NBOME
COMLEX-USA MASTER BLUEPRINT

2. Osteopathic Patient Care and Procedural Skills

Overview

Osteopathic physicians must provide osteopathic medical care that is patient centered, compassionate, safe, effective, evidence based, timely, efficient, and equitable in order to promote health and the body’s self-regulatory and self-healing nature, in both the care of the patient and the care of communities and populations. Osteopathic physicians must provide these elements of effective osteopathic patient care, as appropriate to their scope of practice, to patients in a broad range of diverse and special populations in varied clinical settings, including outpatient, inpatient and home care settings, across the lifecycle. This patient care involves determining and monitoring the nature of the patient’s concern or complaint; appropriately incorporating osteopathic principles, practice, and OMT; and implementing effective, equitable, timely, evidence based, and mutually agreed-upon diagnostic and patient care plans, including appropriate patient education and follow-up. This includes performing all other diagnostic and therapeutic clinical procedures essential for the area of practice. In the delivery of the highest-quality patient care, promotion of wellness, and prevention of disease, osteopathic physicians must be able to serve appropriately as members or leaders of interprofessional health care teams and foster effective communication with and between other professionals. Interprofessional team outcomes will be mapped primarily to the systems-based practice domain (Domain 7).

Required Elements

2.1 Data Gathering

DEFINITION The osteopathic physician must effectively gather accurate, essential data from all sources, including the patient, secondary sources, medical records, and physical examination (including osteopathic structural examination), regardless of patient age or clinical setting. MEASURED OUTCOMES The osteopathic physician must:
  • elicit the patient’s view of the concern, complaint, or issue.
  • elicit the essential information regarding medication and allergy histories, social history, family history, sexual history, developmental milestones, and psychosocial issues that contribute to the patient’s behaviors or condition.
  • elicit a comprehensive patient-focused history, including symptoms, psychological factors, cultural considerations, need for interpretive or adaptive services, and community/social factors, from the patient and other sources as appropriate and in a timely manner.
  • elicit the essential information regarding past medical history of diseases, disorders, and surgical procedures.
  • elicit the essential information regarding mechanism of injury and disease presentations and/or biomechanical influences that contribute to the patient’s condition.
  • adapt the gathering of information effectively to the situation and interview patients, families, and caregivers in various clinical settings.
  • gather information regarding health promotion and disease prevention through medical-history taking and physical examination regarding the biomedical, biomechanical, and biopsychosocial issues that contribute to health and disease.
  • apply an appropriate knowledge base to medical-history taking and physical examination, regarding the psychosocial and cultural issues that contribute to health, disease, and behavior.
  • determine the patient’s living circumstances and the depth and scope of the patient’s support network.
  • explore the patient’s beliefs, concerns, expectations, and literacy about health and disease while considering contextual factors such as the patient’s age, gender, culture, literacy, sexual orientation, spirituality, and economic background.
  • interpret the results of relevant laboratory, imaging, and other diagnostic studies in the context of patient care.

2.2 Differential Diagnosis

DEFINITION The osteopathic physician must formulate a differential diagnosis based on the patient evaluation and epidemiologic data, prioritize diagnoses appropriately, and determine the nature of the concern or complaint in the context of the patient’s life cycle and in a variety of health care settings. MEASURED OUTCOMES The osteopathic physician must:
  • generate, assess, and test appropriate hypotheses during the medical interview and physical examination.
  • generate and prioritize an appropriate list of potential diagnoses given the medical history, physical examination findings, and other available data, recognizing the effect of biomedical, biomechanical, psychosocial, and cultural factors.

2.3 Essential Clinical Procedures

DEFINITION The osteopathic physician must perform basic clinical procedures essential for the generalist practice of osteopathic medicine. MEASURED OUTCOMES The osteopathic physician must:
  • perform a clinically appropriate physical examination including evaluation of each of the body areas (head, neck, chest, abdomen, genitalia/groin/buttocks, back/spine, and upper and lower extremities) and organ and body systems (constitutional; cardiovascular; ears, nose, mouth, and throat; eyes; genitourinary–female and male; hematologic/lymphatic/immunologic; musculoskeletal; neurologic; psychiatric; respiratory; and skin).
  • perform an osteopathic structural examination and OMT.
  • employ hand hygiene practices, universal precautions, and medical aseptic technique to minimize nosocomial infections.

2.4 Patient Care Management

DEFINITION The osteopathic physician must provide diagnostic information; develop a safe, evidence-based, cost-effective, equitable, patient-centered care plan; and use all ethical and appropriate options for the goal of relieving the patient’s physical and psychological distress. Within the context of evidence-based and cost-effective care, the osteopathic physician must assess the patient’s motivation, willingness, and ability to cooperate with the diagnostic and therapeutic plan. MEASURED OUTCOMES The osteopathic physician must:
  • elicit and consider the patient’s perspective in developing and planning the diagnostic and care plan with patients and their families, including orders and prescriptions, using a nonjudgmental approach to elicit health beliefs and values that may influence the patient's comfort and compliance with the treatment plan.
  • identify, ethically address, and appropriately relieve the patient’s suffering and distress while maintaining patient dignity.

2.5 Patient Education

DEFINITION The osteopathic physician must assess patients’ health literacy and understanding and must counsel and educate patients accordingly. MEASURED OUTCOMES The osteopathic physician must:
  • explain the nature of the patient’s concern or complaint at a level commensurate with the patient’s health literacy.
  • describe diagnostic procedures, therapeutic options, and care plans at a level commensurate with the patient’s health literacy.
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