UH ADULT & PEDIATRIC ALLERGY/IMMUNOLOGY FELLOWSHIP 2019-20 OSTEOPATHIC RECOGNITION OSTEOPATHIC PROGRAM PERSONNEL 1.

DESCRIBE ANY ADDITIONAL QUALIFICATIONS FOR THE DIRECTOR OF OSTEOPATHIC EDUCATION, NOT LISTED IN THE ACCREDITATION DATA SYSTEM (ADS) FACULTY ROSTER THAT ARE RELEVANT TO THE ROLE. IF NONE, INDICATE “NOT APPLICABLE” IN THE BOX BELOW (4)]. ▸ Not applicable. OSTEOPATHIC PROGRAM PERSONNEL 1. LIST THE PARTICIPATING SITES WHERE FELLOWS WILL RECEIVE EDUCATION IN OSTEOPATHIC PRINCIPLES AND PRACTICE (OPP), ALONG WITH THE OSTEOPATHIC FACULTY MEMBER APPROVED AS THE LOCAL SITE DIRECTOR WHO IS ACCOUNTABLE FOR DESIGNATED OSTEOPATHIC FELLOW EDUCATION AND SUPERVISION.

Name of Participating Site Name of Site Director 1 Allergy/Immunology Robert Hostoffer, DO, MEd, FAAP, FACOP, FACP, FACOI, UH Associates, Inc., 5915 Adult & Pediatric Allergy/Immunology Fellowship Program Landerbrook Drive #110, Director Mayfield Heights, Ohio 44124 Devi Jhaveri, DO, FAAP, FACOP, UH Adult & Pediatric Allergy/Immunology Fellowship Assistant Program Director 2 University Hospitals (UH) Robert Hostoffer, DO, MEd, FAAP, FACOP, FACP, FACOI, UH Cleveland Medical Center, Adult & Pediatric Allergy/Immunology Fellowship Program 11100 Euclid Avenue, Director Cleveland, Ohio 44106 Devi Jhaveri, DO, FAAP, FACOP, UH Adult & Pediatric Allergy/Immunology Fellowship Assistant Program Director 3 UH Richmond Medical Center, Christopher L. Tangen, DO, Program Director, ACGME- 27100 Chardon Road, accredited Transitional Year Program, UH Regional Hospitals, Richmond Heights, Ohio 44143 Medical Director, Sports Medicine

Susan M. Ratay, DO, MS, Director of Osteopathic Education, University Hospitals Osteopathic Consortium OSTEOPATHIC PROGRAM PERSONNEL 2. OSTEOPATHIC PROGRAM PERSONNEL 3.A. HOW DOES THE PROGRAM VERIFY THAT OSTEOPATHIC FACULTY MEMBERS PARTICIPATE IN A REQUIRED FACULTY DEVELOPMENT PROGRAM THAT INCLUDES OPP?

▸ UH-Lake Erie Consortium for Osteopathic Medical Training (LECOMT) partnership

▸ Faculty development series centered around “Teaching and Learning” and “Scholarly Activity”

▸ Integration of OPP

▸ Cleveland Academy of Osteopathic Medicine (CAOM) Annual OMT Seminar.

▸ American College of Osteopathic Pediatricians (ACOP) program integration of OPP/OMT in the care of pediatric patient (POMT)

▸ Scholar Teacher videos developed to enhance OPP instruction

▸ Mid-Western University Costin Institute Scholars Program application of OPP in training programs (Dr. Jhaveri)

▸ Masters of Medical Education program via LECOM to develop a greater understanding of curriculum and teaching (Dr. Hostoffer). OSTEOPATHIC PROGRAM PERSONNEL 3.A. SCHOLAR TEACHER OSTEOPATHIC PROGRAM PERSONNEL 3.A. OSTEOPATHIC PROGRAM PERSONNEL 3.A. OSTEOPATHIC PROGRAM PERSONNEL 3.B.

HOW DOES THE PROGRAM VERIFY THAT OSTEOPATHIC FACULTY MEMBERS PARTICIPATE IN A REQUIRED FACULTY DEVELOPMENT PROGRAM THAT INCLUDES ONGOING EDUCATION ADDRESSING EVALUATION AND ASSESSMENT IN COMPETENCY-BASED MEDICAL EDUCATION?

▸ Active participation of faculty in organized clinical discussions, rounds, didactics, and conferences-workshops by:

▸ Evaluating OMM/OPP competency throughout 2 years of Allergy/Immunology Fellowship. ▸ Supervising OPP/OMT application in clinical care of patients, especially in ambulatory A/I training site.

▸ Faculty facilitators for OPP/OMT focused educational offerings, including:

▸ Monthly Osteopathic A/I Journal Club

▸ Quarterly POMT Modules

▸ Osteopathic-focused scholarly projects

▸ Scholar Series, designed to develop scholarly environments and meet fellows’ program research requirements:

▸ Scholar Specific to assist w/ case presentation

▸ Scholar Teacher for use in ACGME Osteopathic Recognition

▸ UH Regional Hospitals Osteopathic-focused faculty facilitate OPP/OMT focused educational offerings, including:

▸ UH ONMM Grand Rounds Series

▸ Monthly Osteopathic Neuromusculoskeletal Medicine (ONMM) Core Faculty Didactic-Workshop Series OSTEOPATHIC PROGRAM PERSONNEL 3.B. OSTEOPATHIC PROGRAM PERSONNEL 3.B. OSTEOPATHIC PROGRAM PERSONNEL 3.B. OSTEOPATHIC PROGRAM PERSONNEL 4.

