The Journal of the American Osteopathic Association

Context: Many studies have reported a decline in empathy as allopathic medical students progress through medical school. Data are needed to compare the pattern of changes in empathy in osteopathic and allopathic medical students. Also, it is important to investigate the associations between measures of empathy and attitudes toward interprofessional collaboration, which are among major elements of professionalism in medicine.

Objectives: (1) To investigate correlations between empathy and interprofessional collaboration in osteopathic medical students; (2) to examine differences in empathy and interprofessional collaboration scores by sex, class year, and specialty interest; and (3) to compare empathy scores by class year between osteopathic and allopathic medical students.

Design: Correlational and comparative study.

Setting: Ohio University Heritage College of Osteopathic Medicine.

Participants: Osteopathic medical students enrolled in academic year 2011-2012.

Main Outcome Measures: The Jefferson Scale of Empathy (JSE) and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) scores.

Results: Student respondents (N=373) included 197 women (53%) and 176 men (47%). Significant correlation was found between scores on the JSE and JSAPNC (r=0.42, P<.01). Women scored higher than men on the JSE (mean scores, 117.1 and 111.9, respectively; F_1,371=19.6, P<.01) and the JSAPNC (mean scores, 50.1 and 48.7, respectively; F_1,371=6.5, P<.01). No statistically significant difference on the scores of the 2 scales was observed among students who planned to pursue “people-oriented” specialties (150 [40%]) compared with those interested in “technology/procedure-oriented” specialties (170 [45%]). No statistically significant change in empathy scores was found in different class years of the osteopathic medical students. Comparisons of empathy scores with allopathic medical students showed no significant difference in the first and second years, but osteopathic medical students had a higher mean empathy score (M=114.4) than their allopathic counterparts (M=110.9) in the third year (t₁₅₈=2.31, P<.05), and their empathy scores remained high, although not statistically significant, in the fourth year of osteopathic medical school.

Conclusion: The decline in empathy that is often reported among allopathic medical students was not observed. The present study can serve as a step toward further longitudinal research on the development of empathy and attitudes toward teamwork among osteopathic medical students.

Pediatric Rheumatology

We describe pGALS (paediatric Gait, Arms, Legs and Spine) – a simple quick musculoskeletal assessment to distinguish abnormal from normal joints in children and young people. The use of pGALS is aimed at the non-specialist in paediatric musculoskeletal medicine as a basic clinical skill to be used in conjunction with essential knowledge about red flags, normal development and awareness of patterns of musculoskeletal pathologies. pGALS has been validated in school-aged children and also in the context of acute general paediatrics to detect abnormal
joints. We propose that pGALS is an important part of basic clinical skills to be acquired by all doctors who may be involved in the care of children. The learning of pGALS along with basic knowledge is a useful way to increase awareness of joint disease, facilitate early recognition of joint problems and prompt referral to specialist teams to optimise clinical outcomes. We have compiled this article as a resource that can be used by the paediatric rheumatology community to facilitate teaching.

Full text available here.

Chiropractic & Manual Therapies

Background: To determine whether osteopathic medical students, fellows, residents, and practicing physicians
differ in their ability to identify inanimate objects and if these skills relate to palpatory experience.

Methods: Fifteen commonly known objects were fixed to a board and blinded with a cotton cloth. In Part I of
testing, participants were asked to identify 9 objects, with choices provided. In Part II participants were asked to
identify 6 objects using one word only. Part III consisted of identifying the shape of an object in Part II.

Results: Eighty-nine osteopathic medical students, fellows, residents, and practicing physicians participated in the
study. Overall, correct identification of objects was higher in Part I with choices than in Part II without choices
available. No statistically significant difference was found among osteopathic medical students, fellows, residents,
and practicing physicians in the correct identification of the objects.

Conclusions: Accuracy in tactile identification of objects among varying levels of palpatory experience was not
found. Correlation with clinical palpation cannot be made as it requires a subset of palpatory skills not tested in this
study. Accuracy and measurement of palpation should be studied further to demonstrate if palpatory experience
improves palpatory accuracy.

Full text available here.

The Journal of Orthopaedic and Sports Physical Therapy

STUDY DESIGN: Case series.

OBJECTIVES: To use blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) to determine if supraspinal activation in response to noxious mechanical stimuli varies pre- and post-thrust manipulation to the thoracic spine.

BACKGROUND: Recent studies have demonstrated the effectiveness of thoracic thrust manipulation in reducing pain and improving function in some individuals with neck and shoulder pain. However, the mechanisms by which manipulation exerts such effects remain largely unexplained. The use of fMRI in the animal model has revealed a decrease in cortical activity in response to noxious stimuli following manual joint mobilization. Supraspinal mediation contributing to hypoalgesia in humans may be triggered following spinal manipulation.

METHODS: Ten healthy volunteers (5 women, 5 men) between the ages of 23 and 48 years (mean, 31.2 years) were recruited. Subjects underwent fMRI scanning while receiving noxious stimuli applied to the cuticle of the index finger at a rate of 1 Hz for periods of 15 seconds, alternating with periods of 15 seconds without stimuli, for a total duration of 5 minutes. Subjects then received a supine thrust manipulation directed to the midthoracic spine and were immediately returned to the scanner for reimaging with a second delivery of noxious stimuli. An 11-point numeric pain rating scale was administered immediately after the application of noxious stimuli, premanipulation and postmanipulation. Blood oxygenation level-dependent fMRI recorded the cerebral hemodynamic response to the painful stimuli premanipulation and postmanipulation.

RESULTS: The data indicated a significant reduction in subjects' perception of pain (P<.01), as well as a reduction in cerebral blood flow as measured by the blood oxygenation level-dependent response following manipulation to areas associated with the pain matrix (P<.05). There was a significant relationship between reduced activation in the insular cortex and decreased subjective pain ratings on the numeric pain rating scale (r = 0.59, P<.05).

CONCLUSION: This study provides preliminary evidence that suggests that supraspinal mechanisms may be associated with thoracic thrust manipulation and hypoalgesia. However, because the study lacked a control group, the results do not allow for the discernment of the causative effects of manipulation, which may also be related to changes in levels of subjects' fear, anxiety, or expectation of successful outcomes with manipulation. Future investigations should strive to elicit more conclusive findings in the form of randomized clinical trials.

Full text available here.