3. Application of Knowledge for Osteopathic Medical Practice
Osteopathic physicians must demonstrate the understanding and application of established and evolving principles of foundational biomedical and clinical sciences integral to the practice of patient-centered osteopathic medical care. As with the other competency domains, application of knowledge is about ability (ie, knowledge put into action). Cognitive and other learning science theorists explain that the acquisition of declarative knowledge in biomedical and clinical sciences, the conscious knowledge that something is the case, progressively transforms into procedural knowledge (knowing how to do something). This gradual transformation leads the osteopathic physician to develop a problem and task-specific knowledge base that is integrated across individual disciplines. It is this knowledge base that provides a foundation for competent patient-centered osteopathic medical care. An osteopathic physician with a fluent knowledge base in foundational biomedical and clinical sciences, for example, would be able to explain principles of health, disease, and diagnostic and treatment options to patients. Included in this knowledge base is the articulation of core scientific and clinical practice principles relevant to osteopathic medical practice (eg, health and the body’s innate capacity to heal, differential diagnoses, disease etiologies, indications and contraindications, assessment of the risks and benefits of diagnostic and therapeutic interventions).
Knowledge fluency is fundamental to a generalist osteopathic physician’s competency to practice osteopathic medicine. Knowledge fluency is demonstrated by the ability to efficiently interpret, process, and skillfully apply principles of foundational biomedical and clinical sciences in a timely manner. Also important to an osteopathic physician’s knowledge competency is the ability to formulate appropriate clinical questions, retrieve evidence to inform patient care, acquire additional and evolving knowledge for lifelong learning, and apply this knowledge for continuous practice improvement. Demonstration of the understanding and application of core knowledge is fundamental to the incorporation of new knowledge. Continuous quality improvement, however, is primarily addressed in the practice-based learning and improvement domain (Domain 4).
As osteopathic medical knowledge provides the foundation for many physician competency domains, considerable overlap exists between this competency domain and the other six. Testing concepts are mapped here when the primary component being assessed is application of knowledge (eg, the knowledge of the scientific understanding of mechanisms of action; molecular and macro systems including biomolecules, molecules, cells, and organs; origins of disease processes; why certain diagnostic tests and treatments are used).
The principles that underlie the human condition, including its biologic complexity, genetic diversity, homeostatic mechanisms, structure-function interrelationships, development, and interactions of systems and environmental influences, guide the osteopathic physician in the understanding of health and the diagnosis and treatment of disease. While these foundational principles often cross biomedical science and clinical disciplines in the practice of osteopathic medicine, they are mapped here for primary characterization.
3.1 Foundational Biomedical Sciences Knowledge Base
Given the various clinical presentations common and important to osteopathic medical practice and described herein, the osteopathic physician must be able to
demonstrate the application of knowledge of clinically applicable foundational biomedical science concepts related to patient care and health, homeostasis, structure-function relationships, prevention, and disease, and do so in an integrated, patient centered, osteopathic manner.
The osteopathic physician must effectively apply clinically relevant foundational biomedical science knowledge related to:
the molecular, biochemical, tissue, and cellular bases of health and disease.
the anatomic and structural bases of health and disease.
the physiologic and pathologic bases of health and disease.
the microbiologic and immunologic bases of health and disease.
pharmacologic principles and pharmacotherapeutics in health and disease.
epidemiology and population sciences.
medicolegal and governing regulatory principles in medical practice.
3.2 Clinical Sciences Knowledge Base
Given the various clinical presentations common and important to osteopathic medical practice and described herein, the osteopathic physician must be able to demonstrate the application of knowledge of established and evolving clinical science concepts related to patient care and health, homeostasis, structure-function relationships, prevention, and disease and do so in an integrated, patient-centered, osteopathic manner.
The osteopathic physician must effectively apply clinical science knowledge related to disciplines pertaining to the primary-care-oriented focus of osteopathic medical practice, including generalist concepts from the following specialties:
emergency and acute care medicine.
general internal medicine and its subspecialties (eg, allergy/immunology, cardiology, endocrinology, gastroenterology, hematology, infectious diseases, nephrology, oncology, pulmonary medicine, rheumatology).
preventive and occupational medicine.
obstetrics and gynecology.
osteopathic neuromusculoskeletal medicine.
pain medicine, hospice, and palliative care.
physical medicine and rehabilitation.
pediatrics and adolescent medicine.
psychiatry and behavioral medicine.
general surgery and its subspecialties (eg, colon and rectal, neurologic, pediatric, plastic, thoracic, urologic, and vascular).
orthopedics and sports medicine.
otorhinolaryngology and ophthalmology.
other clinical discipline areas relevant to primary care in osteopathic medicine.
3.3 Continuous Knowledge Base Development and Lifelong Learning
The osteopathic physician must demonstrate that he/she acquires and sustains knowledge of applicable foundational biomedical and clinical science concepts appropriate for clinical practice for lifelong learning, including, as applicable, at the point of care.
The osteopathic physician must demonstrate that he/she:
incorporates new developments in foundational biomedical and clinical science knowledge relevant to the practice of osteopathic medicine into his/her practice.
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