LIST THE CORE OSTEOPATHIC FACULTY MEMBERS IDENTIFIED ON THE ADS FACULTY ROSTER.

▸ Dr. Robert Hostoffer, DO, Program Director

▸ Devi Jhaveri, DO, Associate Program Director

▸ Non-ADS Core faculty of UH Regional Hospitals

▸ Susan M. Ratay, DO, MS

▸ Robert Truax, DO

▸ Christopher L. Tangen, DO

▸ LECOMT faculty resources to support training in OPP/OMM OSTEOPATHIC PROGRAM PERSONNEL 4. OSTEOPATHIC PROGRAM PERSONNEL 5A.

ARE ANY OSTEOPATHIC FACULTY MEMBERS, INCLUDING CORE OSTEOPATHIC FACULTY MEMBERS AND THE DIRECTOR OF OSTEOPATHIC EDUCATION, SHARED WITH ANOTHER PROGRAM(S) WITH OSTEOPATHIC RECOGNITION? ARE ANY OSTEOPATHIC FACULTY MEMBERS, INCLUDING CORE OSTEOPATHIC FACULTY MEMBERS AND THE DIRECTOR OF OSTEOPATHIC EDUCATION, SHARED WITH ANOTHER PROGRAM(S) WITH OSTEOPATHIC RECOGNITION?

▸ Yes.

A. LIST THE OSTEOPATHIC FACULTY MEMBERS (INCLUDING THE CORE FACULTY MEMBERS AND DIRECTOR OF OSTEOPATHIC EDUCATION) SHARED WITH OTHER PROGRAMS WITH OSTEOPATHIC RECOGNITION, AND LIST THE APPLICABLE PROGRAM(S).

Osteopathic Faculty Member Program and Sponsoring Institution Susan Ratay, DO, MS Director of Osteopathic Education, University Hospitals Osteopathic Consortium Christopher Tangen, DO Program Director, Traditional Rotating Internship, Program Director, ACGME-accredited Transitional Year Program, Medical Director, Sports Medicine, University Hospitals Regional Hospitals Robert Truax, DO Clinical Faculty and Assistant Professor, Family Medicine Residency Program, Director, Osteopathic Sports Rehabilitation Clinic, Connor Integrative Health Network, University Hospitals Cleveland Medical Center OSTEOPATHIC PROGRAM PERSONNEL 5B.

ARE ANY OSTEOPATHIC FACULTY MEMBERS, INCLUDING CORE OSTEOPATHIC FACULTY MEMBERS AND THE DIRECTOR OF OSTEOPATHIC EDUCATION, SHARED WITH ANOTHER PROGRAM(S) WITH OSTEOPATHIC RECOGNITION? ARE ANY OSTEOPATHIC FACULTY MEMBERS, INCLUDING CORE OSTEOPATHIC FACULTY MEMBERS AND THE DIRECTOR OF OSTEOPATHIC EDUCATION, SHARED WITH ANOTHER PROGRAM(S) WITH OSTEOPATHIC RECOGNITION?

▸ Yes.

B. DESCRIBE HOW THE OSTEOPATHIC FACULTY MEMBERS LISTED IN THE TABLE ABOVE WILL HAVE THEIR TIME DIVIDED BETWEEN EACH PROGRAM AND PARTICIPATING SITE WITH OVERSIGHT MAINTAINED, SO AS NOT TO COMPROMISE THE OSTEOPATHIC EDUCATION OF THE DESIGNATED OSTEOPATHIC RESIDENTS IN THESE PROGRAMS.

▸ The faculty listed participate in various workshops, grand rounds, journal clubs, other didactics, and scholarly work that are scheduled throughout the year.

▸ In some cases, these activities are shared by other services but do not conflict. OSTEOPATHIC EDUCATION PROGRAM 6.A.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO A. PATIENT CARE AND PROCEDURAL SKILLS. ▸ Teaching Methods: Demonstrate patient care skills to:

▸ Recognize entire clinical context. Use relationship b/w structure and function.

▸ Effectively treat and provide medical care that incorporates osteopathic philosophy.

▸ Demonstrate caring attitude, mindful of cultural sensitivities and patient apprehension. ▸ Diagnose and document somatic dysfunction and its treatment.

▸ Complete an osteopathic structural exam. Direct and indirect OMT techniques: HV/LA, articulatory, ME, SCS, MFR, Still Technique and/or OCMM, etc.

▸ Apply OMT in patient care setting that will benefit allergic patient.

▸ Provide health care services expected of an allergy/immunologist that incorporates patient care consistent with osteopathic philosophy, OSTEOPATHIC EDUCATION PROGRAM 6.A (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO A. PATIENT CARE AND PROCEDURAL SKILLS (CONTINUED). ▸ Teaching Methods: Demonstrate ability to:

▸ Incorporate literature and research that integrate osteopathic tenets into clinical decision- making.

▸ Critically evaluate methods of osteopathic clinical practice, integrate evidence-based OPP into patient care, show understanding of research methods, and improve patient care practices as related to field of A/I.

