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Denq W, Tomesch AJ, Lane AD, Thomas A, McNinch NL, Waterbrook A. National Needs Assessment of Emergency Medicine Residencies for Musculoskeletal Knowledge. Cureus 2023; 15:e43638. [PMID: 37719484 PMCID: PMC10504909 DOI: 10.7759/cureus.43638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Musculoskeletal (MSK) complaints and injuries account for a large percentage of presenting chief complaints to the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, there is a documented deficiency in MSK education at all training and practicing levels in the US medical system. The purpose of this needs assessment is to better determine the state of MSK education in Emergency Medicine residency programs. Methods An online needs assessment form was sent to Emergency Medicine program directors in the US. Summary statistics were performed followed by an exploratory analysis. Results Data from 43 of 272 Emergency Medicine program directors that responded to this needs assessment were analyzed. Respondents ranked the importance of MSK education in Emergency Medicine on a Likert scale of 1-5 (very unimportant to very important) at a mean of 4.2. Additionally, 97.6% of respondents believe that their MSK curriculum could be improved. Seventy-nine percent of respondents were somewhat likely or highly likely to use a standardized method or tool to assess MSK knowledge. Of the top three barriers to MSK education implementation, 94.9% cited time, 56.4% cited interdepartmental relations, and 46.2% cited funding. Conclusion MSK knowledge is taught and assessed in highly variable methods across Emergency Medicine residency programs. Although efforts are being made to address the known deficiency in MSK knowledge, further research is needed to perform a larger needs assessment, study innovative MSK education modalities, and develop a standardized MSK assessment for Emergency Medicine residency training.
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Affiliation(s)
- William Denq
- Emergency Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | | | - Allison D Lane
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
| | - Aaron Thomas
- Emergency Medicine/Sports Medicine, Mayo Clinic, Phoenix, USA
| | | | - Anna Waterbrook
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA
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McNeill K, Reyes N, Choe S, Peterson D, Bryant D, Sonnadara RR. A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education. MEDICAL SCIENCE EDUCATOR 2023; 33:777-790. [PMID: 37501799 PMCID: PMC10368607 DOI: 10.1007/s40670-023-01782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 07/29/2023]
Abstract
Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Natasha Reyes
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Stella Choe
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Ranil R. Sonnadara
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1 Canada
- Compute Ontario, Toronto, ON Canada
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Ferderber M, Wilson K, Buchanan BK, Street Callender SV, Deck JW, Kerr H, Lemmen B, Stafford CD, Wang DA, Waterbrook AL. Sports Medicine Curricular Recommendations for Undergraduate Medical Education. Curr Sports Med Rep 2023; 22:172-180. [PMID: 37141612 DOI: 10.1249/jsr.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
ABSTRACT Sports medicine is a unique field encompassing many specialties and aspects of medicine. While musculoskeletal medicine is a significant aspect of sports medicine, the breadth of sports medicine extends beyond the musculoskeletal system and includes the spectrum of care for the patient who is or desires to be physically active. This article provides recommendations for sports medicine education in undergraduate medical education. The framework highlighting these recommendations uses domains of competence. Entrustable professional activities, measures that are endorsed by the Association of American Medical Colleges, were matched to domains of competence to provide objective markers of achievement. In addition to recommended sports medicine educational content, there should be consideration of both methods of assessment and implementation catered to each individual institution's needs and resources. These recommendations may serve as a guide for medical educators and institutions pursing optimization of sports medicine education.
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Affiliation(s)
- Megan Ferderber
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Kristina Wilson
- Department of Pediatrics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Benjamin K Buchanan
- Department of Orthopaedics, Intermountain Healthcare-Southwest Orthopedics & Sports Medicine, St George, UT
| | - Shelley V Street Callender
- Department of Pediatrics and Family Medicine, Mercer University/Atrium Navicent Health System, St Macon, GA
| | - Jason W Deck
- Department of Family Medicine, OU-TU School of Community Medicine/University of Oklahoma Health Science Center, Tulsa, OK
| | - Hamish Kerr
- Department of Medicine and Pediatrics, Albany Medical College, Albany, NY
| | - Brooke Lemmen
- Department of Family Medicine, Central Michigan University Medical Sciences College of Medicine, Mount Pleasant, MI
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - David A Wang
- Department of Medicine, Hospital for Special Surgery, Paramus, NJ
| | - Anna L Waterbrook
- Department of Emergency and Sports Medicine, The University of Arizona, Tucson, AZ
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Muacevic A, Adler JR, Tomesch A, Zagroba S, Cahir TM, Waterbrook A. Impact of Sports Medicine and Orthopedic Surgery Rotations on Musculoskeletal Knowledge in Residency: An Update and Longitudinal Study. Cureus 2022; 14:e32830. [PMID: 36742273 PMCID: PMC9891394 DOI: 10.7759/cureus.32830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Musculoskeletal (MSK) complaints and injuries account for a significant percentage of presenting chief complaints to the emergency department in the United States (US). Despite the prevalence of disease and economic impact on the US healthcare system, there is a documented deficiency in MSK education at all training and practicing levels in the US medical system. The purpose of this study is to determine MSK knowledge acquisition after an orthopedic or primary care sports medicine (PCSM) rotation in three emergency medicine (EM) residency programs at a single institution. Methods A total of 115 EM post-graduate year 1 (PGY-1) residents participated in and completed this study over five academic years. Based on existing residency program curricula, the participants were categorized into two groups. One group completed a traditional four-week Orthopedic Surgery rotation and the other group completed a four-week Sports Medicine rotation. The validated written Freedman and Bernstein MSK examination (FB-MSK) was administered to all participants at the start of residency and at completion of their rotation. Fifty-nine of the participants participated in a longitudinal secondary study over five academic years. The FB-MSK was offered to all participants every year following the completion of their rotation during their residency. Results Post-rotation scores improved regardless of which group the resident belonged to. The orthopedic group improved an average of 3.11 points (p = <0.0001, CI 2.39 to 3.82) and the average improvement in the PCSM group was 3.97 points (p = <0.0001, CI 2.81 to 5.83). The post-rotation scores were similar regardless of the group (p = 0.4287, CI -0.73 to 1.70). The amount of improvement in scores between the two groups was not statistically significant (p = 0.209, CI -0.49 to 2.21). Of the longitudinal participants, PGY-3+ significantly scored higher than PGY-1 (p = 0.0325, 95% CI 0.165 to 3.658). Conclusion Regardless of rotation type, MSK knowledge acquisition appears to significantly improve. EM senior residents demonstrate significant MSK knowledge acquisition during residency. Further studies on a multi-institutional level are needed to account for MSK curriculum variability in residency programs.
