mede 8417 - unt health science center · the osteopathic manipulative medicine clerkship reinforces...
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Texas College of Osteopathic Medicine Our mission: Create solutions for a healthier community by preparing tomorrow’s patient-centered physicians and scientists and advancing the continuum of medical knowledge, discovery, and osteopathic health care.
2019 - 2020
OSTEOPATHIC MANIPULATIVE MEDICINE
CLERKSHIP SYLLABUS
MEDE 8417
CLERKSHIP DIRECTORS
Kendi Hensel, DO, PhD, FAAO
CLERKSHIP COORDINATOR
Cari McTaggart
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Table of Contents
Page 3 Clerkship Purpose
Page 3 Osteopathic Manipulative Medicine Clerkship Description
Page 3 General Clerkship Competencies
Page 4 Clerkship Specific Competencies
Page 5 Interprofessional Education
Page 6 CORE Entrustable Professional Activities (EPA’s) For Entering Residency
Page 7 Clerkship Goals and Learning Objectives
Page 8 Required Didactics and Assignments
Page 9 Evaluation and Grading
Page 15 Rotation Sites
Page 17 General Responsibilities
Page 24 Disclaimer
Page 28 Appendices
• Learning Resources
• Didactic Review Syllabus I
• Didactic Review Syllabus II
• Guidelines for the OMM Case Report
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Purpose of the Clinical Clerkship
The clinical clerkships affiliated with the Texas College of Osteopathic Medicine serve to
provide supervised, high quality opportunities for third and fourth year medical students to
apply and transform the declarative medical knowledge and basic clinical skills that they
have acquired into procedural clinical competence, while also functioning as learning
members of health care teams.
The clinical clerkships promote and support TCOM students in developing clinical
competence with emphasis on the core competencies beyond medical knowledge alone.
Clerkships are encouraged to seek opportunities for students to provide Health and
Wellness Counseling, develop improved interpersonal and communication skills,
professionalism, as well as practice-based learning and improvement.
Clerkship Description
The Osteopathic Manipulative Medicine clerkship reinforces the philosophy, principles
and practice of osteopathic medicine for primary care physicians and specialists in a
clinical and hospital setting. This rotation is designed as an opportunity for osteopathic
medical students to develop the clinical skills required for the assessment of health, and
the recognition, diagnosis and treatment of disease, with particular attention to the
Neuromusculoskeletal system. Students will be expected to recall and improve upon
techniques learned in the first two years of the curriculum, and be exposed to additional
osteopathic manipulative techniques. The application of the osteopathic philosophy and
principles in the care of patients will be emphasized. A basic foundation of academic,
research, and clinical experience is included, integrating the basic medical sciences and
osteopathic philosophy and principles with the clinical manifestations of health and
disease.
General Clerkship Competencies
The goals of the Clinical Clerkships are to enable TCOM students to achieve competence
as graduate osteopathic medical students. As such, the goals of the clerkship curriculum
are represented by the AACOM Osteopathic Core Competencies for Medical Students.
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For the purposes of the TCOM Clinical Clerkship Competencies, the AACOM 14
Competencies have been condensed into the following 8:
1. Osteopathic Principles and Practices OPP
2. Medical Knowledge MK
3. Patient Care PC
4. Interpersonal and Communication Skills ICS
5. Professionalism P
6. Practice-Based Learning and Improvement PBLI
7. Systems-Based Practice SBP
8. Health Promotion/Disease Prevention HPDP
Clerkship Specific Competencies
The student on OMM service shall be expected to acquire and demonstrate the following
skills during the course of the rotation:
1. Obtain a complete and/or problem oriented history from patients
2. Perform a complete physical examination with particular attention to the osteopathic
structural exam and/or respiratory/circulatory osteopathic exam.
3. Develop increased confidence in the specific tasks of the neurologic and
musculoskeletal examination.
4. Demonstrate professional demeanor and provide compassionate and respectful care to
patients
5. Review and develop a thorough understanding of anatomy, with particular attention to
the musculoskeletal system.
6. Participate in documentation (to an allowable extent) and improve these skills
7. Provide information to patients regarding stretching, aerobic activity, and strength
training
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8. Identify urgent and emergent conditions that may present primarily with
musculoskeletal pain
9. Identify urgent and emergent conditions that may present at the time of the office visit
that may require intervention/stabilization with transfer to a hospital facility for further
assessment and management.
10. Understand when steroid injections, viscosupplementation, dry needling or
acupuncture may be appropriate.
11. Confidently and accurately perform, to any appropriate region, Osteopathic
Manipulative Techniques, including: Muscle Energy, Counterstrain, Facilitated Position
Release, Still’s Technique, High-Velocity/Low-Amplitude, Articulatory, Balanced
Ligamentous Tension, Visceral Techniques, and Osteopathic Cranial Techniques.
12. Identify when Physical Therapy referral would be appropriate.
13. Review the Choosing Wisely topics relevant to OMT and understand appropriateness
of certain diagnostics and interventions.
14. Develop an appreciation for the biopsychosocial model and how emotional/social
issues may affect physical complaints.
15. Identify when opioid management is appropriate, its adverse effects, and when to
advise discontinuation.
16. Appropriately identify when OMT may be contraindicated.
17. Develop an appreciation for the appropriate use of imaging and laboratory studies.
Interprofessional Education/Practice
Competency Domain 1: Values/Ethics for Interprofessional Service
Competency Domain 2: Roles/Responsibilities
Competency Domain 3: Interprofessional Communication
Competency Domain 4: Teams and Teamwork
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During the course of the clerkship, there will be an opportunity to interact with students
from the Department of Physical Therapy within the School of Health Professions. This
will take the form of an online discussion with prompts from faculty at either or both
schools. You will be required to comment on a question or reply to a comment from a
student from the other program. Professionalism and appropriate netiquette are a must
for this activity. Please see the canvas page for details on this activity.