▸ Treat patients in manner consistent w/ most up-to-date information on diagnostic and therapeutic effectiveness related to OPP.

▸ Perform self-evaluations of osteopathic practice patterns and practice-based improvement activities using systematic methodology.

▸ Adult and Pediatric Allergy and Immunology Fellowship 2019-2020 Manual + Quick Reference

▸ Ohio University Heritage College of Osteopathic Medicine’s OMM Quick Card: A publication of the CORE Osteopathic Principles and Practices Committee MANUAL + QUICK REFERENCE OSTEOPATHIC EDUCATION PROGRAM 6.A. OSTEOPATHIC EDUCATION PROGRAM 6.A (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO A. PATIENT CARE AND PROCEDURAL SKILLS (CONTINUED).

▸ Assessment Methods

▸ Complement bi-annual review w/…

▸ Direct observation

▸ Chart review

▸ Procedure logs

▸ Mid-year and end-of-year evaluations

▸ Structural examinations

▸ OMT under supervision of osteopathic attending physician OSTEOPATHIC EDUCATION PROGRAM 6.B.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO B. MEDICAL KNOWLEDGE.

▸ Teaching Methods: Understand fundamental concepts involving OPP at beginning of training program. Over course of Fellowship, gain greater depth of medical knowledge in integrating osteopathic concepts in A/I.

▸ Demonstrate ability to:

▸ Apply integrative knowledge of accepted standards of osteopathic clinical practice and/or OPP

▸ Demonstrate competency in understanding and application of OPP to A/I patient.

▸ Demonstrate treatment of person rather than symptoms.

▸ Demonstrate understanding of somato-visceral relationships and role of musculoskeletal system in disease as it relates to integumentary system.

▸ Perform critical appraisals of literature related to OPP, especially studies that incorporate osteopathic concepts in A/I. OSTEOPATHIC EDUCATION PROGRAM 6.B (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO B. MEDICAL KNOWLEDGE (CONTINUED).

▸ Teaching methods:

▸ Didactic and workshop training

▸ Medical knowledge in OPP/OMT presented and evaluated

▸ Primary ambulatory training site

▸ Weekly Allergy-Immunology AOA Board review

▸ POMT Modules

▸ UH Regional Hospitals campuses.

▸ Didactic-workshop training for ONMM Grand Rounds

▸ Monthly ONMM Core Faculty Didactic-Workshop Series OSTEOPATHIC EDUCATION PROGRAM 6.B (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO B. MEDICAL KNOWLEDGE (CONTINUED).

▸ Teaching Methods: Multiple opportunities for training to improve medical knowledge incorporating OPP and specifically, osteopathic concepts in A/I

▸ Weekly A/I AOA Board review

▸ Section on OPP-focused questions

▸ 1/3 of AOA A/I Boards pertain to integration of osteopathic concepts in A/I

▸ Monthly Osteopathic Neuromusculoskeletal Medicine (ONMM) Core Faculty Didactic-Workshop Series expect Fellows:

▸ Understand fundamental knowledge of OMT modality and perform relevant techniques

▸ Perform required elements of structural exam

▸ Complete pertinent osteopathic-focused board examination questions

▸ ONMM Grand Rounds

▸ 1st and 3rd Friday/month during academic year

▸ Participation when topics pertinent to A/I. Examples: Sinusitis, Pneumonia, Asthma, etc.

▸ Quarterly POMT Modules, e.g., Chapman’s Reflexes, chest, otitis media, URI, CF, etc. OSTEOPATHIC EDUCATION PROGRAM 6.B. OSTEOPATHIC EDUCATION PROGRAM 6.B (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO B. MEDICAL KNOWLEDGE (CONTINUED).

▸ Assessment Methods

▸ Documentation of medical knowledge in OPP application

▸ Rotation, mid-year, and annual evaluations

▸ Portfolio

▸ Evaluated on each session for OPP/OMT didactic training:

▸ Monthly ONMM Core Faculty Didactic-Workshop Series

▸ ONMM Grand Rounds

▸ Quarterly POMT Modules

▸ Weekly A/I AOA Board Review

▸ CAOM Annual OMM Seminar

▸ Didactic session performance evaluation

▸ Mid-year and annual evaluations

▸ Board-like questions

▸ Identifying core model for utilizing OPP (Postural/Structural, Respiratory-Circulatory, Neurologic, Metabolic, Behavioral) OSTEOPATHIC EDUCATION PROGRAM 6.C.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO C. PRACTICE-BASED LEARNING AND IMPROVEMENT

▸ Teaching Methods: Complete osteopathic-focused scholarly projects during Fellowship:

▸ Drs. Hostoffer and Jhaveri assure accurate application of osteopathic concepts to A/I

▸ Longitudinal rotations with Drs. Hostoffer and Jhaveri, where clinical encounters will be discussed to identify evidenced-based OPP/OMT applications

▸ A/I OMT Module

▸ Presentation

▸ Handout to highlight key concepts and instructions for identified OMT techniques

▸ Evaluation tool with board-like questions.

▸ Osteopathic-Focused Research Project

▸ Group project, with each Fellow actively participating.