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Mulcaire-Jones E, Barker AM, Beck JP, Lawrence P, Cannon GW, Battistone MJ. Impact of a Musculoskeletal "Mini-Residency" Professional Development Program on Knee Magnetic Resonance Imaging Orders by Primary Care Providers. J Clin Rheumatol 2022; 28:245-249. [PMID: 35358112 PMCID: PMC9336568 DOI: 10.1097/rhu.0000000000001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US Department of Veterans Affairs has created a portfolio of educational programs to train primary care providers (PCPs) in the evaluation and management of common musculoskeletal (MSK) conditions. Appropriate resource utilization for evaluation of knee pain, including limiting unnecessary magnetic resonance imaging (MRI) studies, is an important theme of these initiatives. The objective of this study was to report the utilization of knee MRI by PCP providers before and after the MSK education program and to determine the appropriateness of these MRI orders. METHODS Twenty-six PCPs participated in the MSK Mini-Residency educational program held in Salt Lake City between April 2012 and October 2014. Knee MRI orders submitted by these providers 12 months before and 12 months after their participation were reviewed. Magnetic resonance imaging orders were categorized as "inappropriate," "probably inappropriate," or "possibly appropriate," based on accepted guidelines for knee MRI utilization. Differences in the numbers of precourse and postcourse MRI orders for each of these categories were compared using Student t test. RESULTS Following our program, MRI orders decreased from 130 (precourse) to 93 (postcourse), a reduction of 28% ( p = 0.04). This reduction was observed entirely within the "inappropriate" and "probably inappropriate" categories; the number of orders categorized as "possibly appropriate" increased, but not significantly. CONCLUSIONS The MSK Mini-Residency training program was a successful educational intervention and was associated with a reduction in inappropriate knee MRI utilization for some participants, while keeping appropriate MRI utilization stable.
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Affiliation(s)
| | - Andrea M. Barker
- Veterans Affairs Salt Lake City Health Care System
- Departments of Family and Preventive Medicine
| | | | | | - Grant W. Cannon
- Veterans Affairs Salt Lake City Health Care System
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Michael J. Battistone
- Veterans Affairs Salt Lake City Health Care System
- Division of Rheumatology, University of Utah, Salt Lake City, UT
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Choi S, Ooi S, Carpenter E. A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2022; 9:23821205211072764. [PMID: 35036567 PMCID: PMC8755927 DOI: 10.1177/23821205211072764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Adequate exposure and teaching of Trauma and Orthopaedics (T&O) to medical students is fundamental in order to obtain sufficient knowledge and sustain their interest in T&O as a career. The primary aim is to assess the exposure and delivery of T&O at all medical schools in the UK. The secondary aim is to determine whether there are any associations between attending a particular medical school and having a strong interest in pursuing a career in T&O. METHODS To explore the primary aim, all 33 UK medical schools were investigated in the study, by means of a questionnaire distributed to medical students. This did not include 'new' medical schools, defined as those established from 2014 onwards. To investigate the secondary aim of exploring associations between students' and alumni's medical schools and their interest in T&O as a career, British Orthopaedic Training Association (BOTA) members were reviewed, using the General Medical Council register to identify the universities from which members had graduated. The authors have made the assumption that membership of BOTA signified an interest in T&O as a career. RESULTS Results were obtained for all 33 medical schools. The mean total teaching time specifically for T&O throughout medical school was 18 days, ranging from 3 to 60 days in total. 118 BOTA members were reviewed. No member of BOTA in the study had attended medical school in Keele, Liverpool, Plymouth or Lancashire. These universities taught below the national average number of days in T&O. DISUCSSION There is a large national variance in the number of compulsory teaching days provided for T&O. The authors advocate medical schools to aim for at least the national average in duration of T&O of 18 days.
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7
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Peeler J. Efficacy of an intensive 2-week musculoskeletal anatomy course in a medical education setting. Ann Anat 2021; 239:151802. [PMID: 34265385 DOI: 10.1016/j.aanat.2021.151802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
There is little consistency in student contact hours and teaching activities used in medical curriculums across North America, and controversy exists regarding the most efficient or effective way to teach musculoskeletal (MSK) anatomy in medical school. The purpose of this investigation was to retrospectively examine academic performance and levels of course satisfaction among first year medical students who had completed an intensive 2-week MSK anatomy course during the pre-clerkship portion of their Association of Faculties of Medicine in Canada accredited undergraduate medical program. Course data from formative and summative student evaluations, as well as end-of-course satisfaction surveys were analyzed for a homogenous group of 549 first-year medical students over a 5-year period. Data indicated that student's academic performance on both formative and summative evaluations for the 2-week MSK anatomy course were consistently high, and not significantly different from the results for other system-based 1st year anatomy courses delivered over longer durations. Likert data from end-of-course surveys also suggested that student feedback regarding the course was overwhelmingly positive, and that the 2-week MSK anatomy course had the highest level of overall satisfaction when compared to all other first-year anatomy courses. These results can be used to help in the design and implementation of MSK anatomy courses within medical curriculums, and contribute to a growing body of literature which is focused on examining the effect of curricular design on MSK anatomy learning in a medical education setting.
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Affiliation(s)
- Jason Peeler
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Pan Am Clinic, Winnipeg, Manitoba, Canada.
