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Kwiatkowski A, Shakoor N, Manadan A, Block JA, Khandelwal S. Incorporating interactive workshops into bedside teaching: completion of a multi-modal rheumatology rotation significantly increases internal medicine residents' competency and comfort with comprehensive knee examinations. BMC MEDICAL EDUCATION 2022; 22:355. [PMID: 35538536 PMCID: PMC9092684 DOI: 10.1186/s12909-022-03425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents' competency and comfort with knee examinations when compared to the rotation alone. METHODS Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. RESULTS Fifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025). CONCLUSION An elective in rheumatology augmented residents' MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.
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Affiliation(s)
- Alysia Kwiatkowski
- Division of Allergy, Immunology & Rheumatology, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Sonali Khandelwal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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2
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Koppes DM, Triepels CPR, Notten KJB, Smeets CFA, Kruitwagen RFPM, Van Gorp T, Scheele F, Van Kuijk SMJ. The Level of Anatomical Knowledge, Hard to Establish: a Systematic Narrative Review. MEDICAL SCIENCE EDUCATOR 2022; 32:569-581. [PMID: 35528299 PMCID: PMC9054958 DOI: 10.1007/s40670-022-01509-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This literature review aimed to gain more insight into the level of anatomical knowledge based on published measurements among medical students, residents, fellows, and specialists. METHODS We performed an extensive literature search in three online databases: Medline (using PubMed), Web of Science, and Education Resources Information Centre (ERIC). RESULTS A total of 30 relevant studies were found. In these studies, participants took different anatomy tests, and their mean/median scaled scores range from 22.5 to 82.4% on a 0 to 100% scale. CONCLUSION This review provides an overview of what is known about measured anatomical knowledge. After critically reviewing the literature, we have to conclude that the existing literature confirms that anatomical knowledge is hard to establish, mainly due to the lack of standardisation.Further research should focus on ways to define and assess 'desired anatomical knowledge' in different contexts. In a next phase, we can discuss if anatomical knowledge is lacking and if interventions are needed.
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Affiliation(s)
- Dorothea Maria Koppes
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Present Address: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Charlotte Petronella Robertus Triepels
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Present Address: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Carlijn Franscisca Anna Smeets
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Rutgerus Franciscus Petrus Maria Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Present Address: GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Toon Van Gorp
- Department of Obstetrics and Gynaecology, Leuven University Medical Centre, Leuven, Belgium
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology/Medical Education, OLVG Hospital, Amsterdam, The Netherlands
- Department of Medical Education, VU University Medical Centre, Amsterdam, The Netherlands
- Athena Institute for Trans-Disciplinary Research, VU University, Amsterdam, The Netherlands
| | - Sander Martijn Job Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
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3
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Canoso JJ, Saavedra MÁ, Pascual-Ramos V, Sánchez-Valencia MA, Kalish RA. Musculoskeletal anatomy by self-examination: A learner-centered method for students and practitioners of musculoskeletal medicine. Ann Anat 2020; 228:151457. [DOI: 10.1016/j.aanat.2019.151457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
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4
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Manghani M, Cheung PP, Mogali SR, Prakash A, Chew LC. An evaluation of the effectiveness of teaching anatomy to rheumatologists through combined musculoskeletal sonoanatomy and human cadaveric dissection. Rheumatol Adv Pract 2020; 4:rkaa010. [PMID: 32582878 PMCID: PMC7302048 DOI: 10.1093/rap/rkaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/02/2020] [Indexed: 12/03/2022] Open
Abstract
Objective Our aim was to evaluate the effectiveness of teaching anatomy through combined musculoskeletal sonoanatomy and human cadaveric dissection for rheumatologists practising musculoskeletal US. Methods The principal focus was on scanning and then dissecting relevant musculoskeletal structures. Outcomes measured included confidence levels and objective knowledge. A mixed-methods approach of evaluation and descriptive statistical data analysis was performed. Results The change in confidence ratings by delegates after the teaching event as represented by the mean difference (s.d.) (s.e.m.) for identification of surface anatomy was 1.846 (1.281) (0.355), with Student’s paired t = 5.196 and P=0.000223. The mean difference (s.d.) (s.e.m) for performing IA injections was 1.538 (1.266) (0.351), with Student’s paired t = 4.382, P=0.001, and for recognizing sonoanatomical structures it was 1.769 (1.235) (0.343), with Student’s paired t = 5.165 and P= 0.000235. There was a significant increase in correct identification of anatomical and sonoanatomical knowledge in the pre- and post-course assessments. Rotator cuff interval region improved from 13 to 73%, P = 0.004; knee tendons insertion sites from 47 to 93%, P = 0.016; and muscles not adjacent to joints from 27 to 93%, P = 0.002. Conclusion Dissection of joints enabled a three-dimensional relational mind map of the relevant regions of the human body, producing clarity in understanding regional relational topographic anatomy and sonoanatomy. The combination of US and cadaveric dissection improved learners’ satisfaction, confidence and knowledge in areas where soft tissue complaints are common, which is likely to lead to accurate early diagnosis and cost-conscious, better overall care.
