Standardization of the hospital record for osteopathic structural examination: Part 2. Effects of an educational intervention on documentation of palpatory and structural findings and diagnosis

The purpose of this two-part study was to develop and test an instructional videotape for use in the osteopathic hospital setting; to standardize a procedure for documentation of palpatory and structural findings and diagnoses; and to examine the program's influence on the correlation of palpable and structural findings with a diagnostic impression of somatic dysfunction. To that end, the authors analyzed results of a survey of the medical records of 20 osteopathic training hospitals. Patients' charts were randomly pulled before and after house staff who performed admitting hospital examinations viewed an educational videotape. The videotape emphasized that the structural and palpatory screening examination should simply answer the question, "Is there a problem in the musculoskeletal system?" Chi-square analysis was used to evaluate the frequency of documentation of altered structural findings (structure, motion, tissue changes) and the diagnostic impression of somatic dysfunction and their correlation. Based on more than 300 reviewed charts, the authors found that the frequency of documentation of structural and palpatory examination was not significantly altered after house staff viewed the videotape. A sequence of hospital-based instruction in osteopathic principles and practices has been initiated at more than 50 osteopathic medical institutions, and the problems related to continuing medical education and clinical research in osteopathic medicine are discussed.