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8
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Denq W, Fox JD, Lane A, Caballero B, Godfrey B, Yim J, Hughes KE, Cahir TM, Waterbrook A. Impact of Sports Medicine and Orthopedic Surgery Rotations on Musculoskeletal Knowledge in Residency. Cureus 2021; 13:e14211. [PMID: 33948401 PMCID: PMC8086753 DOI: 10.7759/cureus.14211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Musculoskeletal (MSK) complaints and injuries comprise 18.7% of emergency department visits. However, only 61% of emergency physicians (EP) pass a validated written Freedman and Bernstein MSK examination (FB-MSK). Educational interventions such as a primary care sports medicine (PCSM) rotation aid in MSK residency education. This study utilizes a validated MSK examination to evaluate and compare MSK knowledge acquisition following a traditional orthopedic rotation and a PCSM rotation. Methods Forty-nine interns were recruited to participate in this study over two academic years. The FB-MSK was administered to all participants at the start of residency. Participants were divided into two groups based on their residency sites; one group completed a traditional four-week orthopedic surgery rotation and the second group completed a four-week PCSM rotation. Forty-six of the forty-nine participants were administered the FB-MSK after completion of their rotations. Results Individual post-rotation scores significantly improved regardless of rotation (mean difference 2.78, p<0.001; 95% CI 2.05-3.52). The orthopedic surgery group significantly improved (mean difference 2.84, p<0.001; 95% CI 1.93-3.73) and the PCSM group significantly improved (mean difference 2.64, p=0.002; 95% CI 1.23-4.07). There was no significant difference in pre-rotation scores between the two groups (p=0.86; 95% CI -2.13 to 1.79). There was no significant difference in post-rotation scores between the two groups (p=0.66; 95% CI -1.98 to 1.26). There was no significant difference in mean score improvement between the two groups (p=0.81; 95% CI -1.33 to 1.69). Conclusion This study demonstrates significant MSK knowledge acquisition and no difference in the level of knowledge acquisition after completion of either traditional orthopedic surgery or PCSM residency rotation.
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Affiliation(s)
- William Denq
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine, Tucson, USA
| | - James D Fox
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Allison Lane
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine, Tucson, USA
| | | | - Brandon Godfrey
- Emergency Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Jay Yim
- Emergency Medicine, University of Arizona College of Medicine, Tucson, USA
| | - Kate E Hughes
- Emergency Medicine, University of Arizona, Tucson, USA
| | | | - Anna Waterbrook
- Emergency Medicine/Sports Medicine, University of Arizona College of Medicine, Tucson, USA
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Liddle DG, Changstrom B, Senter C, Meirick P, Stern N, Putukian M, Shah S, Powell A, Dixit S, Eerkes K, Moran B, Barnes KP, Dal Molin C, Myers R, Waterbrook AL. Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training. Curr Sports Med Rep 2021; 20:113-123. [PMID: 33560036 DOI: 10.1249/jsr.0000000000000811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.
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Affiliation(s)
- David G Liddle
- Intermountain Sports Medicine, Intermountain Healthcare, Logan Regional Orthopedics and Sports Medicine, Logan, UT
| | - Bradley Changstrom
- Department of Medicine, Division of Internal Medicine, University of Colorado, Denver, CO
| | - Carlin Senter
- Department of Orthopaedic Surgery, Division of Sports Medicine, University of California San Francisco, San Francisco, CA
| | | | | | - Margot Putukian
- Princeton University, McCosh Health Center, University Health Services, Preinceton, NJ
| | - Selina Shah
- Center for Sports Medicine, Walnut Creek, CA
| | - Amy Powell
- Department of Orthopaedic Surgery and Department of Internal Medicine, Division of General Internal Medicine, University of Utah, Salt Lake City, UT
| | - Sameer Dixit
- Department of Primary Care Sports Medicine, Hospital for Special Surgery, New York, NY
| | - Kevin Eerkes
- NYU Langone Health, Department of Internal Medicine, New York University, New York, NY
| | - Byron Moran
- Department of Orthopaedic Surgery, Division of Sports Medicine, College of Medicine, University of South Florida, Tampa, FL
| | - Kenneth P Barnes
- Department of Orthopaedic Surgery, Division of Sports Medicine, Moses H. Cone Memorial Hospital, Greensboro, NC
| | - Claudia Dal Molin
- Department of Internal Medicine and Department of Orthopaedic Surgery, Division of Sports Medicine, University of Maryland, Baltimore, MD
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Wang T, Xiong G, Lu L, Bernstein J, Ladd A. Musculoskeletal Education in Medical Schools: a Survey in California and Review of Literature. MEDICAL SCIENCE EDUCATOR 2021; 31:131-136. [PMID: 34457873 PMCID: PMC8368391 DOI: 10.1007/s40670-020-01144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Though musculoskeletal complaints account for roughly one-quarter of primary care and emergency department visits, only 2% of US medical school curriculum is devoted to musculoskeletal disease. Many graduating students demonstrate poor knowledge and report low confidence in treating musculoskeletal disorders. This study defines the current state of musculoskeletal curriculum of medical schools in detail to identify variations and potential shortcomings. METHODS All eleven medical schools in California were invited to participate in an in-depth survey detailing the design and content of their musculoskeletal curriculum. RESULTS A response rate of 100% was achieved. Overall, schools devoted an average of 58.7 h to musculoskeletal medicine, of which more than half was spent covering anatomy. The primary instructor for musculoskeletal medicine was a clinician in four schools (36.4%). Six schools offered a dedicated musculoskeletal physical exam course. No schools required students to complete a clinical rotation in musculoskeletal medicine. There was high variability among institutions when evaluating core subject coverage. DISCUSSION There is large variation in the content and structure of musculoskeletal instruction among California medical schools. Increased curricular time, integration of preclinical and clinical experiences, greater specialist participation, and standardized objectives may provide more consistent and comprehensive musculoskeletal education. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01144-3.
