AOA – Seven Core Competencies of

OMM Case Considerations Toolbox

AOA Core Competency #1 OSTEOPATHIC PHILOSOPHY AND OSTEOPATHIC MANIPULATIVE MEDICINE

OMM Case Considerations Form

OMM Case Story Board Template

OMM Procedure Log

Global Communication/Professionalism Rating by Simulated Patient

OMM Case Assessment Form

Osteo SOAP Note Form (TBA)

Hit Counter

AOA – Core Competency #1 OSTEOPATHIC PHILOSOPHY AND OSTEOPATHIC MANIPULATIVE MEDICINE

COMPETENCY #1:

OSTEOPATHIC PHILOSOPHY AND OSTEOPATHIC MANIPULATIVE MEDICINE

DEFINITION:

Residents are expected to demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Treatment (OMT) appropriate to their specialty. 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.

REQUIRED ELEMENTS:

1. Demonstrate competency in the understanding and application of OMT appropriate to the medical specialty.

Suggested Methodology to Achieve Compliance

Provide opportunities for active participation for residents in hospital and ambulatory sites for OMT training.
Teach residents to perform a critical appraisal of medical literature related to OMT.
Observe and credential residents in the performance of OMT by assessing their diagnostic skills, medical knowledge, and problem-solving abilities.
Computer educational modules

2. Integrate Osteopathic Concepts and OMT into the medical care provided to patients as appropriate.

Suggested Methodology to Achieve Compliance

Have residents assume increasing responsibility for the incorporation of osteopathic concepts in patient management.
Participate in activities that provide educational programs at the student and intern levels.
Participate in CME programs provided by COMS, the AAO, and specialty colleges.
Computer Teaching Modules

3. Understand and integrate Osteopathic Principles and Philosophy into all clinical and patient care activities.

0Suggested Methodology to Achieve Compliance

Utilize caring, compassionate behavior with patients.
Demonstrate the treatment of people rather than symptoms.
Demonstrate understanding of somato-visceral relationships and the role of the musculoskeletal disease.
Demonstrate listening skills in interaction with patients.
Demonstrate knowledge of and behavior in accordance with the Osteopathic Oath and AOA Code of Ethics.

-------------------------------------------------------------------------------------------------------------------------------------------------

OMM Case Considerations Form

		0	1	2	3	N/A
Relevant Concerns with Fluid Congestion (venous & lymphatic, in particular):	Delineate the drainage pathway for the area, viscus, joint, or other component relevant to the case. Follow this to its terminal drainage.
	Describe and portray the ‘choke points’ that may impede drainage along this path.
	Suggest possible Osteopathic manipulative interventions that may assist in drainage of the fluid congestion associated with this case.

Relevant Sympathetic Nervous System Concerns:	Delineate the sympathetic innervations for the area, viscus, joint, or other component relevant to the case. Follow its course to the spinal cord.
	Describe and portray the fascial ‘choke points’ that may increase tension on this nervous pathway to the spinal cord.
	Suggest possible Osteopathic manipulative interventions that may assist in normalization of the sympathetic influences associated with this case.

Relevant Parasympathetic Nervous System Concerns:	Delineate the parasympathetic innervation for the area, viscus, joint, or other component relevant to the case. Follow its course to the spinal cord.
	Describe and portray the fascial ‘choke points’ that may increase tension on this nervous pathway to the spinal cord.
	Suggest possible Osteopathic manipulative interventions that may assist in normalization of parasympathetic influences associated with this case.

Relevant Pain Concerns:	Delineate the pathway for afferent pain fibers for the area, viscus, joint, or other component relevant to the case. Follow its course to the spinal cord.
	Describe and portray the fascial ‘choke points’ that may increase tension of this nervous pathway to the spinal cord.
	Suggest possible Osteopathic manipulative interventions that may assist in normalization of nociceptive influences associated with this case.

Relevant Biomechanical Concerns:	Delineate the local and regional biomechanical concerns that may impact this case.
	Delineate the inter-regional biomechanical concerns that may impact this case.
	Suggest possible Osteopathic manipulative interventions that may assist in normalization of biomechanical influences associated with this case.

Relevant Psychosocial concerns:	Delineate the historical psychosocial concerns that could be relevant to this case.
	Delineate the psychosocial concerns relevant to palpatory contact with the patient in this case.
	Suggest possible approaches to Osteopathic manipulative management that may assist in acknowledging and/or addressing the psychosocial concerns related to this case.