▸ Recently submitted “Asthma: The Osteopathic Modular Approach” OSTEOPATHIC EDUCATION PROGRAM 6.C (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO C. PRACTICE-BASED LEARNING AND IMPROVEMENT (CONTINUED).

▸ Teaching Methods:

▸ Weekly A/I Journal Club with monthly focus on topic that integrates OPP in A/I

▸ Weekly A/I AOA Board Review

▸ Senior A/I Fellow(s) lead, presenting all questions and reviewing responses

▸ OPP-focused questions

▸ Weekly application of Osteopathic Models of Patient Care to mechanisms and clinical significance of Clusters of Differentiation (CDs) /Interleukins (ILs)

▸ Weekly “one-liners” (clinical vignettes) with at least monthly OPP focus

▸ Self-study encouraged by A/I training w/in primary ambulatory training site

▸ Libraries

▸ Access to UH Medical, UH Core, and LECOM Core

▸ Also Site 1 Learning Center, UH Regional Hospitals, Cleveland Health Sciences Library, and LECOM Learning Resource Center, which offer OPP resources to support osteopathic-focused training and scholarly activity. OSTEOPATHIC EDUCATION PROGRAM 6.C. OSTEOPATHIC EDUCATION PROGRAM 6.C (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO C. PRACTICE-BASED LEARNING AND IMPROVEMENT (CONTINUED).

▸ Assessment Methods:

▸ Rotation, mid-year, and year-end evaluations document OPP application

▸ Practice-based learning

▸ Improvement domain

▸ Quality improvement

▸ Clinical setting OPP application

▸ Critical appraisal to determine benefit of OMT in patient care setting. OSTEOPATHIC EDUCATION PROGRAM 6.D.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO D. INTERPERSONAL AND COMMUNICATIONS SKILLS

▸ Teaching Methods: Application of interpersonal and communication skills are critical components of patient-centered approach, integrated into osteopathic medicine.

▸ Demonstrate:

▸ Interpersonal and communication skill to effectively discuss osteopathic concepts and their role in patient care

▸ Appropriate verbal and non-verbal skills

▸ Integrate OPP into interpersonal skills and communication skills

▸ ALL inpatient consults and ambulatory clinics

▸ Evaluated by osteopathic attendings

▸ Explain benefits and risks of OMT when applied in clinical setting. OSTEOPATHIC EDUCATION PROGRAM 6.D (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO D. INTERPERSONAL AND COMMUNICATIONS SKILLS (CONTINUED).

▸ Assessment Methods:

▸ Rotation, mid-year and year-end evaluations

▸ Documentation on interpersonal and communications skills

▸ Reflect patient-centered focus of osteopathic profession.

▸ Also assessed by direct supervision

▸ “Patient Assessment Form” and “Global Evaluation Form”

▸ Confidential

▸ Focused on core competencies, especially interpersonal skills, communication, and professionalism OSTEOPATHIC EDUCATION PROGRAM 6.D. OSTEOPATHIC EDUCATION PROGRAM 6.E.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO E. PROFESSIONALISM.

▸ Teaching Methods: Application of OPP into professionalism competency demonstrates integration of behavioral and social sciences.

▸ Demonstrate awareness of issues of culture, religion, age, gender, sexual orientation, and mental and physical disabilities, as they may influence patient’s perception of touch w/in context of OPP

▸ Treat terminally ill w/ compassion in management of pain, palliative care, appropriate touch, and preparation for death

▸ Demonstrate increased understanding of conflicts of interest inherent to osteopathic clinical practice and appropriate responses to societal, community, and health care industry pressures

▸ Utilize caring, compassionate behavior and appropriate touch w/ patients, as related to their specialty areas.

▸ When clinically indicated, under supervision of an osteopathic attending and consent provided by the patient, osteopathic structural examinations and OMT in all clinical settings.

▸ OPP integrated into professionalism in all clinical training sites, including ambulatory and inpatient settings, and evaluated by osteopathic attendings when present. OSTEOPATHIC EDUCATION PROGRAM 6.E (CONTINUED).

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO E. PROFESSIONALISM (CONTINUED).

▸ Assessment Methods: Rotation, mid-year, and year-end evaluations

▸ Documentation of professionalism

▸ Expected competence for profession that has patient-centered focus.

▸ “Patient Assessment Form” and “Global Evaluation Form”

▸ Confidential

▸ Focused on core competencies, especially interpersonal skills and communication and professionalism OSTEOPATHIC EDUCATION PROGRAM 6.E. OSTEOPATHIC EDUCATION PROGRAM 6.F.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO F. SYSTEMS-BASED PRACTICE.

▸ Teaching Methods:

▸ Integration of OPP involving system-based practice competency:

▸ Demonstrate understanding of role of osteopathic clinical practice in health care delivery systems

▸ Provide effective and qualitative osteopathic patient care w/in system

▸ Practice cost-effective medicine

▸ Advocate for quality osteopathic health care on behalf of their patients

▸ Demonstrate understanding of cost benefit of OMT, including reimbursement and correct coding and billing processes.

▸ Clinical application of OPP and OMT for A/I primarily in ambulatory setting.

▸ Rotate longitudinally w/ supervision by Drs. Hostoffer and Jhaveri.