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Affiliation(s)
- Mona Manghani
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Department of Medicine, Yong Loo Lin School of Medicine
| | - Peter P Cheung
- Department of Medicine, Yong Loo Lin School of Medicine
- Division of Rheumatology, University Medicine Cluster, National University Health System
| | | | - Ashutosh Prakash
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - Li-Ching Chew
- Department of Medicine, Yong Loo Lin School of Medicine
- Department of Rheumatology and Immunology, Singapore General Hospital
- Department of Medicine, DukeNUS Medical School, Singapore, Singapore
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5
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Villaseñor-Ovies P, Navarro-Zarza JE, Canoso JJ. The rheumatology physical examination: making clinical anatomy relevant. Clin Rheumatol 2019; 39:651-657. [PMID: 31446539 DOI: 10.1007/s10067-019-04725-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors' surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system.Key Points• Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes• Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders• An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine• A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray.
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Affiliation(s)
- Pablo Villaseñor-Ovies
- Hospital General de Tijuana, Tijuana, Baja California, Mexico. .,Hospital Angeles Tijuana, Tijuana, Baja California, Mexico. .,Universidad Autónoma de Baja California, Tijuana, Baja California, Mexico.
| | | | - Juan J Canoso
- ABC Medical Center, Mexico City, Mexico.,Tufts University School of Medicine, Boston, MA, USA
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6
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AAV-KLF7 Promotes Descending Propriospinal Neuron Axonal Plasticity after Spinal Cord Injury. Neural Plast 2017; 2017:1621629. [PMID: 28884027 PMCID: PMC5572611 DOI: 10.1155/2017/1621629] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/27/2017] [Accepted: 06/12/2017] [Indexed: 01/16/2023] Open
Abstract
DPSN axons mediate and maintain a variety of normal spinal functions. Unsurprisingly, DPSN tracts have been shown to mediate functional recovery following SCI. KLF7 could contribute to CST axon plasticity after spinal cord injury. In the present study, we assessed whether KLF7 could effectively promote DPSN axon regeneration and synapse formation following SCI. An AAV-KLF7 construct was used to overexpress KLF7. In vitro, KLF7 and target proteins were successfully elevated and axonal outgrowth was enhanced. In vivo, young adult C57BL/6 mice received a T10 contusion followed by an AAV-KLF7 injection at the T7–9 levels above the lesion. Five weeks later, overexpression of KLF7 was expressed in DPSN. KLF7 and KLF7 target genes (NGF, TrkA, GAP43, and P0) were detectably increased in the injured spinal cord. Myelin sparring at the lesion site, DPSN axonal regeneration and synapse formation, muscle weight, motor endplate morphology, and functional parameters were all additionally improved by KLF7 treatment. Our findings suggest that KLF7 promotes DPSN axonal plasticity and the formation of synapses with motor neurons at the caudal spinal cord, leading to improved functional recovery and further supporting the potential of AAV-KLF7 as a therapeutic agent for spinal cord injury.
