Osteopathic education dates back to 1892 when the American School of Osteopathy opened its doors in Kirksville, MO. Recognized as the first profession to develop manipulative techniques into a teachable and general system of health care (Brantingham, 1986, Lewit, 1997), and with its focus on patient-oriented approach, it has always emphasized clinical skills mastery. The educational modus operandi has been an apprenticeship and lecturing style where the professor or lecturer has been considered the ultimate source of the knowledge given. Although many excellent clinicians have been educated in this fashion, this authorative style of content delivery also creates many challenges in the current educational climate. Information is easily accessible to students and statements and assumptions made in the classroom are quickly challenged. Shifting roles from lecturers to facilitators may make the lecturer feel less vulnerable, and emphasizing both philosophy and science in teaching research may help both faculty and students to make more balanced and realistic judgments.
There is frequently a tension between the generalist nature of osteopathic education and the evidence-based movement leaving osteopathic students the feeling of existing in a nebulous world of non-science. This may be partly due to the epistemological deficiencies of evidence-based medicine where it cannot accommodate concepts that resist quantitative analysis and therefore cannot logically differentiate human beings from complex machines (Pruessner et al, 1992, Henry et al, 2007). The intellectual basis of osteopathy’s generalist nature whose task is to make sense of a complex system – their patients and those factors or variable that influence those patients’ well-being, rests with an understanding and appreciation of that complexity (Pruessner et al, 1992, Montgomery, 2006, Sweeney, 2006). This is often in contrast to the reductionist reasoning that has governed science for the best part of centuries (Engel, 1988). Moreover, research has a tendency to create fractions within osteopathic schools as it challenges many of the models, myths and monoliths that osteopathic education perpetuates. Faculty and students who rigidly adheres to rules or plans often becomes defensive, whereas those on the opposite end become dismissive. Changing the nature of educational delivery and content may help resolve this tension. Students and faculty should develop philosophical skills and attitudes to (1) examine key assumptions, (2) broaden their perspectives and gain self-knowledge, (3) develop critical thinking skills about the kind of judgments they make, how bias affects their views, and the scope and limits of their knowledge claims, (4) generate tolerance, openness, and skepticism about dogma; and (5) cultivate empathy (Kopelman, 1995).
This presentation will look at osteopathic education and research and with this as the backdrop try contextualize the challenges facing the profession today, and offer perspectives for further development within osteopathy.
Christian Fossum, D.O.
Associate Professor, Norwegian University College of Health Sciences, Oslo, Norway
Doctoral Student, British School of Osteopathy and the University of Bedfordshire, U.K.