CORE Entrustable Professional Activities (EPAS) For Entering Residency
These are the skills and behaviors expected of first year residents on day one of their
residencies, as described by the ACGME residency directors and described in detail in
the AAMC document of the above name. It is hoped that clinical clerkship directors and
facilitators will make as much effort as possible to ensure that TCOM students have
opportunities to practice these skills and behaviors on all clinical rotations.
1. Gather a history and perform a physical examination.
2. Prioritize a differential diagnosis following a clinical encounter.
3. Recommend and interpret common diagnostic and screening tests.
4. Enter and discuss orders and prescriptions.
5. Document a clinical encounter in the patient record.
6. Provide an oral presentation of a clinical encounter.
7. Form clinical questions and retrieve evidence to advance patient care.
8. Give or receive a patient handover to transition care responsibility.
9. Collaborate as a member of an Interprofessional team.
10. Recognize a patient requiring urgent or emergent care and initiate evaluation and
management.
11. Obtain informed consent for tests and/or procedures.
12. Perform general procedures of a physician.
13. Identify system failures and contribute to a culture of safety and improvement.
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Clerkship Goals and Learning Objectives
The goal of the Department of Manipulative Medicine rotation is to provide the student
doctor with an opportunity to broaden professional understanding and application of
osteopathic philosophy, principles and practices. During the rotation the student doctor
will develop further by applying his/her skills to patient care and academic activities. The
student doctor is a valued member of the clinical staff and academic department.
The rotation is based in the Manipulative Medicine Clinic (UNTHSC Health Pavilion, 6th
floor) and at each assigned preceptor’s clinic. The student doctor gains exposure to
variations in style approaches to patients, and in the application of osteopathic philosophy
and principles. Student doctors work with residents and department faculty. By the end of
the rotation, the student doctor will be able to:
• Incorporate osteopathic manipulative medicine and, specifically, osteopathic
structural exam, manipulative diagnosis and treatment into the clinical and/or
hospital setting. OPP, MK, PC
• Differentiate and apply appropriate OMT techniques to treat common conditions
that present in the clinical and/or hospital setting. OPP, MK, PC
• Exhibit proficiency in history-taking and physical exam skills. MK, PC, P
• Demonstrate comprehension of material covered in the didactics and clinical
setting by passing the COMAT exam at the completion of the OMM clerkship.
OPP, MK, PC
Treatment opportunities are provided in primary care settings with scheduled clinical
patients and/or hospital patients, where hospital service is established. The student
doctor is expected to see and treat patients in the clinic when assigned and to be
prepared to participate in all patient care responsibilities. These include reviewing patient
case histories and progress notes, locating imaging prior to the patient's office visit and
consulting with the supervising physician or faculty for any questions.
Other responsibilities include:
• Documenting patient care activities in a weekly log. ICS, PBLI
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• For student doctors assigned to OMM faculty, attendance and participation as a
teaching assistant in all Year I and II Lab activities and Student Assistant
preparatory sessions. P, PBLI
Required Didactics and Assignments
Working under the supervision of faculty members during the OMM core rotation, student
doctors evaluate and treat private patients in the preceptor’s practice, the OMM Health
Pavilion offices and in a hospital environment. The student observes and, where
appropriate, assists in the interview, examination and treatment of patients. Opportunities
for discussion with the attending physician are available and conducted in private. These
activities are documented in a weekly Procedure Log, submitted by 11:59 p.m. each
Sunday of the rotation.
Resources are delivered digitally to all rotation participants using UNTHSC’s Canvas
platform. These resources augment the Gibson Lewis Library guides, tutorials, collections
and services and support successful completion of the required coursework and the
COMAT exam.
The COMAT exam, covering topics pertinent to the OMM clerkship and Osteopathic
principles generally, is administered online on the last Friday for DFW-based clerkships.
The exam is proctored on campus and taken online. For student doctors in remote
locations, the exam is administered on the last Friday of the rotation by the remote site
coordinator. Failure of a COMAT exam results in a grade of incomplete in the rotation. If
a student fails a core COMAT examination, he/she will be given one opportunity to
remediate the exam. Successful remediation will permit the student to receive a maximum
grade of 70 for this component, pending the successful passing and completion of all
other components of the course requirements will result in a pass for the course. Failure
of any remediation constitutes a failure in the course.
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Evaluation and Grading
The final grade of Honors/Pass/Fail for the core rotation is derived from the following
components:
Component Evaluation Tool Minimum Score Required Student Clinical Performance
Clinical Clerkship Evaluation
Upon completion of this clerkship students should perform the behaviors outlined within the “expected” level of each competency rated on the Clinical Clerkship Evaluation and the AACOM Osteopathic Core Competencies for Medical Students. Student evaluations with ratings of below expected for any competency may result in failure.
Standardized Testing
OMM COMAT Exam
Scaled Score of 70
OMM Internal Quizzes
Pre-Rotation, Weekly and Didactic Quizzes
Pre-Rotation Quiz - complete Weekly Quizzes – Score of 85 or above on each Didactic Quiz - Score of 70 or above
IPE – OMM/PT Discussion online Complete
Choosing Wisely
Discussion at 2nd Didactic
Complete
Institute for Healthcare Improvement Patient Safety #105
Completion Certificate
Complete and upload by posted due date
Procedure Log
Weekly procedure records
Score of 70 or above (-10 points per week if not completed by Sunday of each week)
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Students must achieve the minimum required score in each component area to pass the
course.
Students may be eligible for “Honors”, designated by the Clerkship Director, if they meet
all expected requirements to pass the clerkship and:
• Score 91 or above on the COMAT exam for that clerkship. The score will be set
and approved on an annual basis by the clerkship director, the assistant dean for
clinical education, and the senior associate dean for academic affairs.
• Achieve an “Exceeds Expectation” on at least one of their clinical evaluation
competency areas.
• Do not have a “Below Expectation” on any clinical evaluation competency area.
• Do not violate any Clinical Education policy or procedure while on the rotation, e.g.
attendance policy.
