We asked over 100 practicing osteopaths what advice the would give to students interested in learning osteopath. These are their responses, grouped by category. Click on each topic to see their words of wisdom.
1. Take classes “Definitely attend hands-on-hands courses with good teacher to student ratios. Preferably at least 1:4. A basic course in Osteopathy in the Cranial Field will teach you more in a week than you are likely to learn in the years in the OMM classroom and labs at your school. ” “Take courses as often as you have time and money for. Remember, as a student you often get a discount and you are not missing paid work or paying for office overhead while you are out, which is what makes courses more expensive once you are in practice.” “Go to a cranial course. Use what you learned. Take the time to do a little cranial on every patient you treat, if only to screen for dysfunction.” “Find a mentor Take a 40 hour course Attend a conference” “Take courses at basic level and spend time with experienced osteopaths. Read, Read, Read– Osteopathic literature. Teachings in the Science of Osteopathy by Dr Sutherland is a good start.” “Attend conferences about osteopathy, and do rotations with people who are doing 100% osteopathy in their private practice.” “Take OMT CME” “Take several 40 hour basic/Intro courses form different sources. Do not assume one course is enough.” “Take as many additional courses as you can, treat as many people as you can, and remember to review anatomy as you learn new things.” “Attend courses, workshops, conferences and convocation so as your schedule allows.” “Go to as many courses with a 1:4 teacher to student ratio as you possibly can. Definitely take a 40 hour introductory or basic course from OCA or SCTF or OPC.” “Take courses and do rotations.” “Definitely attend hands-on-hands courses with good teacher to student ratios. Preferably at least 1:4. A basic course in Osteopathy in the Cranial Field will teach you more in a week than you are likely to learn in the years in the OMM classroom and labs at your school or your residency.” “Go to a cranial course. Use what you learned. Go to another cranial course. Use what you learned. Charge for your time (once you’re in practice) – even though you’re learning as you go, you’re still doing good” “Go to conferences and courses. You’ll still graduate. Have your ears open, and pick a practitioner who makes sense to you. Approach the doc and ask to be treated and taught. If you’ve found the right doc, don’t give up. Make sure you find a couple of docs to follow. We know that you are the future of osteopathy, so don’t be afraid of us. Be ready and willing to work hard.”
2. Treat whenever you can “Try to treat all of your attending’s so they allow you to treat their patients.” “The body teaches you. The more time you can spend treating friends, family, and other students the better. Also on rotations if an opportunity to use OMT or OIM comes along, offer to treat the patient for the attending, if appropriate in the situation and time permits.” “Any time on any rotation strive to do at least one osteopathic procedure/technique on each patient you see, I asked myself-with each patient what is the one most important thing I could do for them-diaphragm release? scar? what would give the greatest impact, in time I could do more each time as i pushed myself to do something with each patient no matter how small, lymphatic pump, CV4, rib raising-that allowed me to develop my skills and become more proficient besides helping the patients.” “When learning, keep practicing. That develops the skill.” “Practice, practice, practice. Always ask, ‘How could I treat this osteopathically’?” “Practice Practice Practice. They need to be comfortable with their hands and palpatory skills and only way to get comfortable is to get your hands on patients. Don’t be afraid to ask questions.” “Pursue OMT as it applies to each rotation in which you are engaged.” “Your curriculum has not prepared you for clinical realities. The skills needed to pass NBOME OMM are not the skills used in real patient care. Get your hands on people: family, friend, house-staff, and treat!” “Treat one person every day!” “Take as many additional courses as you can, treat as many people as you can, and remember to review anatomy as you learn new things.” “You learn by doing, not by watching. Get your hands on each and every patient. Use your hands on each and every rotation. Osteopathy is more than just “treatment”. 50% of what we do is arriving at the right diagnosis. (i.e. big difference between someone suffering from lower back pain vs SI joint pain). Also, you don’t have to be a guru to start practicing osteopathic medicine. You can have a great career and very busy clinic if you only did suboccipital release and diaphragm release. Patients would greatly benefit from just simple techniques. ” “Get your hands on as many patients as possible. Don’t worry about treating them all but learn what the tissues feel like in heart failure, asthma, neuropathy, fractures, post-surgery, sinus infections, etc. You don’t have to put it into words, just feel and learn. Treat whenever you can — friends, M.A.’s, preceptors, and of course, patients when possible.” “Put your hands on every patient who will allow you, and use your friends and family as opportunities to practice techniques and gain experience. Never stop learning.” “Get as much hands-on experience in every office as possible.” “Anatomy, Anatomy, Anatomy Practice! Treat everyone you can. And get treated so you know what osteopathy can do.” “Practice a little every day” “Practice practice practice on family and friends, esp if your rotations won’t let you.” “DO it” “Utilize what you know!, Do it!” “I learned by having my hands on clients as my mentor treated them. Over time I learned to feel the treatment and began to be part of the treatment.” “Practice OMT whenever and wherever you can with as broad-ranging pathologies