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Two computer-assisted clinical case SOAP (subjective, objective, assessment, plan) note exercises were used for second-year osteopathic medical students, and a standardized patient was used during third year to measure recording behaviors regarding structural examinations and osteopathic manipulative treatment (OMT). Students were questioned before leaving campus for clinical rotations and at pregraduation to determine their attitudes toward use of these skills. Ninety-one percent of the students recorded structural examination findings in both computer-assisted clinical case SOAP notes, and 61% suggested OMT be given on their basic science SOAP (pneumonia). All of the students in the osteopathic theory and methods exercise suggested OMT. On a standardized patient with chronic obstructive pulmonary disease, 11% of the students performed a structural examination, and 0.7% suggested OMT. Preclinically, 73% of the students believed they were prepared to conduct structural examinations, and 71% believed they were prepared to use OMT. Between 64% and 73% of pregraduation students, however, reported they had few opportunities to use these skills during clinical rotations. Most of the students believed they would use palpatory diagnosis and OMT for fewer than 25% of their future patients and primarily for patients with musculoskeletal problems.