• The final designation for Honors is at the discretion of the Clerkship Director for
Core clerkships and does not apply to elective rotations.
There is a Pre-Rotation Quiz, three weekly reading quizzes and a Didactic Review Quiz.
All are required. You must complete the Pre-Rotation quiz, pass the weekly quizzes
(score of 85 on each) and Didactic quiz (minimum grade of 70) by the deadline. If
minimum score is not achieved on the weekly quizzes, additional opportunities will be
given. If minimum score is not achieved on the didactic quiz, one opportunity to
remediate may be granted.
The Procedure Log will be graded on timeliness (due weekly on Sunday) and having
entered all procedures. Ten (10) points will be deducted per week for entries not made or
completed by the time due. A minimum score of 70 is required to pass this component.
This is graded as pass or fail.
Students will participate in an IPE discussion on Canvas one week during the rotation with PT students, the Choosing Wisely discussion at the second didactic session and complete Institute for Healthcare Improvement Patient Safety #105. These are scored
complete/incomplete and are a required component to finish the course. Failure to
complete them all may result in a failure of the course.
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Clinical Performance and skills are assessed by each attending with which the student
has contact. Professionalism and work habits are a significant portion of the clinical
assessment. These include the student attitude, demeanor, and interaction with
attendings, peers, and staff. Character qualities such as punctuality, honesty, bedside
manner, integrity, etc. are important in your professional development. Each student will
practice case presentations until demonstrating adequate ability to convey relevant
patient presentation, history, physical exam findings, appropriate differential diagnosis
and treatment plan. Preceptor must directly observe student in the collection and
presentation of the above information, give feedback and re-observe until appropriate skill
level is demonstrated. This is graded as pass or fail. Upon completion of this clerkship
students should perform the behaviors outlined within the “expected” level of each
competency rated on the Clinical Clerkship Evaluation and the AACOM Osteopathic Core
Competencies for Medical Students. Student evaluations with ratings of below expected
for any competency may result in failure.
A passing score of at least 70 (scaled) on the OMM COMAT exam is a required
component of this course. Testing and Evaluation Services will notify students of exam
date, location, and start time. Students must be seated in their designated seats prior to
the published exam time. Any student arriving late to the COMAT exam will receive no
additional time to take the exam. They will be required to stop taking the examination at
the published stop time. A student will lose 10 points on the exam for late arrival. If the 10
point reduction results in a score below 70, the student will not be required to remediate
the exam. However, the score will be recorded as is. See also section 4.2.1 of Clinical
Education Policy and Procedure Manual for COMAT exam and remediation procedures.
A written case report, soft tissue clinic or health fair attendance, make up time in the
clinic, or other activities at the discretion of the clerkship director may be assigned as a
remediation requirement. If a case report is assigned, follow the Case Report Guidelines
and Rubric as included in the Appendix 4. Turnitin will be utilized to obtain an originality
report for any Case Report submitted.
If a student fails any of the listed components, he/she may be given one opportunity to
remediate that requirement at the discretion of the course director. Successful
remediation will permit the student to receive a passing grade for that component,
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pending the successful passing and completion of all other components of the course
requirements. Failure of any remediation constitutes a failure in the course. Failure and
remediation policy shall be directed by the Vice President for Student Affairs as set forth
in the Uniform Policies.
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Rotation Sites
DFW Metroplex
UNT Health – Health Pavilion UNTHSC
Dr. R. Todd Dombroski, Dr. Kendi Hensel, Dr. Yein Lee, Dr. David Mason,
Dr. Dante Paredes, Dr. Ryan Seals, Dr. Sajid Surve
855 Montgomery St, 6th Floor, Fort Worth, TX 76107
Local Private Clinics under the direction of:
Dr. Ade Adedokun
Dr. Ben Dagley
Dr. Mark Dirnberger
Dr. James Irvine
Dr. Samuel Lee
Dr. Joseph Moran
Dr. Chau Pham
Dr. Arthur Speece
Longview, TX
Christus Good Shepherd Medical Center
Dr. John McDonald, Dr. Benjamin Cameron
700 E. Marshall Ave., Longview, TX 75601
Conroe, TX
Lonestar Family Health/ Conroe Family Medicine Residency Program
Dr. Michael Abdelsayed
16902 Southwest Frwy, Physicians Pavilion, Ste 100
Sugar Land, TX 77479
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Corpus Christi, TX
Dr. Marian Hendricks
5833 Spohn Dr., Bldg. 601, Corpus Christi, TX 78414
Dr. Jacqueline Phillips
3315 S. Almeda Street, Corpus Christi, TX 78411
Houston, TX
Dr. Adam Weglein
6800 West Loop S., Ste 500, Bellaire, TX 77401
Weatherford, TX
Dr. Ron McDaniel
1710 Santa Fe Drive, Weatherford, TX 76086
Faculty and Staff
University Faculty
• Kendi Hensel, D.O., Ph.D., FAAO, Clerkship Director, Associate Professor
• Ryan Seals, D.O., Interim Chair Family Medicine and Osteopathic Manipulative
Medicine, Associate Professor and Year II Course Director
• R. Todd Dombroski, D.O., Associate Professor
• Yein Lee, D.O., Assistant Professor and Year I OMM Medical Practice Course
Director
• David Mason, D.O., MBA, FACOFP, Interim Senior Associate Dean, FM/ONMM
Residency Director, Associate Professor
• Dante Paredes, D.O., Assistant Professor
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• Sajid Surve, D.O., Associate Professor and Performing Arts Medicine Fellowship
Program Director, Year 1 Foundations of Osteopathic Manipulative Medicine
Course Director
• Stuart Williams, D.O. , Associate Professor
Adjunct Clinical Faculty
• Dallas/Fort Worth Metroplex (Listed under rotations sites, local private clinics)
OMM CORE Rotation Staff
• Cari McTaggart, Clerkship Coordinator
MET-552
817-735-0234
UNTHSC Neuromuscular Medicine Clinic Contact
• Lenora Salazar, Supervisor, Clinic Operations
Health Pavilion - 6th Floor
817-735-5160 / 817-735-5003
General Responsibilities
The OMM Rotation Schedule will be posted on Canvas on 3 June 2019; students will
have ten (10) days to make switches of location with another student within the scheduled
period. In order for switches to be accepted, an email from both students requesting the
change, with an explanation for the request is required. Site only change requests will not
be considered without a switch with another student. Once the ten (10) days have
passed, no further changes to the schedule will be allowed for the remainder of the
academic year. The OMM rotation pre-requisites, assignments and assessments are
delivered online via UNTHSC Canvas. The site opens to the student at 5 p.m. on the
Friday before the first day of rotation
• The Pre-Rotation quiz is taken on the first day of the rotation.