possible.” “At least palpate every patient you can, structural exam, feel everyones back see if you can correlate viscerosomatic reflexes with their complaints or medical hx. Work on family and friends to build confidence and discuss with people what you do. Go to courses shadow old timers lots of different people.” “Treat as many people as you can to acquire experience. However do not stub your toe by risking your neck with perhaps, the majority of rotation situations by over-playing your hand with regard to OMM.” “Try to get your hands on as many people as possible. Try to apply your Osteopathic skills in both the clinics and the hospitals as you are able or allowed to do. AT Still said to ‘palpate miles and miles of necks’. And know your ANATOMY!!” “Get as much hands-on in your 1st 2 years as possible. One very good OMT rotation is better than many lousy ones. I spent most of my electives in 3rd and 4th year in internal medicine. I felt it necessary to prepare me for internship. I still think it was wise. It is easy to remember OMT with a quick review. By the way, treating hospital patients really does help them. One treatment I gave as an intern cured a post-op ileus that the surgery residents had given up on because the drugs were not working. They just said, “he’s gonna die.” Just don’t forget the viscera-somatic reflex. If you treat the back and it comes right back, you probably need to treat the related viscera.” “Treat someone every day, even if it is only 5 minutes. Take as many classes as you can, even when told you can’t ;)” “Do it. Get your hands on people. Don’t be afraid to touch a patient and make him or her feel better.” “Practice as much as possible.” “Put your hands on patients in the hospital even if only for a brief moment. You will learn a lot about how different disease states feel. Treat your patients with manual technique as much as possible regardless of their diagnosis. A. T. Still did not get famous treating musculoskeletal diseases. OMM can help any condition.”
3. Palpate whenever you can, even if you aren't treating “Get your hands on as many patients as possible. Don’t worry about treating them all but learn what the tissues feel like in heart failure, asthma, neuropathy, fractures, post-surgery, sinus infections, etc. You don’t have to put it into words, just feel and learn. Treat whenever you can — friends, M.A.’s, preceptors, and of course, patients when possible.” “Put your hands on every patient who will allow you, and use your friends and family as opportunities to practice techniques and gain experience. Never stop learning.” “Volume. The more people you palpate, the better your skills will be. Don’t be afraid to palpate; if you use common sense and respect for the mechanism you will not hurt the patient. You always have a chance of doing more help than harm. Be curious. Feel what the tissues feel like in someone w compartment syndrome, stroke, MI, post CABG etc.” “Keep putting your hands on patients.” “Look for opportunities to continue developing palpation skills. Even in rotations where OMM may not be prominent, the opportunity still exists to touch patients and think osteopathically during H&Ps, and physical exams. Increasing proficiency with techniques comes from having strong palpation skills and you can always evaluate paravertebral musculature when auscultating heart and lungs, palpate abdominal fascia/diaphragmatic motion while examining the abdomen, assess fascial restriction when addressing joints, etc.” “Get your hands on as many patients as possible; even if your attending does not allow you to treat, use the opportunity of the physical exam to look for somatic dysfunctions and correlate to their chief complaint.” “Even if your preceptor isn’t comfortable letting you do OMT, there is plenty of opportunity to diagnose/feel what is going on in the patient’s body.” “Listen with your hands to as many patients, friends, and family as you can.” “You learn by doing, not by watching. Get your hands on each and every patient. Use your hands on each and every rotation. Osteopathy is more than just “treatment”. 50% of what we do is arriving at the right diagnosis. (i.e. big difference between someone suffering from lower back pain vs SI joint pain). Also, you don’t have to be a guru to start practicing osteopathic medicine. You can have a great career and very busy clinic if you only did suboccipital release and diaphragm release. Patients would greatly benefit from just simple techniques. ” “At least palpate every patient you can, structural exam, feel everyones back see if you can correlate viscerosomatic reflexes with their complaints or medical hx. Work on family and friends to build confidence and discuss with people what you do. Go to courses shadow old timers lots of different people.” “Be still and know. Listen with your hands. There is so much–it really depends on their skill and comfort level. I think I always tell them to ‘just be’.” “Pick one patient from your list and diagnose at least 3-5 regions on them – even if you can’t treat them (don’t have time, preceptor, etc), you can diagnose them and gain information about how their structure and function are interrelated. If you can listen to their hearts and lungs, you can put your hands on their thorax!” “Make sure to use the palpatory skills learned in OPP to help you with your physical examination with patients. Even if you unable to perform a OMM treatment , you can use the skill from clinical examination to better help your patient by providing a thorough physical exam.” “Put your hands on patients in the hospital even if only for a brief moment. You will learn a lot about how different disease states feel. Treat your patients with manual technique as much as possible regardless of their diagnosis. A. T. Still did not get famous treating musculoskeletal diseases. OMM can help any condition.” “Get your hands on patients as often as possible, to learn what health and illnesses feel like.”