▸ Core training site (Site 1)

▸ UH Regional Hospitals-Richmond Medical Center (Consults)

▸ UH Cleveland Medical Center (Consults)

▸ Drs. Hostoffer and Jhaveri role-model and supervise application of osteopathic concepts in regards to current health care system.

▸ Exposure to billing and coding procedures for OMT during didactics and in primary longitudinal ambulatory training sites. OSTEOPATHIC EDUCATION PROGRAM 6.F.

LIST TEACHING METHODS (E.G., DIDACTIC PRESENTATION/WORKSHOP, INPATIENT TEACHING ROUNDS, PRECEPTOR AMBULATORY CLINIC, SKILLS AND/OR SIMULATION LAB, ETC.) AND ASSESSMENT METHODS (E.G., ROTATION EVALUATIONS, MEDICAL RECORD REVIEW, OSCE; LOGS, PATIENT SURVEY, ETC.) USED TO INTEGRATE OPP INTO F. SYSTEMS-BASED PRACTICE (CONTINUED).

▸ Assessment Methods:

▸ Rotation, mid-year, and end-of-year evaluations include documentation in systems- based practice, which is central to our patient-centered profession.

▸ Quality Improvement tasks

▸ Access OMT application through log tracking

▸ Ensure patients are benefiting from OPP in clinical setting.

▸ Required to track use of OMT in all clinical settings. EMR modifications requested to add additional tracking mechanism. OSTEOPATHIC EDUCATION PROGRAM 6.F. OSTEOPATHIC LEARNING ENVIRONMENT 7.

LIST THE PLANNED LEARNING ACTIVITIES PROVIDED FOR THE DESIGNATED OSTEOPATHIC FELLOWS THAT INTEGRATE OPP (E.G., GRAND ROUNDS, JOURNAL CLUB, OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)/OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) WORKSHOPS, CORE LECTURES, ETC.), INCLUDING THOSE THAT ADVANCE PROCEDURAL SKILLS ACQUISITION IN OMM.

Learning Frequency and Type of osteopathic faculty member Osteopathic faculty Activity number of hours in participation (e.g., lead, moderate, members, who will duration evaluate, observe, etc.) participate Journal Club Monthly; 30 min. - 1 Dr. Hostoffer, Dr. w/ osteopathic Moderate hr. Jhaveri focus Clusters of differentiation (CDs) Weekly; 30 min. - 1 /Interleukins Moderate Dr. Hostoffer hr. (ILs) with osteopathic focus Osteopathic “one-liners” Monthly; 30 min. - 1 Moderate Dr. Hostoffer (case hr. vignettes) OSTEOPATHIC LEARNING ENVIRONMENT 7.

LIST THE PLANNED LEARNING ACTIVITIES PROVIDED FOR THE DESIGNATED OSTEOPATHIC FELLOWS THAT INTEGRATE OPP (E.G., GRAND ROUNDS, JOURNAL CLUB, OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)/OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) WORKSHOPS, CORE LECTURES, ETC.), INCLUDING THOSE THAT ADVANCE PROCEDURAL SKILLS ACQUISITION IN OMM.

Learning Activity Frequency and Type of osteopathic faculty member Osteopathic faculty number of hours participation (e.g., lead, moderate, members, who will in duration evaluate, observe, etc.) participate American Dr. Hostoffer, Dr. Academy of Jhaveri Osteopathy (AAO) Annual Quarterly; 1 hr. Moderate Convocation Lectures (DVD format) Foundations of Dr. Hostoffer Osteopathic Monthly; 30 min. Moderate Medicine, 4e - 1 hr. readinings OMM Workshop Yearly; 1 Dr. Hostoffer, Dr. (Directed by Paul business day (8-9 Lead Jhaveri Evans, DO) hrs.) OSTEOPATHIC LEARNING ENVIRONMENT 7.

LIST THE PLANNED LEARNING ACTIVITIES PROVIDED FOR THE DESIGNATED OSTEOPATHIC FELLOWS THAT INTEGRATE OPP (E.G., GRAND ROUNDS, JOURNAL CLUB, OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)/OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) WORKSHOPS, CORE LECTURES, ETC.), INCLUDING THOSE THAT ADVANCE PROCEDURAL SKILLS ACQUISITION IN OMM.

Learning Activity Frequency and Type of osteopathic faculty Osteopathic faculty number of hours member participation (e.g., lead, members, who will in duration moderate, evaluate, observe, etc.) participate Cleveland Dr. Hostoffer, Dr. Academy of Jhaveri Yearly; 2 business Osteopathic Lead days Medicine (CAOM) OMM Workshop Pediatric Dr. Hostoffer, Dr. Osteopathic Jhaveri Quarterly; 30 min. Manipulative Moderate – 1 hr. Treatment (POMT) Modules Assigned Reading Dr. Hostoffer, Dr. Lists with Yearly; variable Moderate Jhaveri Reflections OSTEOPATHIC LEARNING ENVIRONMENT 7.

LIST THE PLANNED LEARNING ACTIVITIES PROVIDED FOR THE DESIGNATED OSTEOPATHIC FELLOWS THAT INTEGRATE OPP (E.G., GRAND ROUNDS, JOURNAL CLUB, OSTEOPATHIC MANIPULATIVE MEDICINE (OMM)/OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) WORKSHOPS, CORE LECTURES, ETC.), INCLUDING THOSE THAT ADVANCE PROCEDURAL SKILLS ACQUISITION IN OMM.