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• NextGen Instructions and NMM template video are to be reviewed prior to the start
of the rotation if you are assigned to the DFW area
• The Procedure Log is submitted weekly, due each Sunday by 11:59pm .
• Choosing Wisely to be reviewed and discussed during the second didactic session
• IPE OMM/PT Discussion will occur during one week of the rotation, participation
required
• IHI – Institute for Healthcare Improvement Patient Safety #105
• There are three quizzes, due on Sundays through the rotation.
• The didactic review quiz is due during the last week of the rotation.
• Exit interviews are done via online survey and if requested an in-person
appointment can be scheduled with the clerkship director.
• Two textbooks are provided for students while on rotation. The 5-Minute
Osteopathic Manipulative Medicine Consult and Osteopathic Manipulative
Medicine Review for the Boards, Third Edition. These books must be returned in
good condition at the end of the rotation. Students are responsible for all lost or
damaged books.
• Final clinical evaluation must be completed with your preceptor during the rotation.
It is the student’s responsibility to make an appointment with the preceptor to get
this completed during the rotation; this is completed in eMedley. Additionally this
document may be reviewed at a scheduled meeting with the clerkship director,
should the student request it, at the end of the rotation. The coordinator will advise
of the scheduled time for each requested appointment
• Professional demeanor with patients and colleagues is expected at all times.
• Completion of all site specific online training is required.
• Strict observance to the dress code established at T.C.O.M. is observed in the
clinic, hospital and practice training areas. Clinic jackets and badges are required
and, per clinic policy, the use of perfume or fragrances is not allowed.
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• Proper lab attire is required for didactics sessions on the first and third Monday
afternoons of the rotation. Lab attire includes t-shirts (short or long sleeve), yoga
pants, track pants or sweatpants.
• The student doctor is expected to respect the patient's right to privacy with
confidentiality and to respect the physician-patient relationship.
• During the rotation the student doctor will be held responsible for conduct
consistent with the T.C.O.M. Code of Student Conduct.
(http://www.hsc.unt.edu/Departments/StudentAffairs/StudentPolicyHandbook/Stud
entCodeofConductandDiscipline.cfm)
5.2 ATTENDANCE
5.2.1 Absences in 3rd & 4th Year
Absences in 3rd Year
The focus of the clinical experience in years 3 and 4 is patient care. 100% attendance is,
therefore, required to be certain that continuity of care is maintained. Students may not
miss the first day of any clinical rotation. It is understood; however, that certain situations
may arise that will result in absence from required daily participation.
In such instances the following procedures will be observed:
• Students are provided with 5 education days to use during third year to attend
conferences, RAD, workshops, etc. In the event a student requires more than 5
education days, a student may submit for an extension by contacting the Office of
Clinical Education.
• Students are allowed up to 8 absences in each of the fall and spring semesters
total. Any absences beyond that must be made up in period 13 to complete the
third year and before progressing to fourth year. Any combination of time out (excluding PE) that results in a student missing more than 4 days of a 4-week block or 6 days of a 6-week block will result in failure of the clerkship.
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• All absences shall require submission of the electronic 3rd Year Request for
Absence from Clerkship form a minimum of 10 business days before the start of
the rotation to allow time for schedule adjustments.
• Absences due to emergent reasons such as illness, the absence request is due
immediately with supporting documentation. Students are required to notify their
site/preceptor and clerkship coordinator of all emergent leave.
• Students are allowed up to three days for the COMLEX PE exam- 1 day for travel
to the exam, the test day, and an additional day for return travel. Requests beyond
this may be denied by the Director of Clinical Education. You may not schedule
your COMLEX PE exam on a date which causes you to miss the orientation day
for a rotation. COMLEX PE is not considered part of your absences and must be
requested within 48 hours of scheduling the exam date.
Unapproved absences or absence in excess of the above policy will require remediation
or result in a failing grade at the discretion of the Office of Clinical Education.
Failure to notify the clerkship director, rotation supervisor and Office of Clinical Education of any absence will be considered neglect of duty and may result in a failing grade for the clerkship.
Exposure to Blood Borne Pathogens
Universal Precautions: The term “universal precautions” refers to infection control which
presumes that every direct contact with body fluids is potentially infectious. The
Occupational Safety and Health Administration (OSHA) regulations for health care
professionals who are considered to be at risk of occupational exposure to bloodborne
diseases can be found at https://www.osha.gov/SLTC/bloodbornepathogens/index.html
Bloodborne pathogens refer to pathogenic microorganisms that are present in human
blood and can cause disease in humans (e.g. HBV, HIV, etc.). Exposure Incident means
“a specific eye, mouth, other mucous membranes, non-intact skin, or parenteral contact
with blood or potentially infectious materials.” Contact can occur via a splash, needle stick
(including acupuncture needles), puncture/cut wound from sharp instrument, or human
bite. Other potentially infectious body fluids other than blood include semen; vaginal
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secretions; pleural, pericardial, synovial, peritoneal, cerebral spinal, amniotic fluid; saliva
during dental procedures; and any other body fluid visibly contaminated with blood.
Policy/Procedure: If a TCOM medical student is exposed to bloodborne pathogens either
by direct contact with blood or other body fluids via the eyes, mucous membranes, human
bite, or sharps (e.g., needle stick, lancet stick, scalpel cut, etc.) while on rotation, it is to
be handled as an EMERGENCY SITUATION.