Deficient (Level #0): Has not learned rules or principles. Lacks any sense of the overall task.

o Unorganized attempt to apply rules or plans

o No situational perception

o No discretionary judgment

Novice (Level #1): Operates by consciously-learnt context-free rules. Lacks any sense of the overall task.

o Rigid adherence to taught rules or plans

o Little situational perception

o No discretionary judgment

Competent (Level #2): Has now learnt to recognize many context-free and situational elements. Still lacks any sense of their overall importance to the task, and rapidly becomes overwhelmed. Tries to overcome this by hierarchical goal-based planning. This hierarchical decomposition of the task means that, at any time, the competent pays attention only to that small number of features relevant to a particular sub-goal, thus avoiding being overwhelmed.

o Coping with crowdedness

o Now sees actions at least partially in terms of longer-term goals

o Conscious deliberate planning

o Standardized and routinized procedures

Proficient (Level #3): Performs his/her task logically, almost all the time. Occasionally has to stop and deliberate, but this involves critical reflection on his/her deductions, rather than goal-based planning.

o Readily incorporates rules, guidelines or maxims

o Logical grasp of situations based on understanding

o Analytic approaches to problem solving

o Vision of what is possible

-------------------------------------------------------------------------------------------------------------------------------

OMM Case Story Board Template

1. OMM Relevant Concerns

Review the existing case. What 2–3 OMM Relevant Concerns would you like to focus on? Circle 2 or 3

● Fluid Congestion ● Parasympathetic ● Biomechanical

● Sympathetic ● Pain ● Psychosocial

2. Other Case Information Needed

Based on your review of the existing case and the OMM Relevant Concerns you just picked, what other information do you need to add to (or have for) this case?

● History

● Musculoskeletal Findings

● Lab Requests

1. .

2. .

3. .

● Imaging Requests

1. .

2. .

3. .

● Other?

1. .

2. .

3. .

Remember, do not do all 6 Relevant Concerns. Only do the 2 or 3 that you chose early.

3. Specific information about the Relevant Concerns

Based on the specifics of this case, expand the information you need for each of the Relevant Concerns you picked in #1 above.

● Fluid Congestion ● Parasympathetic (See next page for Biomechanical and Psychosocial Concerns)

● Sympathetic ● Pain

List one of your Relevant Concerns ________________________________________________________________________________

a. Delineate the _________________ for the area, viscus, joint, or other component relevant to the case. Follow it’s course:

Teaching Points:

b. Describe and portray the fascial ‘choke points’ and what results this may have

Fascial ‘choke points ’_________________________________________________________________________________________

That may result in ____________________________________________________________________________________________

Teaching Points:

c. Suggest possible Osteopathic manipulative interventions:

1. .

2. .

3. .

Teaching Points:

4. Specific information about the Relevant Concerns

Based on the specifics of this case, expand the information you need for each of the Relevant Concerns you picked in #1 above.

● Fluid Congestion ● Parasympathetic (See next page for Biomechanical and Psychosocial Concerns)

● Sympathetic ● Pain

List one of your Relevant Concerns ________________________________________________________________________________

a. Delineate the _________________ for the area, viscus, joint, or other component relevant to the case. Follow it’s course:

Teaching Points:

b. Describe and portray the fascial ‘choke points’ and what results this may have

Fascial ‘choke points ’_________________________________________________________________________________________

That may result in ____________________________________________________________________________________________

Teaching Points:

c. Suggest possible Osteopathic manipulative interventions:

1. .

2. .

3. .

Teaching Points:

5. Specific information about the Relevant Biomechanical Concerns

Based on the specifics of this case, expand the information you need for the Relevant Biomechanical Concerns.

a. Delineate the local and regional biomechanical concerns that may impact this case.

Teaching Points:

b. Delineate the inter-regional biomechanical concerns that may impact this case.

Teaching Points:

c. Suggest possible Osteopathic manipulative intervention that may assist in normalization of biomechanical influences associated with this case.

1. .

2. .

3. .

Teaching Points:

6. Specific information about the Relevant Psychosocial Concerns

Based on the specifics of this case, expand the information you need for the Relevant Psychosocial Concerns.

a. Delineate the historical psychosocial concerns that could be relevant to this case.

Teaching Points:

b. Delineate the psychosocial concerns relevant to palpatory contact with the patient in this case.

Teaching Points:

c. Suggest possible approaches to Osteopathic manipulative management that may assist in acknowledging and/or addressing the psychosocial concerns related to this case.

1. .

2. .

3. .

Teaching Points:

7. Overall OMM Management Priorities and Focus:

8. Areas of Emphasis for Student / Intern Table Time:

9. Areas of Emphasis for Table Time for Residents in this Specialty:

10. Additional Resources:

---------------------------------------------------------------------------------------------------------------------------------------

OMM Procedure Log

Name _____________________________________________________

Rotation ___________________________________________________

Date	Medical Record #	Encounter	IP	OP
		Description: Complaint: Osteopathic Lesion: Treatment: Results:
		Description: Complaint: Osteopathic Lesion: Treatment: Results:
		Description: Complaint: Osteopathic Lesion: Treatment: Results:
		Description: Complaint: Osteopathic Lesion: Treatment: Results:
		Description: Complaint: Osteopathic Lesion: Treatment: Results:

Please document a minimum of ___inpatient and ___outpatient OMM procedures.

