSU C Fossum, 2006
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Viscerosomatic considerations in osteopathic
manipulative medicine
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Viscerosomatic considerations in osteopathic
manipulative medicine

• Palpatory Clues to Lymphatic Involvement
• Decreased movement of rib cage and reduced
  diaphragmatic excursion
• Myofascial tension and somatic dysfunctions in
  areas of transverse diaphragms and spinal
  junctions
• Fullness and bogginess palpated in areas of
  regional lymphatic drainage
• Presence of Chapmans Reflexes

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• Evidence-Based Medicine
• the integration of best research evidence with
  clinical expertise
  and patient values

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The Osteopathic Physician

• The relationship between the Osteopath
• and the patient is the heart of Osteopathy.
• (Podmore, 2001)

Figure adapted from ACP Journal Club
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Evidence Search I

• A search for the best evidence is based upon the
  hierarchy of studies as shown

Elsevier Ltd. 2005. Straus et al. Evidence Based
Medicine
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Evidence Search II

• An appraisal of the osteopathic
• literature is critical to ensure the
• osteopathic paradigm is foremost in
  the philosophical application of
  information to patient care.

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Search Requirements

• Search of relevant data from the osteopathic
  literature
• Ost Med (http//ostmed.hsc.unt.edu/ostmed/)
• A.T. Still Library Online Text
• ACOFP, JAOA, Journal of the AAO
• Systems or synopses engines
• Poems (www.infopoems.com)
• Up to Date (www.uptodate.com
• Family Practice Inquiry Network (www.fpin.org)
• Studies, synopsis
• PubMed Linkout ATSU Kirksville PubMed plus
  links to the journals owned by ATSU/KCOM
• OVID, Google Scholar, others

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Evaluation of clinical experiences using sps
based on seven core competencies
Osteopathic Philosophy and Treatment
Integration of Osteopathic Principles
Expectations for OMS I Medical Microbiology
OMT Applications
Totals Competency One
OMT Integration
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to whom much is given, much is expected
LUKE THE
PHYSICIAN
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Your feedback is desired. Please
submit paper or E-comments to request
templatesmlockwood_at_atsu.edu
fax[phone]