Learning Activity Frequency and Type of osteopathic faculty Osteopathic faculty number of hours member participation (e.g., lead, members, who will in duration moderate, evaluate, observe, etc.) participate Monthly; full Dr. Hostoffer, Dr. UHOC Workshops afternoon (4-5 Observe Jhaveri hrs.) Dr. Hostoffer LECOM Fellow Monthly; full Lectures in Lead afternoon (4 hrs.) Respiratory OMM Dr. Hostoffer OMM Billing Yearly; 1 hour Moderate Lecture OSTEOPATHIC SCHOLARLY ACTIVITY DIDACTICS OSTEOPATHIC LEARNING ENVIRONMENT 7. UHOC OMM WORKSHOP OSTEOPATHIC LEARNING ENVIRONMENT 7. LECOM ALLERGY/URT OMM OSTEOPATHIC LEARNING ENVIRONMENT 7. OSTEOPATHIC EDUCATION PROGRAM 8.

WHAT LEARNING ACTIVITIES ARE PROVIDED FOR OSTEOPATHIC FACULTY MEMBERS TO ADVANCE THEIR PROCEDURAL SKILLS ACQUISITION IN OMM?

▸ UH-LECOMT partnership

▸ Year-long faculty development series centered around “Teaching and Learning” and “Scholarly Activity”

▸ Integration of OPP

▸ Core competencies, basis of each rotation evaluation.

▸ CAOM Annual OMT Seminar.

▸ ACOP program integration of OPP/OMT in the care of pediatric patient (POMT)

▸ Scholar Teacher videos developed to enhance OPP instruction

▸ Mid-Western University Costin Institute Scholars Program application of OPP in training programs (Dr. Jhaveri)

▸ Masters of Medical Education program via LECOM to develop a greater understanding of curriculum and teaching (Dr. Hostoffer).

▸ Additional resource: “A Teaching Guide for Osteopathic Manipulative Medicine, Second Edition” by AACOM/ECOP (Kendi Hensel, DO, PhD, FAAO and Tyler Cymet, DO, Executive Editors, 2018). SCHOLAR TEACHER OSTEOPATHIC LEARNING ENVIRONMENT 8. OSTEOPATHIC LEARNING ENVIRONMENT 8. OSTEOPATHIC LEARNING ENVIRONMENT 9.

IDENTIFY THE CLINICAL SETTINGS WHERE DESIGNATED OSTEOPATHIC FELLOWS WILL PROVIDE OSTEOPATHIC PATIENT CARE. AMBULATORY SETTING.

▸ Clinical application of OPP/OMT primarily in ambulatory, UH-affiliated teaching practice (Site 1).

▸ Inpatient opportunities to perform osteopathic structural examination and utilize OMT at UH Cleveland Medical Center and UH Regional Hospitals (Richmond Medical Center).

▸ Historically an osteopathic hospital.

▸ Training ground for AOA and ACGME Osteopathic Recognition training programs

▸ Drs. Hostoffer and Jhaveri are core osteopathic-focused Allergy/Immunology faculty who can supervise application of OPP/OMT at both Site 1 and Regional Hospitals.

▸ OPP in patient encounters is encouraged and considered when appropriate to patient care.

▸ Primary sites of didactic training for OPP/OMT include Site 1 Learning Center and conference space at UH Regional Hospitals Richmond campuses.

▸ Necessary media equipment, i.e. computer, projector, large screen, etc.

▸ Portable OMT exam tables available OSTEOPATHIC LEARNING ENVIRONMENT 10.

DESCRIBE HOW AND WHEN DESIGNATED OSTEOPATHIC FELLOWS TEACH OPP.

▸ Multiple opportunities to teach OPP:

▸ Co-present at UH ONMM Grand Round series for Allergy/Immunology topic that integrates OPP/OMT

▸ Osteopathic-focused faculty facilitators moderate and assist all learners presenting

▸ Divided into sections: Case presentation; osteopathic principles involving that topic; evidenced-base literature on the integration of OPP/OMT with that topic; several OMT techniques that apply to that topic and developing board-like questions.

▸ Develop an Allergy/Immunology OMT Module

▸ Present at monthly Osteopathic-focused Journal Club.

▸ Role model and teach OPP as it relates to Allergy/Immunology to LECOM and other visiting osteopathic medical students frequently rotate onto

▸ Participants in OMM faculty development series Scholar Teacher OSTEOPATHIC LEARNING ENVIRONMENT 10. LECOM ALLERGY/URT OMM OSTEOPATHIC LEARNING ENVIRONMENT 10. SCHOLAR TEACHER OSTEOPATHIC LEARNING ENVIRONMENT 10. OSTEOPATHIC LEARNING ENVIRONMENT 11.

DESCRIBE THE LEARNING ENVIRONMENT THAT SUPPORTS OSTEOPATHIC SCHOLARLY ACTIVITY BY OSTEOPATHIC FACULTY MEMBERS AND THE RESOURCES PROVIDED FOR THEM. ▸ Development of peer-reviewed journals and books in osteopathic scholarly work

▸ Wu SS, Hostoffer R, Gibbons K, Shaw HH, Shaw, MB. “Case Study: Dizziness.” Chapter 48A. Osteopathic Considerations in Patients with Head, Eyes, Ears, Nose, and Throat Disorders. In Foundations of Osteopathic Medicine. 4th Edition (Published).