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7
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Anatomic Knowledge and Perceptions of the Adequacy of Anatomic Education Among Applicants to Orthopaedic Residency. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2017; 1:e016. [PMID: 30211350 PMCID: PMC6132332 DOI: 10.5435/jaaosglobal-d-17-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The time dedicated to the study of human anatomy within medical school curriculums has been substantially reduced. The effect of this on the knowledge of incoming orthopaedic trainees is unknown. The current study aimed to evaluate both the subjective perceptions and objective anatomic knowledge of fourth-year medical students applying for orthopaedic residency. Methods: A multicenter prospective study was performed that assessed 224 students during the course of their interview day for an orthopaedic residency. Participants provided demographic data and a subjective assessment of the quality of their anatomic education, and completed either an upper or lower extremity anatomic examination. Mean total scores and subscores for various anatomic regions and concepts were calculated. Results: Students on average rated the adequacy of their anatomic education as 6.5 on a 10-point scale. Similarly, they rated the level of importance their medical school placed on anatomic education as 6.2 on a 10-point scale. Almost 90% rated the time dedicated to anatomy as good or fair. Of six possible methods for learning anatomy, dissection was rated the highest. On objective examinations, the mean score for correct answers was 44.2%. This improved to 56.4% when correct and acceptable answers were considered. Regardless of anatomic regions or concepts evaluated, percent correct scores did not reach 50%. There were no significant correlations between performance on the anatomic examinations and either prior academic performance measures or the student's subjective assessment of their anatomic education. Conclusions: Current students applying into orthopaedic residency do not appear to be adequately prepared with the prerequisite anatomic knowledge. These deficits must be explicitly addressed during residency training to produce competent, safe orthopaedic surgeons.
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8
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Hernández-Díaz C, Alvarez-Nemegyei J, Navarro-Zarza JE, Villaseñor-Ovies P, Kalish RA, Canoso JJ, Vargas A, Chiapas-Gasca K, Biundo JJ, de Toro Santos FJ, McGonagle D, Carette S, Saavedra MÁ. A survey of anatomical items relevant to the practice of rheumatology: pelvis, lower extremity, and gait. Clin Rheumatol 2017; 36:2813-2819. [PMID: 28573372 DOI: 10.1007/s10067-017-3702-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022]
Abstract
This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are most relevant to the practice of rheumatology. To determine their perceived relevance to clinical practice, seven members of the Mexican Clinical Anatomy Task Force compiled an initial list of 470 anatomical items. Ten local and international experts according to a 0-10 Likert scale ranked these items. Of the original list, 101 (21.48%) items were considered relevant (global rate >40). These included 36/137 (26.27%) pelvis and hip items, 25/82 (30.48%) knee items, 22/168 (13.98%) ankle/foot items, 11/68 (16.17%) neurologic items, and 7/15 (46.66%) gait-related items. We propose that these 101 anatomical items of the lower extremity, when added to the 115 anatomic items of the upper extremity and spine we previously reported, may represent an approximation to the minimal anatomical knowledge central to the competent practice of rheumatology. The meager representation of ankle and foot items may reflect a lesser emphasis in these anatomical regions during rheumatologic training. Attention to these and related items during rheumatologic training and beyond may sharpen the rheumatologist's ability in the differential diagnosis of regional pain syndromes as well as strengthen an endangered art: the rheumatologic physical examination.
