My name is Alfred Amendolara. I'm a fourth year medical student at Norda College of Osteopathic Medicine, and today I'm going to talk a little bit about DO representation and guideline development. Let me give some background first. According to the American Osteopathic Association, 11% of practicing physicians in the U.S. are DOs, and this number is growing rapidly. Nearly 25% of current medical students attend an osteopathic medical school. However, DOs remain underrepresented in the production of research. This is especially noticeable in high-profile and high-impact journals and with grant funding. Nearly no R01 grants have been awarded to osteopathic physicians in a number of specialties. This is a problem. Research and scholarship are core drivers of medicine today. Many practice decisions are guided by evidence-based medicine, and guidelines are some of the most highly cited work. So establishing representation in the development of these guidelines equates to maintaining a degree of practice autonomy. Without involvement in guideline development, DOs risk giving up control of their own practice of medicine. So our objective for this project was to assess the relative contribution of DOs to the body of literature guiding practice, especially when it comes to U.S.-based guidelines published in recent years. So how did we go about doing this? Well, we collected guidelines from the ECRI Guideline Trust Database from the years 2021 to 2023. We extracted only the U.S.-based guidelines and manually counted and categorized authors into one of three groups based on terminal degree. Those groups are MD holders, DO holders, and other degree holders, which contains all authors that had some other terminal degree, whether it be a PhD or some other professional degree. We also collected some additional data, including sponsoring organization, the type of sponsoring organization, and the specialty. And you can see here a bit more detailed of a breakdown, including our inclusion and exclusion criteria, which are pretty similar or pretty simple. We only included U.S.-based guidelines and any non-U.S.-based guideline, so any guideline sponsored or published by a non-U.S. entity was excluded. So let's talk a bit about what we found. Overall, we collected 604 guidelines with a total of 9,367 authors. Of that, 110 authors were DOs, which is about 1.19%. Out of our total guidelines, 88 guidelines featured at least one DO author, which is about 14.56%. We can see that there's an increasing trend in both number of authors and number of guidelines featuring a DO author. In 2021, about 1% of authors held a DO, and by 2023, that number increased to 1.49%. And we see a similar trend with guidelines. In 2021, 22 guidelines featured at least one DO author, which is about 11%. And by 2023, 35 guidelines featured a DO author, which is about 19%. So this is only some of our data, some of our preliminary data. We have broken this down by organization type and by specialty and taken a little bit closer of a look into it, but these are our preliminary results. We hope to release the rest of it with the full manuscript. So now we can talk a little bit about how to interpret these results. The absolute number of DO authors is lower than expected. There are approximately 10 times the number of practicing MDs as practicing DOs, yet we found nearly 65 times the number of MD authors as DO authors. The percent of guidelines with at least one author is higher, more in line with the proportion of practicing DOs. However, this comes with a huge caveat, and that caveat is that guideline author lists rarely if ever have a single author on them, and none of the guidelines we investigated has a single author. So therefore, while this proportion of guidelines with one DO author is reassuring, it doesn't really offset the low absolute number of DO authors that we found. Maybe even more importantly, we found that no osteopathic sponsoring organizations were identified in the ECRI database. So taken as a whole, it's safe to say that DOs are underrepresented in absolute terms, but that they are present and involved in guideline development to some degree. There are some limitations to this study. Guidelines certainly exist outside of the ECRI database, and those were not included. We also did not consider unique authors, so authors were counted every time they appeared in an author list, which may skew results slightly. And likewise, societies or groups that frequently published guidelines every year may skew results versus societies or groups that less frequently published guidelines. So with all that being said, we have a couple of key takeaways. In absolute terms, DOs are underrepresented in the author lists. The number of articles with at least one DO author does suggest that DOs are at least involved in the process, but neither of these measures alone convey the whole story. Somewhat reassuringly, both metrics did increase over the three-year period we investigated, but more work is needed to monitor these trends. Thank you.

Doctors of Osteopathy

medical research

DO representation

guideline development

underrepresentation