Why is identification with osteopathy decreasing in medical students?

Context: Across eight classes at Lincoln Memorial University - DeBusk College of Osteopathic Medicine (DCOM), survey data reveal a decrease in students' identification with osteopathy, which is what distinguishes an osteopathic physician's values, attitudes, and commitment to the tenets of osteopathy. Without intervention, this trend of decreasing osteopathic identification may produce future generations of osteopaths who devalue the specific tenets of osteopathy.

Objectives: This study aims to determine factors that influence a student's identification with osteopathy, as quantified by Likert-style survey response data, and to precisely quantify these factors' predictive effect on osteopathic identification while simultaneously controlling for other possibly confounding factors. We hypothesize that preparedness and osteopathic manipulative medicine (OMM) skills will be the strongest predictors of osteopathic identification.

Methods: We utilized retrospective survey data from 1991 past DCOM students. Identifying data were redacted and replaced with research IDs. The survey contained an item that gauged respondents' identification with osteopathy. To explore our primary objective, we utilized paired samples t tests to determine changes in osteopathic identification from matriculation to graduation within each class, as well as Pearson's correlation coefficient to determine each item's correlation with osteopathic identification. To explore objective 2, we utilized multiple regressions and structural equation modeling (SEM) path analyses to quantify these factors' ability to predict osteopathic identification.

Results: Osteopathic identification decreased between matriculation and graduation for each class (10-21 % decrease, p<0.001). Feeling highly motivated to serve the community correlated best with osteopathic identification upon matriculation (r=0.2; p<0.001). One's perception of one's OMM skills - both in explaining OMM philosophy (r=0.5; p<0.001) and utilizing OMM (r=0.5; p<0.001) - as well as feeling happy to be an osteopath (r=0.6; p<0.001), best correlated with osteopathic identification upon graduation. OMM Skills have the greatest direct predictive effect on osteopathic identification, with an effect size of 0.4 (p<0.001). Commitment to Organization, mediated by both OMM Skills and Preparedness, has the greatest overall predictive effect on osteopathic identification, with an effect size of 0.6 (p<0.001).

Conclusions: The current study builds on past research by utilizing SEM path analysis to elucidate the predictive value of multiple factors on osteopathic identification. Application of the current study should consider looking at interventions geared toward increasing students' OMM skills as well as their commitment to their institution, field, and career overall.