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Affiliation(s)
- Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, México, DF, Mexico
| | - José Alvarez-Nemegyei
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
| | - José Eduardo Navarro-Zarza
- Hospital General de Chilpancingo Raymundo Abarca Alarcón, Chilpancingo, Gro, Mexico.,Universidad Autónoma de Guerrero, Acapulco, Gro, Mexico
| | - Pablo Villaseñor-Ovies
- Hospital Ángeles de Tijuana, Tijuana, BC, Mexico.,Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Juan J Canoso
- Centro Médico ABC, México, DF, Mexico.,Tufts Medical School, Boston, MA, USA
| | - Angélica Vargas
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, Mexico
| | | | | | - Francisco Javier de Toro Santos
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario A Coruña (CHUAC), Sergas, Universidad La Coruña (UDC), Coruña, Spain
| | - Dennis McGonagle
- UK National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Simon Carette
- Division of Rheumatology, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Miguel Ángel Saavedra
- Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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9
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Blake T, Marais D, Hassell AB, Stevenson K, Paskins Z. Getting back to the dissecting room: An evaluation of an innovative course in musculoskeletal anatomy for UK-based rheumatology training. Musculoskeletal Care 2017; 15:405-412. [PMID: 28317249 DOI: 10.1002/msc.1188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The rheumatologist relies heavily on clinical skills to diagnose diverse conditions, something that is correlated with one's knowledge of clinical anatomy. More recently, rheumatology has offered further career flexibility with opportunities to develop skills such as joint injection and musculoskeletal (MSK) ultrasound, both of which require a sound understanding of anatomy. Currently, there are no formal strategies to support competency-based anatomy learning in rheumatology in the UK. This study aimed to evaluate an innovative applied anatomy course utilizing cadaveric material, targeted at clinicians practising in rheumatology and MSK medicine. METHODS A new course was developed for rheumatologists, rheumatology trainees and allied health professionals practising rheumatology and MSK medicine, with the principal focus being on applied MSK anatomy. A questionnaire was given to course attendees and a mixed methods approach of evaluation used. Descriptive statistical data analysis was performed. RESULTS The course received overall positive feedback and statistically significant improvements in levels of confidence in anatomy (mean 52.35-83.53, p < 0.0001), injections (mean 57.65-81.18, p < 0.0001), examination of the upper limb (mean 60.59-76.47, p < 0.0001) and examination of the lower limb (mean 58.24-77.65, p < 0.0001). Course attendees also favoured a peer-assisted and multidisciplinary learning approach. CONCLUSIONS This study lends support for the use of cadaveric material in the teaching of postgraduate anatomy to rheumatologists. It has demonstrated a continual need for hands-on and interactive anatomy training in an ever-advancing digital world. To be successful, cadaveric learning should not be viewed in a purely 'pre-clinical' setting, but instead integrated with postgraduate learning.
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Affiliation(s)
- Tim Blake
- Rheumatology Department, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, UK.,Education and Research Team, Warwick Medical School, University of Warwick, Coventry, UK
| | - Debbi Marais
- Education and Research Team, Warwick Medical School, University of Warwick, Coventry, UK.,Social Science and Systems in Health, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew B Hassell
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK.,School of Medicine, Keele University, UK.,Haywood Hospital, Staffordshire and Stoke on Trent Partnership NHS Trust, Burslem, UK
| | - Kay Stevenson
- Haywood Hospital, Staffordshire and Stoke on Trent Partnership NHS Trust, Burslem, UK
| | - Zoe Paskins
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, UK.,Haywood Hospital, Staffordshire and Stoke on Trent Partnership NHS Trust, Burslem, UK
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10
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Villaseñor-Ovies P, Navarro-Zarza JE, Saavedra MÁ, Hernández-Díaz C, Canoso JJ, Biundo JJ, Kalish RA, de Toro Santos FJ, McGonagle D, Carette S, Alvarez-Nemegyei J. A survey of anatomical items relevant to the practice of rheumatology: upper extremity, head, neck, spine, and general concepts. Clin Rheumatol 2016; 35:3025-3030. [PMID: 27539219 DOI: 10.1007/s10067-016-3378-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/06/2016] [Indexed: 11/25/2022]
Abstract
This study aimed to identify the anatomical items of the upper extremity and spine that are potentially relevant to the practice of rheumatology. Ten rheumatologists interested in clinical anatomy who published, taught, and/or participated as active members of Clinical Anatomy Interest groups (six seniors, four juniors), participated in a one-round relevance Delphi exercise. An initial, 560-item list that included 45 (8.0 %) general concepts items; 138 (24.8 %) hand items; 100 (17.8 %) forearm and elbow items; 147 (26.2 %) shoulder items; and 130 (23.2 %) head, neck, and spine items was compiled by 5 of the participants. Each item was graded for importance with a Likert scale from 1 (not important) to 5 (very important). Thus, scores could range from 10 (1 × 10) to 50 (5 × 10). An item score of ≥40 was considered most relevant to competent practice as a rheumatologist. Mean item Likert scores ranged from 2.2 ± 0.5 to 4.6 ± 0.7. A total of 115 (20.5 %) of the 560 initial items reached relevance. Broken down by categories, this final relevant item list was composed by 7 (6.1 %) general concepts items; 32 (27.8 %) hand items; 20 (17.4 %) forearm and elbow items; 33 (28.7 %) shoulder items; and 23 (17.6 %) head, neck, and spine items. In this Delphi exercise, a group of practicing academic rheumatologists with an interest in clinical anatomy compiled a list of anatomical items that were deemed important to the practice of rheumatology. We suggest these items be considered curricular priorities when training rheumatology fellows in clinical anatomy skills and in programs of continuing rheumatology education.