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Affiliation(s)
- Tim Wang
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Grace Xiong
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Laura Lu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Joseph Bernstein
- University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
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Fernández-Ávila DG, Rojas MX, Ramírez C, Rodelo L, Soriano E. Effectiveness of the use of an algorithm in the diagnostic approach of joint pain patients by primary care physicians. Rheumatol Int 2020; 40:1857-1864. [PMID: 32200425 DOI: 10.1007/s00296-020-04552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
There is a high percentage of error in the approach of patients with joint pain by primary care physicians. An algorithm can help improve this misdiagnosis problem. Our study seeks to determine the effectiveness of an algorithm when used by primary care physicians for the diagnosis of cases of joint pain patients. A randomized clinical experiment was carried out. Primary care physicians from five cities in Colombia developed a series of clinical cases, which were presented to them through a website on their personal cell phones. Half of the doctors developed the cases using the diagnostic algorithm, and the other half developed the cases without the use of the algorithm. Main measures were proportion of correct diagnosis, number, type of laboratory and diagnostic images requested for the diagnostic approach of clinical cases. Two hundred and twenty-four primary care physicians participated. The overall proportion of cases correctly diagnosed was 37.3% higher in the intervention group; we found a greater difference in cases of spondyloarthritis (60.8%), followed by systemic lupus erythematosus with joint involvement (32.2%), rheumatoid arthritis (30.3%) and osteoarthritis (25.9%). The average number of tests requested to develop clinical cases was lower in the intervention group than in the control group, both globally and for each of the four diseases, with statistically significant differences for each of the comparisons. The diagnostic algorithm proved to be an effective tool when used by primary care physicians; the proportion of correct diagnoses increased, and the number of tests requested in the development of the cases decreased.
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Affiliation(s)
- D G Fernández-Ávila
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - M X Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Ramírez
- Rheumatoid Arthritis Program, Sánitas EPS, Bogotá, Colombia
| | | | - E Soriano
- Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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12
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Barker AM, LaRochelle JS, Artino AR, Wiltz SA, Kim LM, Battistone MJ. SimLEARN Musculoskeletal Training for VHA Primary Care Providers and Health Professions Educators. Fed Pract 2020; 37:42-47. [PMID: 32047355 PMCID: PMC7010344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A simulation-based training curricula applied to the primary care evaluation and management of shoulder and knee pain resulted in improved access to care for veterans and cost savings for the health care system.
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Affiliation(s)
- Andrea M Barker
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Jeffrey S LaRochelle
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Anthony R Artino
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Scott A Wiltz
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Laura M Kim
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Michael J Battistone
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
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Battistone MJ, Barker AM, Durning SJ. Interprofessional Musculoskeletal Education: A Review of National Initiatives from the Department of Veterans Affairs. Rheum Dis Clin North Am 2019; 46:135-153. [PMID: 31757281 DOI: 10.1016/j.rdc.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article reviews several national programs in musculoskeletal education initiated by the Department of Veterans Affairs over the past decade. These programs have become sustained interprofessional opportunities for learners across disciplines and along the continuum of health professions education (HPE) and training pathways. This article also describes opportunities for leaders in rheumatology and other HPE programs to join these efforts and to collaborate in the scholarship that will be necessary in constructing educational programs fit for the purpose of ensuring a well-trained, competent workforce of health care providers.
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Affiliation(s)
- Michael J Battistone
- Division of Rheumatology, Department of Medicine, Center of Excellence in Musculoskeletal Care and Education, George E. Wahlen Veterans Affairs Salt City Health Care System, University of Utah Health Sciences Center, Salt Lake City VA Medical Center, 11/E, 500 Foothill Drive, Salt Lake City, UT 84148, USA.
| | - Andrea M Barker
- Department of Family and Preventive Medicine, Center of Excellence in Musculoskeletal Care and Education, George E. Wahlen Veterans Affairs Salt City Health Care System, University of Utah Health Sciences Center, Salt Lake City VA Medical Center, 11/E, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Steven J Durning
- Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712, USA
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Webb AL, Green RA, Woodley SJ. The development of a core syllabus for teaching musculoskeletal anatomy of the vertebral column and limbs to medical students. Clin Anat 2019; 32:974-1007. [DOI: 10.1002/ca.23319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alexandra L. Webb
- Medical School, College of Health and MedicineAustralian National University Canberra Australia
| | - Rodney A. Green
- College of Science, Health & EngineeringLa Trobe University Bendigo Australia
| | - Stephanie J. Woodley
- Department of Anatomy, School of Biomedical SciencesUniversity of Otago Dunedin New Zealand
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Musculoskeletal Education in Medical Schools: A Survey of Allopathic and Osteopathic Medical Students. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e019. [PMID: 30211396 PMCID: PMC6132304 DOI: 10.5435/jaaosglobal-d-18-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Musculoskeletal (MSK) disorders are one of the most common causes of disability and emergency department and physician visits in the United States. However, there is very little consistency in how physicians in training are prepared to treat MSK disorders. On the basis of published reports, medical school graduates have a relative lack of cognitive mastery in MSK medicine, even with the recent increase in instruction. This study sought to compare MSK education at an allopathic medical school with that at an osteopathic medical school. Methods: An anonymous survey of students in medical school graduate years 2, 3, and 4 at Michigan State University College of Human Medicine (allopathic) and College of Osteopathic Medicine (osteopathic) was conducted. Questions were structured into three main categories: demographic information, content of the current MSK curriculum, and opinions regarding importance, instruction, and assessment of MSK education. Results: As of 2010, 83% of medical schools require MSK courses because of the United States Bone and Joint Initiative to incorporate such coursework into core curriculum. Yet only 54% of surveyed students thought that their MSK education was adequate. A greater portion of osteopathic students (57.1%) compared with allopathic students (26.8%) thought that their MSK curriculum is adequate, and as a consequence, 36.6% of allopathic students thought that they were inadequately prepared for the MSK content of US medical licensing examinations compared with 8.1% of osteopathic students. Further curriculum development and improvement is needed to advance physicians' abilities to address and treat MSK disorders. Medical students surveyed feel that this goal can be accomplished by emphasizing MSK education in third and fourth years of medical school. Conclusion: These findings highlight differences in MSK education between an allopathic and osteopathic medical school. Further standardization of the curriculum in medical schools may help improve the quality of teaching student comfort levels of new physicians. Level of Evidence: Level III