----------------------------------------------------------------------------------------------------------------------------------

Global Communication/Professionalism Rating by Simulated Patient

Not Done Done

Introduces him/herself _____ ____

Greets patient by name _____ ____

Washes hands _____ ____

		Deficient	Learning	Competent
1.	The examinee demonstrated an organized approach to his/her evaluation of me. (to the point, organized)	1	2	3
2.	The examinee showed a courteous and compassionate attitude toward me. (appropriately draped patient)	1	2	3
3.	The examinee was a good listener and showed an interest in me. (attentive, not interrupting, made eye contact)	1	2	3
4.	The examinee avoided using medical terms without an explanation of their meaning.	1	2	3
5.	The examinee was professional. (demeanor, dress, introduced self)	1	2	3
6.	The examinee provided enough information regarding diagnosis and treatment options.	1	2	3
7.	I would feel comfortable seeing this examinee again.		Yes	No

Total___/18__

EXAMINATION CHECK SHEET (Patient Care)

0= not done, 1=done, 2=done completely

					Comments
1.	Wash hands	0	1
2.	Observe ears, nose and throat.	0	1
3.	Palpate cervical lymph nodes	0	1
4.	Auscultate heart in four locations (regular, no murmurs)	0	1	2
5.	Auscultate heart on skin	0	1
6.	Auscultate six areas of the lungs. Include a zigzag pattern over the back from top to bottom and zigzag pattern over the chest, and right lateral or right lower chest area.(clear to auscultation)	0	1	2
7.	Auscultate lungs on skin at least once	0	1
8.	Palpate the abdomen for tenderness and splenomegaly	0	1
	Total

HISTORY CHECK SHEET (interviewing/interpersonal)

0= not asked, 1=asked

			Comments
What brings you in today?	0	1
On a scale from 1 to 10, how bad is the pain?	0	1
When did the symptoms begin?	0	1
What were you doing when the symptoms began?	0	1
How long have you had the symptoms?	0	1
What makes it better?	0	1
What makes it worse?	0	1
Did the symptoms begin rather suddenly?	0	1
When did you begin to drool and have difficulty swallowing?	0	1
Have you had anything like this before?	0	1
Total

OMM CHECK SHEET

0= not done, 1=done, 2=done completely

1.	Wash hands	0	1
2.	Appropriately diagnose somatic dysfunction.	0	1	2
3.	Perform Ortho/Neuro evaluation.	0	1	2
4.	Give primary etiology.	0	1
5.	Give differential diagnosis.	0	1	2
6.	Articulate findings to the patient.	0	1
7.	Instruct/place patient into appropriate initial position.	0	1
8.	Check for patient comfort.	0	1
9.	Select and articulate appropriate treatment.	0	1	2
10.	Articulate reassessment.	0	1
11.	Appears practiced and competent in technique.	0	1	2
	Total

-------------------------------------------------------------------------------------------------------------------------------------

OMM Case Assessment Form

Date: ___________________________________ Preceptor/Instructor Sign-Off: _____________________

Patient ID:_______________________________

Diagnosis:_______________________________ Musculoskeletal Diagnosis: _______________________

________________________________________ ______________________________________________

OMM Relevance to patient problem: __________________________________________________________

________________________________________________________________________________________

OMM Treatment / Management: _____________________________________________________________

________________________________________________________________________________________

We recommend your OMM Team
pick a benchmark of evaluating
each trainee on 2-3 case assessments ________________________________________ Recommended Follow-up: ________________________

Date: ___________________________________ Preceptor/Instructor Sign-Off: _____________________

Patient ID:_______________________________

Diagnosis:_______________________________ Musculoskeletal Diagnosis: _______________________

________________________________________ ______________________________________________

OMM Relevance to patient problem: __________________________________________________________

________________________________________________________________________________________

OMM Treatment / Management: _____________________________________________________________

________________________________________________________________________________________

________________________________________ Recommended Follow-up: ________________________

Date: ___________________________________ Preceptor/Instructor Sign-Off: _____________________

Patient ID:_______________________________

Diagnosis:_______________________________ Musculoskeletal Diagnosis: _______________________

________________________________________ ______________________________________________

OMM Relevance to patient problem: __________________________________________________________

________________________________________________________________________________________

OMM Treatment / Management: _____________________________________________________________

________________________________________________________________________________________

________________________________________ Recommended Follow-up: ________________________

--------------------------------------------------------------------------------------------------------------------------------------------

Osteo SOAP Note Form (TBA)