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Affiliation(s)
- Pablo Villaseñor-Ovies
- Hospital Ángeles de Tijuana, Tijuana, BC, Mexico
- Universidad Autónoma de Baja California, Mexicali, Mexico
| | - José Eduardo Navarro-Zarza
- Hospital General de Chilpancingo Raymundo Abarca Alarcón, Chilpancingo, Gro, Mexico
- Universidad Autónoma de Guerrero, Acapulco, Gro, Mexico
| | - Miguel Ángel Saavedra
- Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, México, DF, Mexico
| | - Juan J Canoso
- Centro Médico ABC, México, DF, Mexico
- Tufts Medical School, Boston, MA, USA
| | | | - Robert A Kalish
- Tufts Medical School, Boston, MA, USA
- Tufts Medical Center, Boston, MA, USA
| | - Francisco Javier de Toro Santos
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario A Coruña (CHUAC), Sergas, Universidad La Coruña (UDC), Coruña, Spain
| | - Dennis McGonagle
- UK National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Simon Carette
- Division of Rheumatology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - José Alvarez-Nemegyei
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
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11
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Saavedra MA, Villaseñor-Ovies P, Harfush LA, Navarro-Zarza JE, Canoso JJ, Cruz-Domínguez P, Vargas A, Hernández-Díaz C, Chiapas-Gasca K, Camacho-Galindo J, Alvarez-Nemegyei J, Kalish RA. Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City. Clin Rheumatol 2015; 35:1299-306. [PMID: 26400643 DOI: 10.1007/s10067-015-3076-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 12/26/2022]
Abstract
We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.
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Affiliation(s)
- M A Saavedra
- Jefe de Reumatología, Hospital de Especialidades Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Seris y Zaachila s/n, Col. La Raza, Del., Azcapotzalco, CP 02990, DF, Mexico.
| | - P Villaseñor-Ovies
- Reumatólogo, Hospital Ángeles de Tijuana, Tijuana, BC, Mexico.,Reumatólogo Hospital General de Tijuana, Secretaría de Salud de Baja California, Tijuana, BC, Mexico.,Profesor titular de Reumatologia, Universidad Autónoma de Baja California, CISALUD, Valle de las Palmas, BC, Mexico
| | - L A Harfush
- Ortopedista, Centro Médico ABC, México, DF, Mexico
| | - J E Navarro-Zarza
- Reumatólogo, Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Gro, Chilpancingo, Mexico
| | - J J Canoso
- Reumatólogo, Centro Médico ABC, México DF, Adjunct Professor of Medicine, Tufts Medical School, México, Mexico
| | - P Cruz-Domínguez
- División de Investigación, Hospital de Especialidades Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, México, DF, México
| | - A Vargas
- Reumatolóloga, Instituto Nacional de Cardiología Ignacio Chávez, México, DF, Mexico
| | - C Hernández-Díaz
- Reumatóloga, Jefa, Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, México, DF, Mexico
| | - K Chiapas-Gasca
- Reumatóloga, Hospital Adolfo López Mateos, ISSSTE, México, DF, Mexico
| | | | - J Alvarez-Nemegyei
- Investigador en Ciencias Médicas, Unidad de Investigación, México, DF, Mexico.,Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
| | - R A Kalish
- Rheumatology Department, Tufts Medical Center and Tufts University Medical School, Boston, MA, USA
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12
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Torralba KD, Villaseñor-Ovies P, Evelyn CM, Koolaee RM, Kalish RA. Teaching of clinical anatomy in rheumatology: a review of methodologies. Clin Rheumatol 2015; 34:1157-63. [PMID: 26037454 DOI: 10.1007/s10067-015-2984-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/23/2015] [Indexed: 11/29/2022]
Abstract