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Khorsand D, Khwaja A, Schmale GA. Early musculoskeletal classroom education confers little advantage to medical student knowledge and competency in the absence of clinical experiences: a retrospective comparison study. BMC MEDICAL EDUCATION 2018; 18:46. [PMID: 29580252 PMCID: PMC5870478 DOI: 10.1186/s12909-018-1157-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/15/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Deficiencies in medical student knowledge in musculoskeletal medicine have been well documented. To address these deficiencies, numerous curricular changes at our institution were instituted. The objective of this study was to determine whether medical students in their preclinical years benefit from early exposure to musculoskeletal medicine when compared to students exposed to musculoskeletal medicine just prior to completion of their preclinical curriculum. METHODS United States Medical Licensing Examination (USMLE) Step 1 and 2 scores were compared for periods of time before and after institution of the new curriculum. Scores on the previously validated 24-question short answer survey from Freedman and Bernstein were also compared over these same periods of time between these two groups and to established standards for competency, using a student's two-tailed unpaired t-test for significance. Entering Medical College Admission Test (MCAT) scores were used to compare baseline preparation of students. RESULTS Overall USMLE scores as well as scores on the USMLE subtest on Musculoskeletal, Skin and Connective Tissue Disease showed no improvement when scores were compared between the two groups of students. There was a statistically significant lower performance on the Freedman and Bernstein knowledge assessment exam for students in the new pre-clinical curriculum as compared to those introduced under the old model, considering both musculoskeletal knowledge (p < 0.001) and proficiency (p < 0.01), though the response rate on the recent survey was low (112/986 or 11%). Spine remained the least understood sub-topic, while a dedicated course in rheumatology likely contributed to increased student knowledge in that area. Additional exposure to musculoskeletal topics during the clinical years increased student knowledge. There was no difference between groups when comparing entering MCAT scores. CONCLUSIONS Classroom curricular changes, including moving the introductory musculoskeletal course to the first year, intended to optimize musculoskeletal medicine education in the pre-clinical years of medical school did not appear to improve student musculoskeletal knowledge at any year of training. Further efforts to improve the education of medical students in musculoskeletal medicine should be directed towards providing more clinical experiences with patients having musculoskeletal concerns. This was a retrospective comparative study, level III evidence.
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Affiliation(s)
- Derek Khorsand
- Department of Interventional and Diagnostic Radiology, University of Washington Medical Center, Health Sciences Building, RR210, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195-7115 USA
| | - Ansab Khwaja
- Department of Orthopaedic Surgery, University of Arizona, 1609 N. Warren Ave, Suite 110, Tucson, AZ 85719 USA
| | - Gregory A. Schmale
- Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, PO Box 5371, 4800 Sand Point Way NE, Seattle, WA 98145-5005 USA
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17
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Grosman-Rimon L, Clarke H, Chan AK, Mills PB, Rathbone ATL, Kumbhare D. Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome. J Back Musculoskelet Rehabil 2018; 30:509-514. [PMID: 27858678 DOI: 10.3233/bmr-150380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. METHODS A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. RESULTS Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. CONCLUSION Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.
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Affiliation(s)
- Liza Grosman-Rimon
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Toronto General Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Aaron K Chan
- University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Patricia Branco Mills
- University of British Columbia, Vancouver, BC, Canada.,GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | | | - Dinesh Kumbhare
- Toronto Rehabilitation Institute, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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An evaluation of the clinical skills and experience within an orthopaedic Integrated Clinical Assessment and Treatment Service. BJGP Open 2017; 1:bjgpopen17X101217. [PMID: 30564691 PMCID: PMC6181100 DOI: 10.3399/bjgpopen17x101217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
Background General practice in the UK is ‘in crisis’. With 20% of GP workload relating to musculoskeletal (MSK) problems, an orthopaedic Integrated Clinical Assessment and Treatment Service (ICATS) could help support assessment of these patients in primary care, alleviating pressure on GPs. However, practitioners in ICATS must be trained appropriately to ensure its effectiveness. Aim This evaluation aimed to identify the training levels of doctors in one Northern Ireland orthopaedic ICATS system, what their future training needs are, and suggestions for how this service could be improved to better support general practice. Design & setting A questionnaire study in an orthopaedic ICATS, Northern Ireland. Method All seven doctors working within the Southern Trust orthopaedic ICATS were asked to complete a questionnaire detailing their training and experience in MSK medicine. Their views on how the service could be improved were elicited. Results Six of seven questionnaires were returned. All responders were Members of the Royal College of General Practitioners (MRCGP), while five of six held a Diploma in Sports and Exercise Medicine (Dip SEM). Half of responders suggested that MSK ultrasound could be beneficial within ICATS. However, it was viewed that extensive training would be required before paediatric MSK patients could be included. Conclusion High levels of training and experience were reported by responders, suggesting ICATS provides a high-level MSK service. Furthermore, it was noted that inclusion of MSK ultrasound and paediatric patients into this service could be beneficial but not without undertaking further training. With appropriate funding and support the ICATS service has the potential to expand the clinical services it offers to general practice, helping to reduce work pressures in primary care at this time of crisis for UK general practice.
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Hose MK, Fontanesi J, Woytowitz M, Jarrin D, Quan A. Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions. J Gen Intern Med 2017; 32:1261-1265. [PMID: 28785987 PMCID: PMC5653557 DOI: 10.1007/s11606-017-4143-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deficiencies in musculoskeletal knowledge are reported at every stage of learning. Medical programs are looking for effective ways to incorporate competency-based training into musculoskeletal education. AIM To evaluate the impact of bedside feedback on learner's shoulder examination skills, confidence, and knowledge of common shoulder conditions. SETTING Four-week musculoskeletal clinic rotation. PARTICIPANTS UCSD third year medical students and internal medicine residents. PROGRAM DESCRIPTION Learners completed three baseline evaluations: videotaped shoulder examination, attitude survey, and knowledge test. During the 4-week intervention learners received bedside observation and feedback from musculoskeletal experts while evaluating patients with shoulder conditions. Post-intervention learners repeated the three assessments. PROGRAM EVALUATION Eighty-nine learners participated. In the primary outcome measure evaluating the pre/post videotaped shoulder examination, significant improvement was seen in 21 of 23 shoulder examination maneuvers. Secondary outcomes include changes in learner confidence and knowledge. Greatest gains in learner confidence were seen in performing the shoulder examination (61.5% improvement) and performing injections (97.1% improvement). Knowledge improved significantly in all categories including anatomy/examination interpretation, diagnosis, and procedures. DISCUSSION Direct observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.