▸ Wu SS, Hostoffer R, Gibbons K, Shaw HH, Shaw, MB. “Case Study: Rhinosinusitis.” Chapter 48A. Osteopathic Consideration in Patients with Head, Eyes, Ears, Nose, and Throat Disorders. In Foundations of Osteopathic Medicine. 4th Edition (Published).

▸ Journal of American Osteopathic Association (JAOA) publications

▸ Peppers BP, Varma P, Kim YM, Hostoffer RW, Rowane MP. Scholar 7: The Development of Regional Community Hospitals’ Scholastic Environment. J Am Osteopath Assoc 2017;117(10):643–650. doi: 10.7556/jaoa.2017.121 (Published).

▸ Wu SS, Graven K, Sergi M, Hostoffer H. Rhinitis: The Osteopathic Modular Approach (Published).

▸ Schend J, Hostoffer H. Asthma: The Osteopathic Modular Approach (Submitted). ▸ Lecturer/participant in lecture series

▸ UHOC

▸ AAO Convocation

▸ CAOM workshop

▸ OMM Workshop directed by Paul Evans, DO

▸ Production and utilization of OMM faculty development series Scholar Teacher and Scholar Specific osteopathic curriculum.

▸ Library of osteopathic textbooks available on site in Site 1 Learning Center.

▸ Additional resources include, “A Teaching Guide for Osteopathic Manipulative Medicine,” by AACOM/ECOP [Kendi Hensel, DO, PhD, Executive Editor. 2014]. OSTEOPATHIC PROGRAM PERSONNEL 3.B. OSTEOPATHIC LEARNING ENVIRONMENT 12.

DESCRIBE THE RESOURCES AVAILABLE TO SUPPORT OSTEOPATHIC MEDICAL EDUCATION IN THE FOLLOWING AREAS: A. REFERENCE MATERIAL PERTAINING TO OMM AND OPP INTEGRATION INTO PATIENT CARE (E.G., PHYSICAL, ON-SITE LIBRARY; ELECTRONIC LIBRARY RESOURCES; OMT VIDEO SERIES BY XYZ; ETC.)

▸ UH Regional Hospitals Medical Library textbooks on OPP vary from recent publications to historical books that are still currently relevant to both art and science involving OPP. A small sampling of OPP textbooks includes:

▸ A Nicholas, A, Nicholas, E. Atlas of Osteopathic Technique. Second Edition. Lippincott Williams & Wilkins. 2011.

▸ Chila, A [ed]. Foundations of Osteopathic Medicine. Lippincott Williams & Wilkins. 2010.

▸ Ward, Robert C. (Executive Editor). Foundations for Osteopathic Medicine. Baltimore, Maryland: Williams & Wilkins. 1997.

▸ Rowane MP, Evans P. Basic Musculoskeletal Skills: The 15 Minute Office Encounter. Indianapolis, IN: American Academy of Osteopathy Publications, 2013 [Second Printing].

▸ Nelson, KE, Glonek, T. Somatic Dysfunction in Osteopathic Family Medicine. Second Edition Lippincott Williams & Wilkins. 2014.

▸ Fryette, Harrison: Principles of Osteopathic Technique. Carmel, CA. Academy of Applied Osteopathy. 1954.

▸ Page, LE: The Principles of Osteopathy. Kirksville, Missouri, Press of Journal Printing Company, 1952.

▸ Walton, WJ: Osteopathic Diagnosis and Technique. Colorado Springs, CO, American Academy of Osteopathy, 1970.

▸ Kuchera, WA. Kuchera, ML: The Kuchera Manual in Osteopathic Principles in Practice. Second Edition (Revised) Kirksville, Missouri: KCOM Press, 1992.

▸ DiGiovanna, EL, Schiowitz, S, Dowling, DJ. An Osteopathic Approach to Diagnosis and Treatment. Third Edition, Philadelphia. PA: Lippincott-Raven Publishers. 2004.

▸ Greenman, Philip E. Principles of Manual Medicine. Second Edition Baltimore, Maryland: Williams & Wilkins. 1996.

▸ Kuchera, ML, Kuchera, WA: Osteopathic Considerations In Somatic Dysfunction. Second Edition (Revised) Kirksville, Missouri: KCOM Press, 1991, 33-52.

▸ Carreiro, J. Pediatric Manual Medicine. Church Livingstone Elsevier. 2009.

▸ Carreiro, J. An Osteopathic Approach to Children. Second Edition. Church Livingstone Elsevier. 2009.

▸ Jones, LH, Kusunose, R. Goering, E. Jones Strain-Counterstrain. Jones Institute. 1995.

▸ Hebgen, EU. Visceral Manipulation in Osteopathy. New York. Thieme Publishing Group. 2011. OSTEOPATHIC EDUCATION PROGRAM 13.A (CONTINUED).

