Palpation: Research and Education / Key Note

Palpation in osteopathic education and practice struggles to define itself as a transferable skill, possibly due to disparate views or conceptual models. One common view of palpation argues that the assumption that a defined criterion standard is always available or accessible is an epistemological flaw, and that counter to this expectation of a reference standard, skill acquisition comes from immersion in the healing process itself. Driven by current trends of evidence-informed practice is the diametrically opposite view that epidemiology is not open to dispute, and in order to evaluate the clinical utility of a diagnostic tests data on both reliability and validity must be available. Following from the latter view, there has been an increasing shift relegating the importance of diagnostic palpation focusing more on clinical prediction rules (CPR) where meeting predetermined criteria in the clinical presentation determines the suitability for manipulative intervention. Increasing emphasis on CPR partly stems from the presumed lack of reliability and validity of clinical palpatory tests used to determine the presence of dysfunction and because of the unknown or debated relationship between pain and dysfunction.

The above adds to the challenges facing the osteopathic profession emphasizing diagnostic palpation in education and practice. The majority of the profession agrees that the training osteopathic students to become proficient in the use of palpatory diagnosis and the application of osteopathic manipulative techniques requires the development of psychomotor skills and manual dexterity combined with the cognitive reasoning as to how and when to apply it as well as on which patients. There is no consensus on the best way of taking the student through this process. This is possibly rooted in several immediate concerns: (1) there is no standardized method of education to ensure adequate learning opportunities for the students; (2) the literature is inconclusive on the reliability and validity of palpatory diagnosis and (3) the theoretical and biomechanical models underpinning the diagnostic process are inconsistent with contemporary research and may therefore hamper the learning process by inducing wrongful interpretation of findings based on assumptions and expectations. That latter is complicated even further by terminology and model confusion related to osteopathic practice.

What is being doing to address these challenges? This presentation will be a review of the art and science of palpation in osteopathic education and practice will be given drawing upon data from cognitive neuroscience, learning of psychomotor skills, reliability and validity studies and errors and inherent problems with such studies, and teaching methods used in osteopathic education, including classroom instruction and newer developments of instrumentation for accurate measurement, feedback and determination of tests characteristics. Examples will be given from different teaching institutions in Europe and the United States.