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Affiliation(s)
- Michal Kalli Hose
- VA San Diego Healthcare System, San Diego, CA, USA. .,University of California San Diego, La Jolla, CA, USA.
| | - John Fontanesi
- Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Manjulika Woytowitz
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | - Diego Jarrin
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | - Anna Quan
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
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20
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Phillips D, Pean CA, Allen K, Zuckerman J, Egol K. Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison. JOURNAL OF SURGICAL EDUCATION 2017; 74:513-518. [PMID: 28017288 DOI: 10.1016/j.jsurg.2016.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/11/2016] [Indexed: 05/21/2023]
Abstract
UNLABELLED Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter. DESIGN Prospective, uncontrolled, observational. SETTING Northeastern academic medical center. PARTICIPANTS A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading. RESULTS The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases. CONCLUSIONS This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice.
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Affiliation(s)
- Donna Phillips
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
| | - Christian A Pean
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Kathleen Allen
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Joseph Zuckerman
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York
| | - Kenneth Egol
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York
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McQuillan T, Wilcox-Fogel N, Kraus E, Ladd A, Fredericson M. Integrating Musculoskeletal Education and Patient Care at Medical Student-Run Free Clinics. PM R 2017; 9:1117-1121. [PMID: 28389399 DOI: 10.1016/j.pmrj.2017.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/11/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Student-run free clinics (SRFCs) have emerged as an important educational component of United States (U.S.) medical schools. Despite the prevalence of musculoskeletal (MSK) problems presenting to SRFCs, students and clinics are often unprepared to diagnose and to treat common MSK complaints. OBJECTIVE We sought to determine the scope of diagnosis and treatment at a medical student-run free clinic specializing in musculoskeletal care using physical medicine and rehabilitation (PM&R) residents. Secondary goals included reviewing student satisfaction and determining the appropriateness of the clinic in medical education. DESIGN Retrospective chart review, anonymous online survey. SETTING Primary care, free student clinic affiliated with tertiary academic medical center. PARTICIPANTS A total of 20 medical student volunteers, 6 PM&R residents, and 91 community patients. METHODS We established a musculoskeletal clinic as a specialty referral clinic for the 2 primary care SRFCs with institutional support from a partner medical school. We then reviewed clinical operations retrospectively using electronic medical records and student satisfaction based on an online survey. MAIN OUTCOME MEASUREMENTS We analyzed patient demographics and chief complaints, referrals provided, and medical services rendered. We also used a 5-point Likert scale to assess student satisfaction. RESULTS A monthly musculoskeletal referral clinic was established with the oversight of PM&R attendings and residents. The clinic received 91 referrals and managed 61 unique patients over a 2.5-year study period. The most common presentations to the clinic involved knee pain (n = 17, 27.9%) and back pain (n = 16, 26.2%). Pro bono relationships with community and institutional partners enabled all patients to receive medical examinations, physical therapy visits, plain film radiographs, and insurance consultations free of charge. Student satisfaction with teaching and patient care was high, with 19 of 20 students reporting their experience as "good" or "excellent." CONCLUSIONS SRFCs represent an underused opportunity to enhance MSK education among medical students by treating a variety of common MSK complaints in an underserved population. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Thomas McQuillan
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, Redwood City, CA 94063(∗).
| | - Nate Wilcox-Fogel
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA(†)
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA(‡)
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA(§)
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Abstract
The prevalence and cost of musculoskeletal diseases have increased dramatically over the last several decades, with more than half of US adults currently affected by a musculoskeletal condition. In response to this development, multiple institutions began reassessing the depth and effectiveness of their musculoskeletal education curriculum. After reporting a deficiency in required preclinical coursework, medical schools began implementing new and varied musculoskeletal programs. These changes have met with mixed success, as demonstrated by scores on competency examinations. To address discrepancies in knowledge and confidence levels and to ensure that physicians are equipped to manage musculoskeletal diseases in the 21st century, efforts to improve medical school education should continue.
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Battistone MJ, Barker AM, Grotzke MP, Beck JP, Lawrence P, Cannon GW. "Mini-Residency" in Musculoskeletal Care: a National Continuing Professional Development Program for Primary Care Providers. J Gen Intern Med 2016; 31:1301-1307. [PMID: 27350280 PMCID: PMC5071283 DOI: 10.1007/s11606-016-3773-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/16/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A cost-effective professional development program enhancing musculoskeletal (MSK) skills of physicians and allied health providers working in primary care settings has been reported at a single site. This article describes the first 2 years of the national expansion and implementation of a 3-day "MSK Mini-residency." METHODS Faculty from Veterans Affairs (VA) medical centers worked in partnership with national program faculty from the Salt Lake City VA to present an intensive, integrated, multidisciplinary program to strengthen the skills of primary care providers in evaluating and managing MSK conditions common in primary care. Course assessments included written surveys and a two-station observed structured clinical examination (OSCE) evaluating the physical examination of the shoulder and knee. RESULTS In the first 2 years of the program, 13 VA facilities participated. Two hundred twenty-seven health care providers, including 135 physicians, were trained. Two hundred seven participants (91 %) completed all pre- and post-course written assessments and the two-station OSCE. DISCUSSION The MSK Mini-residency program is an effective and well-received mixed-method educational initiative to strengthen the skills of primary care physicians and other health care providers in evaluating and managing patients with MSK complaints and to document their competence in performing physical examinations of the shoulder and knee. The 2-year experience in implementation suggests that this model of educational partnerships is a feasible approach to disseminating innovative educational programs in a way that preserves curricular consistency yet is adaptable to local needs.