DESCRIBE THE RESOURCES AVAILABLE TO SUPPORT OSTEOPATHIC MEDICAL EDUCATION IN THE FOLLOWING AREAS: A. REFERENCE MATERIAL PERTAINING TO OMM AND OPP INTEGRATION INTO PATIENT CARE (E.G., PHYSICAL, ON-SITE LIBRARY; ELECTRONIC LIBRARY RESOURCES; OMT VIDEO SERIES BY XYZ; ETC.)

▸ Videos that incorporate OPP, including:

▸ “Treating the Hospitalized Patient with Osteopathic Manipulative Treatment” by Karen Steele, DO, FAAO

▸ “Principles of Manual Medicine” by Philip E. Greenman, DO, FAAO

▸ Series of readings fundamental to understanding OPP and boards review:

▸ Still AT. Osteopathy Research & Practice

▸ Crow WT. Osteopathic Manipulative Medicine Review for Boards (3rd Edition).

▸ Nelson KE. Somatic Dysfunction in Osteopathic Family Medicine.

▸ DiGiovanna EL, Schiowitz S. Dowling DJ. An Osteopathic Approach to Diagnosis and Treatment. OSTEOPATHIC EDUCATION PROGRAM 13.A (CONTINUED). DESCRIBE THE RESOURCES AVAILABLE TO SUPPORT OSTEOPATHIC MEDICAL EDUCATION IN THE FOLLOWING AREAS: A. REFERENCE MATERIAL PERTAINING TO OMM AND OPP INTEGRATION INTO PATIENT CARE (E.G., PHYSICAL, ON-SITE LIBRARY; ELECTRONIC LIBRARY RESOURCES; OMT VIDEO SERIES BY XYZ; ETC.)

▸ OPP/OMM/OMT On-Line Reference materials:

▸ OSTMED.DR® (http://cdm17018.contentdm.oclc.org)

▸ Osteopathic medicine digital library

▸ Books, selective journals, video and images, and core journals, including:

▸ Journal of Osteopathy v.4 (2, 4-12) 1897; v.5 (1- 7) 1898

▸ JAOA – 1950 to present

▸ AOAJ - 1960 to present

▸ LECOM/LECOMT Core Library affiliation w/ UH enables access to the American College of Osteopathic Family Physicians OMT Coursework (http://www.acofp.org/acofpimis/acofporg/apps/OMT/in dex.html) OSTEOPATHIC EDUCATION PROGRAM 13.B.

DESCRIBE THE RESOURCES AVAILABLE TO SUPPORT OSTEOPATHIC MEDICAL EDUCATION IN THE FOLLOWING AREAS: B. ACCESSIBILITY OF EXAMINATION TABLES SUITABLE FOR OMT AND EDUCATION.

▸ 2 portable OMT exam tables

▸ Site 1 for didactic and workshop training sessions.

▸ Amendable for application of OMT in care of patients. ▸ OPP/OMT training sessions

▸ Strive to demonstrate application of OPP/OMT in settings that do not have OMT tables.

▸ Trainees must be able to utilize OMT in an A/I ambulatory and inpatient setting. ▸ Multiple portable OMT tables at UH Regional Hospitals (e.g. 18 portable OMT tables at Richmond Medical Center) training sites for didactic and workshop sessions

▸ ONMM Grand Rounds

▸ Monthly ONMM Core Faculty Didactic-Workshop Series OSTEOPATHIC EVALUATION 14.

SELECT THE COMMITTEE THAT REVIEWS THE PROGRESS OF ALL DESIGNATED OSTEOPATHIC FELLOWS IN THE PROGRAM AS IT RELATES TO OPP.

▸ Clinical Competency Committee (CCC) OSTEOPATHIC EVALUATION 15.

LIST THE OSTEOPATHIC FACULTY MEMBER(S) ON THE CCC.

▸ Robert Hostoffer, DO, MEd, FAAP, FACOP, FACP, FACOI, UH Adult & Pediatric Allergy/Immunology Fellowship Program Director

▸ Devi Jhaveri, DO, FAAP, ACOP, UH Adult & Pediatric Allergy/Immunology Fellowship Assistant Program Director OSTEOPATHIC EVALUATION 15. OSTEOPATHIC EVALUATION 16.A.

WHAT OBJECTIVE FORMATIVE ASSESSMENT IS USED BY THE PROGRAM TO DETERMINE THE FOLLOWING IN DESIGNATED OSTEOPATHIC FELLOWS? A. OSTEOPATHIC MEDICAL KNOWLEDGE:

▸ Yearly in-service.

▸ Osteopathic A/I AOA Boards.

▸ Daily incorporation of OPP into didactics.

▸ Scholarly activity that incorporates OMM and OPP w/ subsequent discussion. OSTEOPATHIC EVALUATION 16.A. OSTEOPATHIC EVALUATION 16.A. DIDACTICS OSTEOPATHIC EVALUATION 16.B.

WHAT OBJECTIVE FORMATIVE ASSESSMENT IS USED BY THE PROGRAM TO DETERMINE THE FOLLOWING IN DESIGNATED OSTEOPATHIC FELLOWS? B. OSTEOPATHIC PROCEDURAL SKILLS:

▸ Biannual formative evaluation

▸ Monthly rotation assessment

▸ 360-degree evaluation form

▸ Objective osteopathic competency evaluation OSTEOPATHIC EVALUATION 16.B. OSTEOPATHIC PICTIONARY OSTEOPATHIC WELLNESS