Perspectives on How Osteopathic Recognition Enhances Patient Care, from Katina Rue, DO

Katina Rue, DO, associate program director for Osteopathic Recognition (OR) and medical student director at the Central Washington Family Medicine Residency (CWFMR) in Yakima, Washington, has recognized the value of osteopathic principles and practice (OPP) since the beginning of her medical career. Along with many other directors of osteopathic education (DOEs; those who lead programs with OR) at medical institutions across the United States, Dr. Rue is gaining valuable perceptions from faculty and staff as she implements and oversees OR programs that will help improve the experiences of physicians, residents, patients, and everyone else involved.

Osteopathic Recognition integrates osteopathic training into graduate medical education (GME), allowing medical residents to apply OPP to patient care. AACOM President and CEO Robert Cain, DO, states in his February 25, 2020, post that OR helps to ensure that new DOs can extend the kind of care to patients that they committed to delivering when they entered osteopathic medical school.

Dr. Rue, who has demonstrated a lifelong commitment to OPP, shared her valuable perspective on the importance of osteopathic training in GME with the OR Matters campaign.

• Dr. Rue, can you share some thoughts on why you think osteopathic training in GME is important?

Osteopathic medical students spend four years learning about OPP and developing their knowledge and skills in these areas. I feel that those practices should not stop at GME. Students are demanding that the tenets upon which osteopathic medicine was founded continue to be followed in their GME years. Osteopathic education is a continuum, and these principles, which embody why most of us went into osteopathic medicine, should continue to be fostered in the GME setting to produce the most highly skilled and compassionate osteopathic physicians. 

• Can you describe key points or events in your life that helped to guide your path toward osteopathic medicine?

Growing up in a medical home—my mother was an operating room nurse director and my father, a hospital pharmacy director—medicine was all around me. As a middle-school adolescent, one of my friends was diagnosed with acute lymphocytic leukemia, to which he ultimately succumbed. His illness and passing brought our community together in so many ways. This experience really helped identify medicine as the field for me. During my undergraduate years, I was interested in physical therapy, but that wasn’t “enough” for me. Then I learned about osteopathic medicine, including its holistic and personal approaches, and I never looked back. I applied only to DO schools, and ultimately only to DO family medicine residencies. 

• What does osteopathic medicine mean to you—in terms of being an osteopathic physician as well as a human being?

Osteopathic medicine means medicine in which patients and physicians are partners, and the physicians understand the context of the patients’ experiences, where the patients are coming from, and where they hope to be—both in life and in health. Osteopathic medicine enables the physician to incorporate each patient’s unique characteristics into treatment, to give the highest quality and most empathic, patient-centered, and evidence-based care.

• What are some important aspects of your OR program that you have implemented to integrate osteopathic training into GME? Have there been any perceptions from faculty or staff that you care to share?

At CWFMR, we have taken several actions to elevate our osteopathic training. We have purchased new osteopathic manipulative treatment (OMT) tables and various supplies, such as suction cups. We have established dedicated OMT clinics, often staffed by neuromuscular medicine specialists in addition to family medicine faculty. We have incorporated OMT visits into everyday care as well. Furthermore, we have trained our MD colleagues so they are comfortable with precepting residents. That was not an easy feat! When we first started incorporating OMT into everyday clinics supervised by allopathic faculty physicians, there was considerable angst. They wondered, what does it mean to discuss osteopathic tenets? And how do I give feedback on the OMT performed by osteopathic residents? We developed an annual two-hour hands-on OMT training course for faculty. We placed osteopathic conversation-starter flyers in the precepting room, which prompted residents and faculty to discuss the osteopathic tenets, as well as the osteopathic techniques that could potentially be used. As a result, allopathic faculty now confidently precept these OMT visits with the osteopathic residents. It’s truly a win-win! 

We give an OMT objective structured clinical examination at the beginning of residents’ first and second years, with longitudinal evaluation and gradually increasing autonomy for the residents to perform OMT independently. Our longitudinal hands-on OMT didactic curriculum includes about nine 1.5-to-2-hour sessions, led by faculty and residents. All residents and medical students—both osteopathic and allopathic—participate, including in breakout sessions on more advanced techniques. Each of these OMT sessions, in addition to covering hands-on OMT skills, incorporates anatomy, technique discussions, and theory. We conduct board prep during these didactics as well. Our osteopathic scholarly activity requires DO residents to give didactic presentations and call out the osteopathic components.

• Do you think that integrating osteopathic training in GME enhances patient care? If so, in what ways?

Yes. Physicians who can incorporate the psychosocial aspects of the human condition, as conveyed through osteopathic training, ultimately develop more trusting physician-patient relationships. I believe that osteopathic training, at all levels of medical education, enhances the human connection. When physicians and patients feel more connected, treatment becomes substantially more individualized and patient-centered, with each patient’s unique context being incorporated into care. 

More About Dr. Rue’s Experience

The OR Matters campaign thanks Dr. Rue for sharing her important perspective with our community. Dr. Rue earned her DO degree from Kansas City University of Medicine and Biosciences, and completed her residency training, including being chief resident, in family medicine and osteopathic manipulative medicine at the Medical Center of Independence, in Missouri. Dr. Rue is also a member of the adjunct clinical faculty at Pacific Northwest University of Health Sciences, she is a clinical instructor in the Department of Family Medicine at the University of Washington School of Medicine and at the Elson S. Floyd College of Medicine, and she serves on the Northwest Osteopathic Medical Foundation Executive Committee and on several Washington Osteopathic Medical Association and Washington Academy of Family Physicians committees. She is the second vice president of the Washington State Medical Association, where she is the first DO to ever be elected to the executive committee. Dr. Rue is an active member of AACOM’s Assembly of Osteopathic Graduate Medical Educators (AOGME).