Post Exposure Protocol
• Immediately wash exposed areas with soap and water.
• If splashed in eyes or mouth, flush with large amounts of water.
• It is critical that you are treated within the first two hours after injury.
• Notify supervisor and follow rotation site exposure protocols (see below for
addresses).
• If facility is not equipped to handle exposure, contact Harris Occupational Health
Clinic (HOH) or appropriate remote site location listed below.
• If HOH or remote listed site is not available, or you are more than 30 minutes from
campus, go to the nearest ER and use your student health insurance.
• You are required to notify Student Health of any care received at another facility.
Dallas Fort Worth & Weatherford Area students with exposures to bloodborne pathogens which occur M-F, 8-5 should report to:
Harris Occupational Health 1651 W. Rosedale, Ste. 105
Fort Worth, TX 76104 T: 817-250-4840 F: 817-878-5250
For exposures occurring afterhours, students should report to the nearest emergency room and use your student health insurance. Conroe remote site students with exposures to bloodborne pathogens which occur M-F, 8-5, should report to the Nurse Manager at:
Lone Star Family Health Center 605 S. Conroe Medical Dr.
Conroe, TX 77304 936-539-4004.
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For exposures occurring afterhours, students should report to :
Emergency Department Conroe Regional Medical Center
504 Medical Center Dr. Conroe, TX 77304
936-539-1111 Longview remote site students with exposures to bloodborne pathogens which occur M-
F, 8-5, should report to:
CHRISTUS Good Shepherd Medical Center Employee Health 1621 N 4th St, Suite 1 Longview, TX 75601
903-315-5154
For exposures occurring afterhours, students should report to:
Emergency Department CHRISTUS Good Shepherd Medical Center
700 E Marshall Ave. Longview, TX 75601
903-315-2000 Corpus remote site students with exposures to bloodborne pathogens should report to:
Christus Spohn OCC Health Nurse at Christus Spohn
also immediately report to your attending and Dr Hinojosa
Bay Area report to charge nurse and medical education office proceed directly to emergency room for treatment
Patient Care Supervision
Cross Listed as TCOM Procedure 5.4 Patient Care Supervision TCOM students and
residents engaged in patient care at UNTHSC operated facilities or as participants in
UNTHSC affiliated training programs shall do so under the supervision of a licensed
health care provider who has been credentialed to provide that scope of care. Visiting
students and residents working in UNTHSC facilities or with UNTHSC employed faculty
shall be similarly supervised.
1. TCOM students and residents engaged in patient care activities shall at all
times be supervised by a duly licensed member of the clinical faculty who
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retains privileges for the scope of care being provided. Faculty or a similarly
credentialed designee (resident or fellow with approved privileges) must be
immediately available in the facility where the activity is taking place. Students
who have demonstrated competence to the faculty may perform patient
histories and physical examinations without immediate supervision if directed to
do so by faculty.
2. TCOM students and residents may form such additional tasks as may be
directed by supervising faculty upon demonstrating competence to perform
those tasks. In most instances, the provision of patient care shall require the
immediate presence of a duly credentialed supervising provider who has
ascertained the trainees’ level of proficiency.
3. TCOM shall assure distribution of this procedure to students, residents and
faculty as part of the orientation plan for clinical training.
4. Students or residents who fail to follow procedures for clinical supervision may
be removed from patient care activities at the discretion of the dean or her/his
designee pending a disciplinary review.
5. Faculty who fail to observe supervision procedures may be removed from
participation in TCOM training programs and may be further subject to
disciplinary action.
Medical Student Use of Chaperones While on rotations, it is important for you to make your position clear to patients by
introducing yourself as a “medical student”. All students should review with their
preceptor and site all chaperone policies to ensure they are in compliance on this rotation.
Without question, any portion of an exam that involves breast, pelvic or rectal exams, and
even during certain portions of an interview that can involve sexual history, should not be
done alone with the patient.
Health Services Students in the DFW & Weatherford area may access health services at the UNTHSC Student Health Clinic.
UNTHSC Student Health Clinic
855 Montgomery St 3rd Floor North
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Fort Worth, TX 76107 817-735-5051
Students in the Conroe area may access health services at Lone Star Family Health Center’s Spring Location.
Lone Star Family Health Center- Spring 440 Rayford Rd. Spring, TX 77386
936-539-4004
Students in the Longview area may access health services at CHRISTUS Trinity Clinical Internal Medicine.
CHRISTUS Trinity Clinical Internal Medicine 703 E. Marshall Ave
Suite 1001 Medical Plaza II
Longview, TX 75601 903-753-7291
Students in the Corpus Christi area may access health services at Prompt Immediate Care.
Promptu Immediate Care 5638 Saratoga Blvd
Corpus Christi, TX 78414 361-444-5280
Promptu Immediate Care 4938 S Staples
Ste E-8 Corpus Christi, TX 78411
361-452-9620
Disclaimer
The OMM clinical clerkship is operated in accordance with the policies and procedures of
the academic programs of Texas College of Osteopathic Medicine as presented in the
class Clerkship Protocol, Student Handbook and College Catalog.
The provisions contained herein do not constitute a contract between the student and the
College. These provisions may be changed at any time for any reason at the discretion of
the clerkship director. When necessary, in the view of the College, appropriate notice of
such change will be given to the student.
Applicable Policies
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All policies of the UNTHSC/Texas College of Osteopathic Medicine will be observed in
the MEDE 8417 course. Students are expected to be familiar with those policies as
presented in the Student Handbook and College Catalog. In general, course policies are
contained within the body of this syllabus. You are responsible for reading and
understanding the contents of this syllabus. Any questions regarding this document
should be directed to the Course Director for clarification.
http://www.hsc.unt.edu/policies/PoliciesList.cfm
Policy Statement
Each student enrolled at UNT Health Science Center is responsible for knowing current
academic policies and scholastic regulations, general and specific requirements, and
operational policies that apply to registration and instruction.
