Development of Osteopathic Neuromusculoskeletal Medicine (ONMM) residency curriculum guidelines to meet Accreditation Council for Graduate Medical Education (ACGME) milestones

Context:
A memorandum of understanding was reached between the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) in 2014 outlining the course for a single accreditation system for graduate medical education. This process was completed in 2020 and has included the transition of AOA-accredited neuromusculoskeletal and Osteopathic Manipulative Medicine (OMM) programs into programs now termed "Osteopathic Neuromusculoskeletal Medicine" (ONMM) under the single accreditation system. Progress through ONMM residency is evaluated on the basis of 15 ACGME milestones that encompass six core competencies. However, there are no curricular guidelines to help guide the achievement of these milestones.

Objectives:
The primary purpose of this study was to develop a proposed structure and content for an ONMM residency curriculum that is based on (1) the alignment of residency curriculum with ACGME milestones in one ACGME-accredited ONMM residency program, and (2) the perceived needs of residents and faculty for an ONMM residency curriculum.

Methods:
A mixed-methods exploratory sequential approach with embedded design was utilized. Qualitative analysis of didactics curriculum content for the past 2 years was coded according to themes identified in the residency curriculum content, which were further coded according to ACGME milestones. Curriculum topics identified in qualitative analysis were utilized to create a questionnaire that was administered to residents and faculty (n=24) in the ONMM residency program to examine the perceived importance of each curriculum topic based on a five-point Likert scale. Open-ended questions were embedded in the questionnaire that asked how faculty and residents define ONMM and what they believe should be the purpose of an ONMM residency curriculum.

Results:
Five themes were identified in qualitative analysis of curriculum: (1) OMM laboratory topics; (2) faculty-led activities and lecture topics; (3) resident-led activities and lecture topics; (4) research; and (5) training courses and volunteer activities. The most important perceived curriculum topics for faculty and residents were osteopathic structural examination, orthopedic exam, direct and indirect methods, osteopathic cranial manipulative medicine, pediatric OMT, common upper and lower extremity injuries, and low back pain. Each of these topics aligned well with ACGME milestones. Residents reported that integrative medicine topics such as acupuncture were a significantly more important OMM laboratory topic (mean=3.58, SD=0.996) compared to faculty (mean=2.33, SD=0.985), t (22)=-3.091, p=0.005. Study participants most commonly described ONMM in terms of the specialized knowledge required for the discipline (n=19, 79.2%) and the Tenets of Osteopathy (n=17, 70.8%), and they felt that the purpose of an ONMM residency curriculum should be to gain knowledge (n=20, 83.3%) and become a competent physician (n=19, 79.2%).

Conclusions:
The present findings were applied to the development of proposed ONMM residency curriculum guidelines and submitted to the American Academy of Osteopathy (AAO) for consideration. They are presented here as a resource for ONMM residencies to develop a program curriculum in alignment with individual program needs.

Keywords: osteopathic manipulative medicine; osteopathic neuromusculoskeletal medicine; post-graduate education; residency curriculum.

PMID: 35106986 DOI: 10.1515/jom-2021-0122