The effect of the COVID-19 pandemic on osteopathic education in ACGME-OR residencies from February 2020 to February 2021.

Context: It remains to be determined exactly how the COVID-19 pandemic has and will continue to impact osteopathic resident education, in particular as it pertains to treatment with osteopathic manipulative medicine (OMM). Although the long-term effects of the pandemic cannot be determined yet, changes in current resident education can be analyzed.

Objectives: Here, we describe how the format, frequency, and environment of OMM training have changed in residency programs from prior to February 2020 to the "lockdown" period of February 2020 to June 2020, and then to the "recovery" period of July 2020 to February 2021.

Methods: A 19-question survey inquiring about the above three categories was emailed via SurveyMonkey to 282 Accreditation Council for Graduate Medical Education (ACGME) residency programs with osteopathic recognition at the end of January 2021.

Results: Of the 282 programs surveyed, 24.5% (69) responded. Osteopathic neuromusculoskeletal medicine (ONMM) programs were excluded from the data analysis, resulting in a modified sample size of n=60. Responses indicated that residency programs dramatically decreased the frequency of OMM didactic education sessions (100.0% [60] reported offering OMM didactic education before the lockdown period; compared to 73.3% [44] during the lockdown period) and shifted their educational programs from an in-person-only environment (88.3% [53] before lockdown; 8.3% [5] during lockdown) to either a combined in-person/virtual platform (6.7% [4] before lockdown; 31.7% [19] during lockdown) or to a virtual-only platform (0.0% [0] before lockdown; 46.7% [28] during lockdown). During the recovery period, 91.7% (55) programs reported giving some form of OMM didactic education. The percentage of programs reporting in-person-only, combined in-person/virtual platform, and virtual-only didactic education were 3.3% (2), 53.3% (32), and 41.7% (25), respectively, during the recovery period. The preferred method of instruction changed from a combination of resident and attending lectures with a hands-on component (55.0%; 33) before lockdown, to the same but without a hands-on component (28.3%; 17) during lockdown, and back to the same but with a hands-on component (36.7%; 22) during the recovery period. Furthermore, the number of programs offering OMM didactic education [OMM patient care] at least once a month decreased from 70.0% (42) [78.3% (47)] before the lockdown period to 46.7% (28) [48.3% (29)] during the lockdown period. It then increased to 55.0% (33) [73.3% (44)] during the recovery period. Finally, before the lockdown period, programs offered OMM patient care predominantly in a combination of an inpatient/outpatient environment (63.3%; 38). The preferred patient care setting changed to an outpatient-only environment (43.3%; 26) during the lockdown period and then back to a combination of an inpatient/outpatient environment (45.0%; 27) during the recovery period.

Conclusions: This study demonstrates that programs have been dramatically impacted by the COVID-19 pandemic, by the augmentation of the osteopathic learning environment, and by the delivery of OMM to patient care within the training programs. These impacts were still present 1 year after the start of the pandemic. It will be imperative for ACGME Osteopathic Recognition (ACGME-OR) programs to continue an assessment of these impacts on resident physicians' learning and preparedness.