The Health Science Center reserves the right to amend or add to the academic policies
and improves the quality of education and is introduced in a fair and deliberate manner
with appropriate notice provided to all students affected by the changes. For a detailed
view of all UNTHSC policies, see: http://www.hsc.unt.edu/policies/
Academic Integrity/Honor Code
Enrollment is considered implicit acceptance of the rules, regulations, and guidelines
governing student behavior at UNT Health Science Center. It the responsibility of the
student to be familiar with all policies governing academic conduct which can be found in
the UNTHSC Student Catalog, Student Policy Handbook and the Student Code of
Conduct and Discipline which are located on the UNTHSC Internet at http://www.hsc.unt.edu/Sites/DivisionofStudentAffairs/
Academic Assistance
Students may schedule one-on-one academic assistance with faculty through in-person
appointments, telephone calls or e-mail communication. Academic assistance is also
available through the UNTHSC Center for Academic Performance (CAP).
http://www.hsc.unt.edu/CAP
Americans with Disabilities Act
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The University of North Texas Health Science Center does not discriminate on the basis
of an individual’s disability and complies with Section 504 and Public Law 101-336
(American with Disabilities Act) in its admissions, accessibility, treatment and employment
of individuals in its programs and activities. UNTHSC provides academic adjustments and
auxiliary aids to individuals with disabilities, as defined under the law, who are otherwise
qualified to meet the institution's academic and employment requirements. For assistance
contact the Equal Employment Opportunity Office at the health science center. Reference
Policy 7.105 Americans with Disabilities Act Protocol in the Student Policy Handbook and
online at: http://www.hsc.unt.edu/policies/
Course and Instructor Evaluation
It is a requirement of all students that they are responsible for evaluating each of their
courses and instructors as defined in UNTHSC Policy 7.120 Student Evaluation of
Courses and Instruction. Please adhere to all guidelines established in the policy.
http://www.hsc.unt.edu/policies/
Course Assessment
In some instances, courses will have a course assessment that will provide immediate
feedback to the course director regarding progress of the course identifying potential
problems and determining if student learning objectives are being achieved.
(Provide all pertinent information regarding the specifics of the groups in the syllabus as
defined in UNTHSC Policy 7.120 Student Evaluation of Courses and Instruction.)
Social Media Policy Statement
Social media has created unique opportunities for interaction, communication, and
networking. Students are expected to abide by the Student Code of Conduct & Discipline
and the Health Insurance Portability and Accountability Act (HIPAA) when using social
media by not revealing patient/client/research subject information, private content, or
proprietary information regarding patients/clients/research subjects of the institution.
The purpose of this policy is to provide students with guidelines and regulations for
appropriate social media use in order to uphold confidentiality and privacy laws and
agreements.
https://app.unthsc.edu/policies/Home/GetFile?policyNumber=07.115
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Syllabus Revision
The syllabus is a guide for this class but is subject to change. Students will be informed of
any change content or exam/assignment dates.
Turnitin and the Family Education Rights and Privacy Act (FERPA)-If applicable
NOTE: UNTHSC has contracted with Turnitin.com for plagiarism detection services.
Use of Turnitin.com is entirely in the discretion of the instructor, but use of such a service
requires that you provide notice (via syllabus) to your students that you are using such
services. In addition, instructors who use Turnitin should be sure to remove student
identifiable information from the work before sending to Turnitin or receive written
permission from the student. There are two methods for using Turnitin for written
assignments. Please refer to the wording guidelines and consent form located on the
Faculty Affairs website at
http://www.hsc.unt.edu/Sites/OfficeofFacultyAffairs/index.cfm?pageName=Turnitin
Zero Tolerance for Sexual Violence and Harassment
All students should be able to study in an atmosphere free of harassment, sexual violence
and gender discrimination. Title IX makes it clear that violence and harassment based on
sex and gender is a Civil Rights offense subject to the same kinds of accountability and
the same kinds of support applied to offenses against other protected categories such as
race, national origin, etc. If you or someone you know has been harassed or assaulted,
you can find the appropriate resources on the UNT Health Science Center’s website:
http://web.unthsc.edu/info/200304/student_affairs/355/title_ix_reporting
The Texas College of Osteopathic Medicine shall not discriminate on the basis of race, ethnicity, color, sex, sexual orientation, gender, gender identity, religion, national origin, age or disabilities.
We reserve the right to make clinical assignments based on needs and availability.
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Appendix 1
Learning Resources Required Textbooks
American Osteopathic Association. (2011). Foundations for Osteopathic Medicine.
Philadelphia: Seffinger, Michael A. Wolters Kluwer.
Foundations for Osteopathic Medicine 4th ed., 2018
Recommended Reading
DiGiovanna, Eileen L.; Schiowitz, Stanley; Dowling, Dennis J. (Eds.). (2005). An
Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Philadelphia: Lippincott
Williams & Wilkins.
An Osteopathic Approach to Diagnosis and Treatment
The Pocket Manual of OMT: Osteopathic Treatment for Physicians (Book with Access
Code). (2010) Beatty, David R.; Li, To Shan; Steele, Karen M., Lippincott, Williams and
Wilkins. 2nd Edition.
The Pocket Manual of OMT: Osteopathic Treatment for Physicians 3rd ed., 2016
Nicholas, Alexander, & Nicholas, Evan A. (2016). Atlas of Osteopathic Techniques (3rd
Edition). Philadelphia: Wolters Kluwer.
Atlas of Osteopathic Techniques
Magoun, Harold. (Ed.). (1976). Osteopathy in the Cranial Field (3rd ed.). Kirksville, MO;
Journal Printing Co.
Osteopathy in the Cranial Field
Hoppenfeld, Stanley, & Hutton, Richard. (1976). Physical Examination of the Spine and
Extremities. New York: Appleton-Century-Crofts.