4. Find a mentor or mentors “Have your ears open, and pick a practitioner who makes sense to you. Approach the doc and ask to be treated and taught. If you’ve found the right doc, don’t give up. Make sure you find a couple of docs to follow. We know that you are the future of osteopathy, so don’t be afraid of us.” “Ask to spend time in the office of someone who actually does this work. Someone that you’ve met at a course and think that you could learn from.” “Search for mentors and keep lines of communication open for future training” “Don’t be afraid to apply OMM. After 2 years of OMM training your are ready. Your patients will benefit from it.”
5. Self-improvement and self-study “Master a rapid screening structural exam that you can do on every patient you see on every rotation and correlate your findings with the conventional medical diagnoses. If you have patients where you don’t even have the opportunity to do a screening exam, choose one body part/region and check it on everyone (e.g. the diaphragm, etc.) and change that region over time. Do not worry about treating patients (if you have the chance do it) but make sure to build your palpatory skill and database in a way that is meaningful (integrated into the rotations you are on). Expand your study of anatomy on each conventional rotation to include osteopathically relevant fascia, innervations, lymphatic and vascular drainage, etc. For example review the osteopathic approach to the pelvis while on OB, the diaphragm and rib cage for Cardiology, etc. They key is to build osteopathic study into your everyday medical study. Focus on the fundamentals – too often students want to fly before they can crawl and then get overwhel “I always tell the students to keep reviewing anatomy, and start to tie it in to clinical scenarios they encounter, so they can start to link symptoms with anatomy and physiology directly (as opposed to just memorizing lists). The number of touches is key to learning OMM so they need to keep working with people, even if just for diagnostic practice in situations where they are unable to treat for whatever reason.” “Keep using the skills you have and become an ‘expert’ on what you feel comfortable treating/doing. Keep learning. Stay connected to study groups, CME etc. through your training and beyond.” “Go to youtube and look up videos about AT Still and Robert Fulford. Keep an open mind.” “Read books by AT Still, he was brilliant! Look up osteopathic research and ask yourself “What questions need to be answered that osteopathy could answer?” Every time you treat a patient, ask the body “what do you want to do?” and help it do that. It was made to correct itself, you are just assisting it! Read up on Chapman’s reflexes and start feeling for them. Believe in Osteopathy, and ask yourself first “what could I do to help the body be healthy?” before you prescribe a medication to help it ‘feel better’.” “Practice what you have learned!” “I would love to hear the answers to this, since I wonder myself.” “Getting an osteopathic treatment is the best way to educate themselves first and foremost. Then, go to courses, apprentice, and treat as much as they can.” “Practice as often as you can. When there are guest OMM speakers, try to attend theses whenever possible. Rotate with different osteopaths as each has a different style to learn from.” “Read the writings of Still, Sutherland (TSO & COT), Rachel Brooks’ on the work of Rollin Becker (Life in Motion & Stillness of Life). Study anatomy anatomy anatomy and physiology, then you can figure out any medical problem.” “Don’t be afraid to apply OMM. After 2 years of OMM training your are ready. Your patients will benefit from it.” “The education you want is the education you search out. Continue the persuit of Osteopathy wherever you can find it, often in the patient that is right in front of you.” “I tell them to try to incorporate their osteopathic knowledge as often as possible, and to discuss their OMT interest early on so that their preceptors will know in advance and can ask questions if they need further information. I also encourage them to frame their discussions in terms of what benefits the patient will receive, supported by the literature when possible.” “Your patient is your instructor. Pay close attention to what they have to teach you, read about their condition and apply it to the next patient. Try to determine how to incorporate the DO philosophy and OMT at each visit, with every patient.” “Keep practicing and work with older