Clinical anatomy may be defined as anatomy that is applied to the care of the patient. It is the foundation of a well-informed physical examination that is so important in rheumatologic practice. Unfortunately, there is both documented and observed evidence of a significant deficiency in the teaching and performance of a competent musculoskeletal examination at multiple levels of medical education including in rheumatology trainees. At the Annual Meeting of the American College of Rheumatology in Boston, MA, that took place in November 2014, a Clinical Anatomy Study Group met to share techniques of teaching clinical anatomy to rheumatology fellows, residents, and students. Techniques that were reviewed included traditional anatomic diagrams, hands-on cross-examination, cadaver study, and musculoskeletal ultrasound. The proceedings of the Study Group section are described in this review.
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Affiliation(s)
- Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University, Loma Linda, USA
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13
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Should all rheumatologists study musculoskeletal anatomy? Clin Rheumatol 2015; 34:1153-6. [PMID: 25912214 DOI: 10.1007/s10067-015-2944-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 04/12/2015] [Indexed: 11/27/2022]
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14
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Saavedra MÁ, Navarro-Zarza JE, Alvarez-Nemegyei J, Canoso JJ, Kalish RA, Villaseñor-Ovies P, Hernández-Díaz C. Self-assessed efficacy of a clinical musculoskeletal anatomy workshop: A preliminary survey. ACTA ACUST UNITED AC 2014; 11:224-6. [PMID: 25544712 DOI: 10.1016/j.reuma.2014.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/11/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To survey the efficacy of a practical workshop on clinical musculoskeletal anatomy held in five American countries. METHODS A self-assessment competence questionnaire sent to participants 1-3 months after the workshop. Results were compared to the results of a practical, instructor-assessed, pre-workshop test. RESULTS The response rate of participants was 76.4%. The overall, self-assessed competence score for anatomical items that had been included in the pre-test was 76.9 (scale 0-100) as compared to an overall score of 48.1 in the practical, pre-workshop test (p<0.001). For items that were addressed in the workshop, but not included in the pre-test, self-assessed competence was rated at 62.9. Differences in anatomical knowledge between individuals from different countries and professional groups noted in the practical pre-test were no longer present in the post-test self-assessment. CONCLUSIONS From this preliminary data and supporting evidence from the literature we believe that our anatomy workshop provides an effective didactic tool for increasing competence in musculoskeletal anatomy.
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Affiliation(s)
- Miguel Ángel Saavedra
- Rheumatology Department, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, IMSS, Mexico City, Mexico.
| | - José E Navarro-Zarza
- Hospital General de Chilpancingo Raymundo Abarca Alarcón, Chilpancingo, Guerrero, Mexico
| | | | | | - Robert A Kalish
- Rheumatology Department, Tufts Medical Center, Boston, MA, United States
| | | | - Cristina Hernández-Díaz
- Musculoskeletal Ultrasonography Laboratory Department, National Institute of Rehabilitation, Mexico City, Mexico
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15
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Evangelisto AM, Nishio MJ, Higgs JB, Kissin EY, Kaeley GS. Musculoskeletal Ultrasound and Anatomy: Comment on the Article by Navarro-Zarza et al. Arthritis Care Res (Hoboken) 2014; 66:1432-3. [DOI: 10.1002/acr.22344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Jay B. Higgs
- San Antonio Military Medical Center and Joint Base San Antonio; San Antonio TX
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16
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Das B. Rheumatology in undergraduate curriculum. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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