Physical Examination of the Spine and Extremities
Greenman, Philip E. (2003). Principles of Manual Medicine, (3rd ed.). Philadelphia:
Lippincott Williams & Wilkins.
Principles of Manual Medicine
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Nelson, Kenneth E., & Glonek, Thomas. (Ed.) (2007). Somatic Dysfunction in Osteopathic
Family Medicine. Philadelphia: Lippincott Williams & Wilkins.
Somatic Dysfunction in Osteopathic Family Medicine
Kuchera, Michael L. & Kuchera, William A. (1991). Osteopathic Considerations in
Systemic Dysfunction (2nd ed.). Kirksville, MO: Kirksville College of Osteopathic Medicine.
Osteopathic Considerations is Systemic Dysfunction
Kuchera, William. (1992). Osteopathic Principles in Practice (2nd ed.). Kirksville, MO:
Kirksville College of Osteopathic Medicine.
Osteopathic Principles in Practice
Channell, Millicent King & Mason, David C (2009), The 5-Minute Osteopathic
Manipulative Medicine Consult, Lippincott Williams & Wilkins
The 5-Minute Osteopathic Manipulative Medicine Consult
Schuenke, Michael; Schulte, Erick; Schumacher, Udo.(Eds.). (2010).Thieme Atlas of
Anatomy; General Anatomy and Musculoskeletal System. Stuttgart; New York: Thieme.
Thieme Atlas of Anatomy; General Anatomy and Musculoskeletal System
Jones, Lawrence H.; Kusunose, Randall S., Goering, Edward K. (1995). Strain and
Counterstrain (2nd ed.). Boise, Idaho: Jones Strain-CounterStrain, Inc.
Strain and Counterstrain
Board Review Books
Crow, William Thomas. (2016). Osteopathic Manipulative Medicine Review for Boards A
Study Guide for COMLEX and Osteopathic Certifying Boards.
Osteopathic Manipulative Medicine Review for Boards
Savarese, Robert G.; Adesina, Adeleke T.; Capocianco, John; Reed, Grant. (2018). OMT
Review; A Comprehensive Review in Osteopathic Medicine. S.I: Savarese.
OMT Review; A Comprehensive Review in Osteopathic Medicine
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Appendix 2
Didactic Review Syllabus I
Orientation Lecture: 3rd Year OMM Review
This lecture provides students with general Osteopathic Principles and Practices.
Upon completion, the student should be able to:
• Explain the basic principles of the Osteopathic Concept. OPP
• Identify anatomical landmarks. OPP, PC
• Perform a neuromusculoskeletal examination. OPP, MK
• Describe the barrier concept and perform motion on a patient. OPP, MK, PC
• Define Somatic Dysfunction. OPP, PC
• Use the proper terminology in describing somatic dysfunction. OPP
• Recognize tissue texture (T) changes, physiologic asymmetry (A) and deficiencies
in ranges (R) of motion as well as elicit areas of tenderness (T) on a patient in the
cervical, thoracic, lumbar, sacral, pelvic and upper and lower extremities (TART).
OPP
• List and describe the performance of three direct methods and three indirect
method used to treat somatic dysfunction. OPP, MK
• Describe the physiology of each region as it applies to normal motion and somatic
dysfunction. OPP, PC
• Treat somatic dysfunction of each region with direct and indirect methods utilizing
a variety of activating forces. OPP, MK
• Describe how somatic dysfunction of each region can effect or be affected by other
structures or organ systems in the body (somato-visceral/viscero-somatic
dysfunction). OPP, MK, PC, P
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Appendix 3
Didactic Review Syllabus II
Clinical Applications
1. Ear, Nose, Throat
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common ENT. These include otitis media, sinusitis, vertigo rhinitis,
pharyngitis, tonsillitis and allergies (OPP, MK, PC).
The student should be able to identify the major elements of the ENT anatomy and
physiology. These include: ear, nose & throat structures and related sympathetic and
parasympathetic innervation and lymphatic drainage (OPP, MK).
2. Cardiovascular
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common cardiovascular problems. These include: Hypertension, Congestive
heart failure, Arrhythmia, and Edema (OPP, MK, PC).
The student should be able to identify the major elements of the cardiovascular anatomy
and physiology. These include: Coronary arteries, myocardium, pericardium, valves,
large arteries and veins, lymphatic drainage and nerve supply (MK).
3. Pulmonary
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common pulmonary problems. These include: Asthma, COPD, Restrictive
Lung Disease, Pneumonia, and Acute Bronchitis (OPP, MK, PC).
The student should be able to identify the major elements of the pulmonary anatomy and
physiology. These include: Sibson’s fascia, diaphragm, central tendon, thoracic wall
(ribs, sternum, vertebrae, and musculature), lungs, bronchi, pulmonary arteries and veins,
lymphatic drainage, pleura, pulmonary ligaments, and nerve supply (MK).
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4. Gastrointestinal
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common gastrointestinal. These include gastritis and peptic ulcer disease,
irritable bowel syndrome and postoperative ileus (OPP, MK, PC).
The student should be able to identify the major elements of the gastrointestinal anatomy
and physiology. These include: abdominal wall, esophagus, stomach, small and large
intestine, pancreas, liver, spleen, abdominal aorta, inferior vena cava, portal venous
system, lymphatic drainage and innervation (OPP, MK).
5. Genitourinary
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common genitourinary problems. These include pyelonephritis, cystitis, dysmenorrhea, pelvic pain, prostate and BPH, low back pain, short leg syndrome (OPP,
MK, PC).
The student should be able to identify the major elements of the genitourinary anatomy
and physiology. These include kidney, bladder, ureter, male/female reproductive system,
sacrum/pelvis, psoas/piriformis/pelvic floor muscles and fascia, iliolumbar ligament,
diaphragms and ribs, lymphatic drainage and innervation (OPP, MK).
