Being a DO in a heavily MD residency program: What surprised me

I can remember the feeling of extreme nervousness and imposter syndrome I felt as I walked into the University of Miami Hospital in July 2021 for my first day of residency. I graduated from medical school during COVID-19 and hadn’t had a true wards experience before starting residency at one of the largest and highest-acuity internal medicine programs in the country. I honestly felt unprepared and nervous to be at such a large and historically allopathic program. I had many questions going through my head regarding expectations and flow of work.

Because this residency program is highly competitive, I feared that I wouldn’t be at the same level as some of my colleagues. What I didn’t appreciate at the time was just how vital some of the skills I had gained during osteopathic medical school would be to patient care and an academic medical team in general.

A unique and valuable skillset

As an osteopathic resident physician training at a large academic institution, I often find myself working on teams in which I am the only person with osteopathic training. What many DO students and residents do not realize is their physical exam skills may be the strongest in an academic medical team environment. In this setting, it is easy to underestimate your skills when surrounded by highly specialized practitioners. However, when you compare training across schools and specialties, osteopathic medical school generally provides a greater emphasis on diagnostic sensitivity through physical exam.

The implications of this are that osteopathic medical students and residents are often the best-positioned to make accurate diagnoses based on physical exam (especially when it comes to the musculoskeletal system). It is a tool that many of us grossly undervalue, especially when we are early in our careers.

Making a difference

I can recall multiple cases in which these skills played a vital role in providing the correct diagnosis and also avoiding unnecessary workup or procedures. As an intern on the cardiology service, there were multiple instances when patients were admitted for chest pain to rule out acute coronary syndrome but were actually experiencing rib somatic dysfunction.

I will never forget the look of disbelief on my attending’s face (an interventional cardiologist) when I provided osteopathic manipulative treatment (OMT) to a patient’s rib at bedside, and it immediately relieved the chest pain for which he had been admitted for three days.

Another time, when I was the senior for a team, one of the rotating osteopathic medical students provided reassurance and treatment for a new mother’s extended sacral dysfunction. The new mother had previously been told by many doctors that the weeks of pain she was experiencing was not possible because “sacrums can’t move.” Even in the surgical specialties, it is not uncommon for general surgery to receive consults for an acute abdomen that turns out just to be a musculoskeletal problem masquerading as something much more sinister.

Navigating OMT

Something I struggled with as a resident physician was determining when OMT was indicated for the inpatient setting. As I did not have any attending physicians who were DOs practicing OMT, this was something I had to figure out on my own. What I’ve learned in almost three years in a high-volume and high-acuity setting is that hospitalized patients stand to benefit significantly from OMT.

Typically, a team on the medicine wards will include one attending, one senior resident (second- or third-year resident), two interns (first-year residents), two to four medical students and sometimes international medical students. It is often the case that as a medical student you are spending the most time of anyone with the one to four patients you are assigned to follow. For this reason, I encourage medical students on my team to try to know as much information as possible about their patients.

Wards are an opportunity for medical students to learn the flow of inpatient medicine. It is also an incredible setting for providing supervised OMT because you will have the time to focus on providing thorough care to a few patients. At baseline, osteopathic exam skills are an amazing way to connect with your patients and earn their trust.

Opportunities abound

On inpatient services, we are often in such a time crunch to get work done that patients feel their medical team isn’t taking the time to truly listen and understand all of their concerns. Your role as a DO student gives you more time with patients. Thus, you have more opportunities to better understand patients’ conditions and concerns and to use and hone your OMT and exam skills.

There is a movement within academic medicine to rely heavily on diagnostic modalities because they are often so readily available and highly accurate to boot. Also, with physicians’ time burdened by many competing demands, relying on diagnostic modalities means physicians can spend less time face-to-face with patients. To those planning to pursue training at an academic center, I encourage you to use your physical exam skills and OMT training as much as possible.

There is an awareness that osteopathic physicians graduate with 200-plus hours devoted to diagnosis and treatment using physical touch. Most osteopathic medical students have a limited amount of experience at tertiary academic medical centers, yet they possess skills which are a significant asset for an academic team.

‘Your knowledge is valued’

For osteopathic medical students rotating at large academic centers, know that your knowledge is valued and an integral part of patient-centered health care. Using your skills and training is simply good health care.

Even if you don’t plan to provide OMT, be assured that the training you received is highly valuable to patient-centered care, especially in an inpatient academic setting. Health care is no longer the linear journey it once was. Complex patients require an even greater mastery of the role that the mind, body and spirit play in disease. Osteopathic physicians and medical students equipped with hands-on training are now more than ever a critical part of a high-performing medical team.

Related reading:

The 4th wave of osteopathic medicine: Re-establishing osteopathic distinctiveness

DO placements in 2024 NRMP Match reach all-time high