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Affiliation(s)
- Michael J Battistone
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. .,Department of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Andrea M Barker
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marissa P Grotzke
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Medicine, Division of Endocrinology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - J Peter Beck
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Phillip Lawrence
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Roseman University of Health Sciences, South Jordan, UT, USA
| | - Grant W Cannon
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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24
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Díaz-Mancha JA, Castillo-López JM, Munuera-Martinez PV, Fernández-Seguín LM, Polo-Padillo J, Heredia-Rizo AM. A Comparison of Fourth-Year Health Sciences Students' Knowledge of Gross Lower and Upper Limb Anatomy: A Cross-Sectional Study. J Manipulative Physiol Ther 2016; 39:450-457. [PMID: 27368755 DOI: 10.1016/j.jmpt.2016.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/01/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the study was to assess and compare the knowledge of fourth-year medicine, physiotherapy (PT), nursing, and podiatry students in carpal and tarsal bone anatomy. METHODS A cross-sectional study was carried out. Based on a nonprobability convenience sampling, 177 fourth-year students (117 women and 60 men, mean age of 23.16 ± 3.82 years) from the podiatry (n = 39), nursing (n = 26), PT (n = 73), and medicine (n = 39) schools at a large Spanish university were included. Measurements were taken of their gross anatomy knowledge by means of the carpal and the tarsal bone tests. Students were asked to identify all carpal and tarsal bones in an illustration of the bony skeleton of both regions and were given a maximum of 5 minutes per test. RESULTS Of a total of 15 bones to be labeled, the PT (11.07 ± 3.30) and podiatry (9.36 ± 2.93) students had the highest rate of correct answers compared with the medicine (6.13 ± 3.27) and nursing (4.04 ± 3.72) undergraduates. When assessing academic degrees and test scores, significant differences were observed between PT and podiatry participants vs those from the medicine and nursing schools (P < .001). CONCLUSION Fourth-year students from the PT and podiatry programs correctly identified a higher number of carpal and tarsal bones than students from the nursing and medicine schools.
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Affiliation(s)
- Juan-Antonio Díaz-Mancha
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - José Manuel Castillo-López
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - Pedro V Munuera-Martinez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | | | - Juan Polo-Padillo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Department of Physical Therapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain.
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Battistone MJ, Barker AM, Grotzke MP, Beck JP, Berdan JT, Butler JM, Milne CK, Huhtala T, Cannon GW. Effectiveness of an Interprofessional and Multidisciplinary Musculoskeletal Training Program. J Grad Med Educ 2016; 8:398-404. [PMID: 27413444 PMCID: PMC4936859 DOI: 10.4300/jgme-d-15-00391.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) problems are common, and a recent US Bone and Joint Initiative calls for new models of education and professional collaboration. Evidence of feasibility and acceptability of innovative methods are needed. OBJECTIVE We assessed if an experimental immersion interdisciplinary MSK curriculum would be acceptable to residents from different specialties, be feasible within existing rotations, and be effective in strengthening clinical skills. METHODS Through funding from the Veterans Affairs Office of Academic Affiliations and the Office of Specialty Care, we developed a Center of Excellence in MSK Care and Education. A core element is the monthly MSK Education Week, which teaches skills and provides opportunities to apply these in clinical settings. Participants include internal medicine, physical medicine and rehabilitation, and orthopaedic surgery residents, as well as students and residents from other health professions programs. All were assigned to the MSK week in lieu of other clinical experiences. Faculty encompassed primary care, rheumatology, endocrinology, orthopaedics, and physical medicine and rehabilitation. Assessments include surveys and a 2-station objective structured clinical examination (OSCE). RESULTS Since 2012, a total of 176 trainees have participated. Percentage of trainees reporting ability to evaluate and manage MSK complaints increased (9% to 87% for shoulder; 18% to 86% for knee), and confidence performing MSK injections increased from 10% to 70%. Competency in evaluation of shoulder and knee pain was confirmed by OSCEs. CONCLUSIONS The MSK week program was accepted by residents from the 3 specialties, with learners reporting improved ability to perform shoulder and knee examinations, as demonstrated by OSCEs.
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Affiliation(s)
- Michael J. Battistone
- Corresponding author: Michael J. Battistone, MD, Salt Lake City VAMC, 500 Foothill Drive, Salt Lake City, UT 84148, 801.582.1565, ext. 4261,
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Battistone MJ, Barker AM, Lawrence P, Grotzke MP, Cannon GW. Mini-Residency in Musculoskeletal Care: An Interprofessional, Mixed-Methods Educational Initiative for Primary Care Providers. Arthritis Care Res (Hoboken) 2016; 68:275-9. [PMID: 26097001 DOI: 10.1002/acr.22644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/28/2015] [Accepted: 06/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A structured educational effort to train primary care providers (PCPs) to perform joint injections has been projected to be cost effective. The US Department of Veterans Affairs (VA) is developing a national continuing professional development program to train PCPs in the evaluation and management of patients with common musculoskeletal conditions. The objective of this pilot project was to confirm initial projections of cost effectiveness and to inform further efforts to develop this program on a national scale. METHODS The Salt Lake City VA served as the national hub for this pilot project. The initial phase included 19 providers, who participated in a weeklong mixed-methods course. Evaluation was conducted by the VA Employee Education System. Assessments included anonymous surveys, structured telephone interviews, and a review of de-identified procedure codes. RESULTS The survey response rate was 100%, with uniformly positive results. All participants recommended the expansion of this program. The mean number of joint injections performed each month increased from 0.3 (precourse) to 3.5 (postcourse), congruent with prior analyses projecting program cost effectiveness. CONCLUSION The musculoskeletal mini-residency is a well-received program, with early evidence of cost effectiveness and impact aligned with course objectives. This pilot program is a foundation for efforts in the national dissemination of this initiative.
