First of all, many osteopathic medical schools are located in underserved areas — or as underserved as possible while still having enough of a medical community to make training possible. My school, LMU-DCOM is located in the middle of Appalachia, for example. Osteopathic medical schools generally encourage students to specialize in primary care, at least as much as they can, considering that our health care system is not osteopathic. A lot of osteopathic medical schools like abbreviations, like LMU-DCOM … for the fun of it, I guess.
The curriculum of allopathic and osteopathic medical schools is about 90 percent the same. Didactics: basic sciences, pharmacology, microbiology, systems, and pre-clinical prep work. What’s different is a course, which at LMU-DCOM is called Osteopathic Principles and Practices (OPP). As the name suggests, this is where doctors of osteopathic medicine learn about the osteopathic approach to medicine and about OMT. Clinical rotations, like at allopathic schools, cover the foundational specialties, selectives and electives. During the didactic years — many, though not all — professors are DOs. I suspect this is due to how quickly osteopathic medicals schools are being founded and the number of DOs in practice. Even among the DO professors, the degree to which the osteopathic approach is emphasized in the non-OPP lectures varies widely.
Clinical rotations are influenced more by the health care system as a whole than the particular medical school, and since the health care system is not osteopathic, there’s not as much a difference in the experience. The degree of osteopathic training largely depends on where you are and who you do elective and selective rotations with. My primary interest was practicing in Wyoming — so I scheduled my electives and selectives here where there’s not as much of an osteopathic presence. I only worked with a few DO preceptors. Based on unofficial surveys I’ve done over the years, osteopathic medical students seem to travel around the country a lot for rotations — more than allopathic medical students do.
Doctors of osteopathic medicine take the COMLEX rather than the USMLE, though some may take both depending on which residencies they apply to. Like the medical schools, these licensing exams are about 90 percent the same, such that at LMU-DCOM we used the USMLE prep course for Step 1. The COMLEX contains questions about osteopathic approach and OMT, of course. In zero-sum fashion, since the tests are the same length, it contains fewer questions about things, like the nitty gritty details of the Krebs cycle, that you rarely need to know in practice.
So what exactly do you learn in an osteopathic medical school that you don’t learn in allopathic school? OMT, of course, which means that you end up studying more anatomy. A lot more anatomy. So you study anatomy, anatomy, and then you go back and study anatomy some more. And due to the drinking from the fire hose effect, by the time you’re finished with training, you still find yourself needing to study anatomy, but I guess that’s what lifelong learning is all about. We learn in detail about the motion of all the structures in the body. For example, a lateral ankle sprain not only due to a tear of the anterior talofibular ligament but also usually also results in somatic dysfunctions (abnormality in motion, among other things) of the tibia, fibula, talus, and navicular. We learn about the importance of fascia, the connective tissue that in anatomy lab, you hack away at and throw away in order to study all the other structures in the body. We learn about the cranial rhythmic impulse, the CRI, which is the motion of the CSF around the brain and spinal cord, that is another vital sign. We learn that the sutures of the skull don’t actually fuse together during adulthood and actually have a tiny amount of mobility.
As for the osteopathic approach, we learn that a lot of that 50 percent of all disorders and disease that are considered “idiopathic” are actually due to somatic dysfunction. Finding out the “why” of an illness matters. Why did this person get sick and their associates? Why did they get sick now and not sooner or later? Why did they get sick to the degree that they did? For disorders localized to one part of the body, like an abscess, why did it appear where it did and not somewhere else? For those diseases that are known and fairly understood and treated the same way in both professions, the rationale for treatment is different. For example, the role of antibiotics in treating bacterial infection is not to cure; the human body is capable of healing, after all. The role of antibiotics is to control the bacterial load just enough that the patient’s immune system can clear the infection without mortality or serious morbidity. Their role is to essentially give the immune system a little nudge.
The final thing that makes osteopathic medical school different is that we are taught that there is more than one approach. Moreover, osteopathic medicine is an alternative to mainstream allopathic medicine. At present, with osteopathic medicine still being a minority, it’s hard to talk about it any other way. Allopathic medicine is still the common frame of reference. I’ve framed this whole post in the same context — for the same reasons. We are very aware of the history and legacy of osteopathic medicine, including the fight for licensing legitimacy and acceptance all throughout training. Depending on where in the country you are, you may spend a great deal of time explaining what osteopathic medicine is and how its the same and different. My understanding of allopathic medical school (and correct me if I’m wrong, allopathic readers) is that it barely acknowledges the existence of osteopathic medicine if at all much less discuss the philosophical differences between the two professions. There’s a certain tedium and frustration that comes from constantly having to explain oneself, but understanding the context also provides a certain perspective that is very beneficial.
Liz Hills is a family physician who blogs at Heal Thyself.
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