6. Geriatrics
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a geriatric
patient as it relates to common problems within this population. These include low back pain, gait and balance issues, Parkinsonism, and dementia (OPP, MK, PC)
7. Neurology
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a patient as
it relates to common neurologic problems. These include: headache/migraine, CVA,
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Parkinsonism, neuromuscular weakness, sciatica, myelopathy, and autonomic disorders
(OPP, MK, PC).
The student should be able to identify the major elements of the genitourinary anatomy
and physiology. These include brain, spinal cord, autonomic nervous system,
somatosensory nervous system, lymphatics and glymphatics (OPP, MK).
8. Pediatrics
The student should be able to list and perform key history, physical examination,
structural diagnostic and Osteopathic Manipulative Techniques in the care of a pediatric
patient as it relates to common problems within this population. These include otitis
media, sinusitis, pneumonia, pharyngitis and asthma (OPP, MK, PC).
9. Hospitalized
The student will learn to perform key history, physical examination, structural diagnostic and Osteopathic Manipulative Techniques in hospitalized patient (OPP, MK, PC).
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Appendix 4 (For Reference if needed as remediation assignment only)
Guidelines for the OMM Case Report
An Introduction to the Case Report and Medical Writing
The OMM Case Report illustrates current practice and treatment issues for the osteopathic physician and medical student. The development and honing of medical writing skills, informed by current and foundational medical literature, supports the exploration of patient care and outcomes, and influences practice within the medical community. A case report is a means of communicating something new that been learnt from clinical practice. Case reports provide essential sources of information for the optimum care of patients because case reports can describe important scientific observations that are missed or are undetectable in clinical trials, provide insightful information that expands our knowledge and spawns new research, and provide information that strays from the classical textbook case and leads to better and safer patient care.
Your OMM rotation emphasizes the application of manipulative treatment across a broad landscape of specialties – in family practice, physical medicine and rehabilitation, geriatrics, pain management and others. The case report allows you to focus deeply on the medical history of single patient, investigate the history, course of treatment, literature and test findings, discuss failings and best practices – and draw your own conclusions.
It is the expectation of the OMM Department that your training, education and unique OMM rotation experience will have prepared you to craft a case report worthy of consideration for submission to a peer-reviewed osteopathic journal. Student and faculty work is submitted for publication to educate, inform, develop and support manipulative medicine practices in the osteopathic community.
The Organization of the Writing
Scientific writing protocol generally requires writing in the third-person perspective and the use of AMA style for format and citation. Your paper should be at least 750 words, but no greater than 1,500 words (not including citation page), double spaced, in 12 pt. Times Roman font, formatted with 1’ margin on all sides, with a running header after the title page. You must save and submit your work/documents as YourLastName.doc or YourLastName.docx by the date/time due.
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The paper is divided into five discrete sections (Title page and Reference pages not included) Incorporate the sections of the paper into your report as subheadings. Each section is weighted and important to the successful construction of the paper as a whole
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The Grading Rubric - This is a guideline on how to begin your paper, for a more definitive guideline see the JAOA link below.
A. A Title Page containing the date of submission. The title page should list the full names of all authors according to the author’s preferred usage. Authors’ names should include all doctoral and master degrees in the order in which they were earned. For authors without doctoral or masters degrees, their highest earned academic degrees should be listed. In addition, the full professional titles and affiliations of all of the manuscript’s authors should be included on the title page.
B. A Brief Narrative Abstract that delivers a brief, concise description – the essentials- of the article. Should consist of four distinct sections. Case Presentation Intro, Literature Review, Discussion and Conclusions/Summary. This abstracted is limited to 150 words.
C. An Introduction to the topic which includes the literature review of relevant publications. Literature review should include osteopathic sources. Introductions should end with a brief objective statement that clearly identifies the purpose of the case report or study.
D. Case Report “Patient Presentation & Findings” This should be in two parts: HPI should include a description of the patient’s chief complaint, age, gender, medical history both past and present, (past medical history, past surgical history, past social history, past family history) past and present medications, past treatments, current treatment plan, review of systems. Physical portion: vital statistics, physical exam, osteopathic structural exam with proper nomenclature as indicated in the Glossary of Osteopathic Terminology, osteopathic treatment plan and outcome. OMT Techniques used or recommended may be added here or included in the Discussion of the case.
E. Comment “Discussion” of the case in the context of relevant medical literature reviewed that shows an exploration and deep understanding of current literature for the pathology regarding best practices, impediments to recovery, other testing, methods of treatment and approaches to improving quality of health/life. This is where you bring it all together. Elaboration of unique techniques, types and goals of treatment and expected outcomes are discussed as related to your case.
Title of Paper
Student Name
UNTHSC/Texas College of Osteopathic Medicine
Preceptor
Attending
Period # and Date
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F. Conclusion that identifies the study’s major findings as they relate to the study’s purpose and the clinical applications of those findings, if appropriate. They should not consist of a summary of the study. This conclusion should be limited to 1 paragraph.
G. Acknowledgements – Authors should limit acknowledgements to people who substantially contributed to either the study or the preparation of the manuscript (optional). Make sure no patient names are included.
H. References - References are required for all material derived from the work of others and should follow the guidelines described in the 10th edition of AMA Manual of Style: A Guide for Authors and Editors (2007). References should include direct, open-access URLs (uniform resource locators) to full-text versions of the reference articles. A URL to an abstract in the National Library of Medicine’s PubMed database does NOT meet this requirement. References should reflect recent or current works as well as from osteopathic sources/journals.
Generally speaking the “A” paper has logical flow from point to point and section to section; the information is credible, take from primary (patient interview, records and test results) and authoritative sources (Such as JAOA, JAMA, and the International Journal of Osteopathic Medicine); all quotes, images, tables and graphs included in the report are given full attribution and in-text citations, used when paraphrasing, acknowledged the original source of information.
Resources
JAOA Information for Authors http://www.jaoa.org/site/misc/ifora.xhtml
AMA Manual of Style: A Guide for Authors and Editors (2007) http://www.amamanualofstyle.com/view/10.1093/jama/9780195176339.001.0001/med-9780195176339