Classroom vs Clinical OMT - Disheartening Many.........
By: Lawrence Chan - RowanSOM
OMT. The reason that many of us are here in an osteopathic school and yet many lose the drive to learn, develop, and utilize OMT at the end of our years. So we wonder why does this happen? Is it the overwhelming pressure to succeed in all the other classes and do well on boards? Perhaps but it is doubtfully the only reason. What I and many others have come to find as the root cause is how OMT as a curriculum is structured and taught.
Rules and techniques are what we are taught in our curriculum whether it be Fryette’s Laws for spinal motion and dysfunction to muscle energy of the innominates. We learn many things and end up being incredibly frustrated by the minutia and what we often times find to be incredibly difficult to practice or even getting things to work. We will find that sometimes rules do not always apply and be at a loss on what to do, or find a dysfunction, try technique(s) and fail to produce any benefit. In short, the once burning passion to learn OMT quickly becomes quenched by frustration or worse, possibly believing OMT is ineffectual. I believe this stems from a general disconnect from what we are taught to what is actually done in practice.
Now we cannot blame our teachers and table trainers for this. At the end of the day these rules and detailed methods set a standard by which we are taught and tested upon, and more importantly to many of us, it is what is tested on the COMLEX. So this standardization is inescapable and possibly a necessary evil. Yet there is so much more than what we are exposed to in this standardization. As we all know from anatomy lab, each person’s body is different, sometimes greatly so and with that comes a fair degree of variance in biomechanics. This does not only apply to patients but to us as practitioners as well in modifying procedures to get techniques to work, a fact often lost in lab (unless one had great trainers). In fact, with all the variance, techniques are really a misnomer for what we are taught. OMT techniques are really treatment principles as opposed to a set of specific setups with certain details for execution – a set of guidelines to achieve a certain result; hence why we see a million different ways to accomplish the same “technique.” You will do what works for you, not necessarily what works for someone else.
In addition to the disconnect is the myriad of techniques and methodologies that typically get used in practice and is never seen in the curriculum. Here at Rowan-SOM, a prime example is Balanced Ligamentous Tension (BLT) or Ligamentous Articular Strain (LAS) is a method of treatment that our attendings use every day in practice and yet all we are taught in regards to it is basic conceptual practice done in a single lab. For a technique methodology that can be applied basically anywhere on the body without much contraindication, it would feel like a great oversight. There are plenty of other lost clinical pearls too such as utilizing SI articulation to resolve the majority of SI issues one can find in practice or other time saving techniques. Why are these all lost? It all again comes back to testability on exams and boards.
Yes, what we are taught will often not make sense to use in practice, but at the same time they are necessary to create a foundation from which we can start to understand the underlying principles behind dysfunctions and thereby apply techniques to treat them. However, to combat that which is lost in academic teachings, I would greatly recommend to many students to spend time shadowing OMM faculty in practice or even better, volunteer in a student-run OMM clinic. If not there, attend all the workshops one can go to, especially Convocation. Be exposed to all the seemingly magical possibilities at the pinnacle of the OMM world. Lastly, remember the advice given to me by a certain residency director, “Don’t let education get in the way of your education.”