students/residents to check your diagnoses.” “Pursue every opportunity to work with those who practice Osteopathy; take courses and read the literature; and use every clinical encounter you can to perceive the living human mechanism at work. Memberships in the UAAO, OCA, and local state Osteopathic societies are a great way to meet all of these goals. Find ways to treat at least one or two people each week.” “Oh, such a question. My practice is to interview anyone wanting to rotate with me beforehand, and tailor the advice, reading, practices, etc. to their experience. A month in my office is a rotation built into the the MSU-COM and Metropolitan Hospital (Grand Rapids) residency programs. That allows me a few more spots per year, which is why I interview people first. I take on occasion a 3rd or 4th year student. There is a famous saying about pilgrimage in every spiritual tradition, “It is solved by walking.” It is by the practice of any discipline that allows one to be shaped by their profession. It shapes us, not the other way around. I recommend not only constant practice, but also self awareness and a sincere aspiration to honor and uphold the responsibilities that come with being a physician.” med.” “For example, subtle cranial work is not the best thing to focus on during rotations. Don’t get ahead of yourself. Expertise comes from a mastery of the fundamentals.” “Ignore what the schools are teaching. Find a mentor or an osteopathic study group near you. Take off your “science brain” (if you need scientific reasoning for why you should take off your science brain, read Nassim Taleb’s books, or spend some time researching surgical studies or psychotherapy studies and the problems with structuring research in operator-dependent disciplines) and learn to feel. Even just spending time feeling the mechanism can be immensely valuable. No diagnosis, no treatment, just feel. Learn to accept uncertainty. Did the patient get better because of your treatment, or would they have gotten better anyway? You’ll never know except in a few cases – accept that and move on. You’ll find the cases that show you it’s real eventually as you practice.” “Be very familiar with and comfortable with the four main tenets of osteopathy”
6. Educate others and be an advocate “Many attendings who are not familiar with OMM will be more comfortable if you can cite literature on effectiveness and safety. Learn a few of the high impact studies and be able to reference the data off the top of your head (e.g, post-operative ilius is always a good one)” “Familiarize yourself with ‘Basic Segmental Dysfunction Theory’ so you can explain and apply OMT correctly in clinical situations to MDs, NDs, PTs, OTs, NPs, PAs, and others.” “Please be careful using the word “treatment”, as it implies a physician-patient relationship. I am willing to participate in the Osteopathic Education Service provided by the AAO at the conferences to provide an educational opportunity to students.”
7. Other advice - the voice of experience “Take care of yourself. Love yourself. Spend time in nature. Get treated.” “Don’t believe everything you are told, keep an open mind and follow your heart. Most of us have learned that we can build exactly the practice we wish because there is a tremendous demand for our work.” “If you do not make a point of learning osteopathy, you will not learn it at all. Most clinical rotations do not include any OMT; majority of DO’s do not practice OMT.” “Keep on practicing OMT, do not lose that you learned in preclinical years” “Read Dr. Still! John Lewis’s biography should be required by all schools. Dr. Fulford’s Touch of Life Philosophy and Mechanical Principles of Osteopathy, AT Still We read one hour before clinic each and every day of the rotation.” “Be treated every 6 months.” “With all the information to acquire take care and preserve the osteopathic spirit that brought you to this mission.” “Read the writings of the great DOs. Even better, work with living DOs practicing Osteopathy in it’s fullness. Get treated as often as possible. Treat others as often as you can. ” “Read The Lengthening Shadow of A.T. Still by Hildreth, available from the AAO. Also Teachings in the Science of Osteopathy ed by Ann Wales. I have a whole book list for the truly interested.” “Be interested” “They must make the effort on their own, and not use the excuse that there is no one to teach them. They must seek it out and practice themselves.” “It’s not just what you do, it’s who you are and how you care.”