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Affiliation(s)
- Michael J Battistone
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Andrea M Barker
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | | | - Marissa P Grotzke
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Grant W Cannon
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
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Inadequacy of Musculoskeletal Knowledge among Undergraduate Medical Students. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2015. [DOI: 10.1016/j.jotr.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Purpose Musculoskeletal disorders (MSDs) are a significant public health problem. It has been observed that after leaving medical school, students are incapable of making a general assessment of the musculoskeletal system. Methods Accordingly, a pilot study was planned using the Freedman and Bernstein questionnaire and carried out in medical schools in India. Three hundred and twelve students at different levels were enrolled and administered the questionnaire. The correctness score for each student was obtained in each group and compared with the recommended qualifying score. Results For the sixth term and the ninth term, 44.61% and 50.71% students met the criterion, respectively, while interns showed the highest proportion of 71.42%. For the majority of the questions, the awareness level of ninth semester students and interns was better than that of sixth term students. Conclusion Compared to studies in other countries, the situation in India is not different. Medical institutions should place stress on orthopaedic education to provide better physicians.
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Padegimas EM, Ilyas AM. Distal radius fractures: emergency department evaluation and management. Orthop Clin North Am 2015; 46:259-70. [PMID: 25771320 DOI: 10.1016/j.ocl.2014.11.010] [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] [Indexed: 02/02/2023]
Abstract
Musculoskeletal injuries are the second most common cause of presentation to emergency departments. Distal radius fractures are an especially common injury pattern that often require evaluation and fracture management in an emergency department. This article reviews the evaluation of distal radius fractures including physical examination and radiographic review. Also discussed is management of distal radius fractures including splinting in the setting of an emergency department consultation.
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Affiliation(s)
- Eric M Padegimas
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 111 South 11th St, Philadelphia, PA 19107, USA.
| | - Asif M Ilyas
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, 111 South 11th St, Philadelphia, PA 19107, USA
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Al-Nammari SS, Pengas I, Asopa V, Jawad A, Rafferty M, Ramachandran M. The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom. J Bone Joint Surg Am 2015; 97:e36. [PMID: 25834088 DOI: 10.2106/jbjs.n.00488] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Musculoskeletal symptoms are common reasons for patients seeking medical attention. Basic competency in musculoskeletal medicine is therefore essential for all clinicians. To our knowledge, this is the first assessment of the competency in musculoskeletal medicine of medical students in the United Kingdom. METHODS Medical students were enrolled after passing final university examinations and being awarded degrees of Bachelor of Medicine, Bachelor of Surgery (MBBS) or Medicinae Baccalaureus, Baccalaureus Chirurgiae (MBChB) in 2013 and were assessed with use of the Freedman and Bernstein musculoskeletal cognitive examination tool. RESULTS Two hundred and thirty students were recruited, of whom 210 were suitable for inclusion. Only 21% (forty-four students) passed the assessment. Mandatory exposure to musculoskeletal medicine during medical school consisted of orthopaedics for 100% of participants for a mean duration of 2.65 weeks, rheumatology for 96% of participants for a mean duration of 2.5 weeks, and sports medicine for 1% of participants for a mean duration of two weeks. There was a significant difference (p = 0.002) in scores between those with career interests in musculoskeletal specialties (69.3%) and the rest of the cohort (54.9%). There was also a significant difference (p = 0.001) in scores between participants with career interests in general practice (42%) and the rest of the cohort (56%). Only 40% of participants considered themselves competent in musculoskeletal medicine. Fifty-five percent thought that musculoskeletal conditions would be an important component of their future practice. CONCLUSIONS Our findings suggest that medical schools may be currently failing to ensure that medical students have a basic competence in musculoskeletal medicine. Further investigation is warranted to fully assess the current training provided by U.K. medical schools in musculoskeletal medicine, and appropriate steps must be taken to improve the quantity and quality of training in musculoskeletal medicine in the United Kingdom.
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Affiliation(s)
- Shafic Said Al-Nammari
- Centre for Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. E-mail address for S.S. Al-Nammari:
| | - Ioannis Pengas
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Vipin Asopa
- St. Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Ali Jawad
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, United Kingdom
| | - Michael Rafferty
- University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Manoj Ramachandran
- Centre for Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. E-mail address for S.S. Al-Nammari:
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Murphy RF, LaPorte DM, Wadey VMR. Musculoskeletal education in medical school: deficits in knowledge and strategies for improvement. J Bone Joint Surg Am 2014; 96:2009-14. [PMID: 25471916 DOI: 10.2106/jbjs.n.00354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Improvements in medical student physical examination skills and performance on validated musculoskeletal competency examinations correspond with undergraduate curricular reform.➤ Curricular reform success in the United States has been achieved by multidisciplinary collaboration.➤ International efforts are focused on improving medical student physical examination skills through patient partners and structured clinical examinations.➤ Technologies such as simulators and online learning tools are effective and well received.
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Affiliation(s)
- Robert F Murphy
- University of Tennessee - Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104. E-mail address for R.F. Murphy:
| | - Dawn M LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street, 5th Floor, JH Outpatient Center (JHOC), Baltimore, MD 21287
| | - Veronica M R Wadey
- Sunnybrook Health Sciences Centre, 43 Wellesley Street, East Suite 327, Toronto, ON M4Y 1H1, Canada
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Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice? Clin Rheumatol 2014; 35:507-11. [PMID: 25190366 DOI: 10.1007/s10067-014-2767-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 07/29/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.
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The tarsal bone test: a basic test of health sciences students' knowledge of lower limb anatomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:939163. [PMID: 25110712 PMCID: PMC4119657 DOI: 10.1155/2014/939163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Abstract
Objectives. The aim of the present study was to design an easy-to-use tool, the tarsal bone test (TBT), to provide a snapshot of podiatry students' basic anatomical knowledge of the bones of the lower limb.
Methods. The study included 254 podiatry students from three different universities, 145 of them were first-year students and 109 were in their fourth and final years. The TBT was administered without prior notice to the participants and was to be completed in 5 minutes.
Results. The results show that 97.2% of the subjects (n = 247) correctly labelled all tarsal bones, while the other 2.8% (n = 7) incorrectly labelled at least one bone, that was either the cuboid (7 times) or the navicular (6 times). Although only one fourth-year student inaccurately identified one bone, no significant differences in the distribution of the correct and incorrect responses were found between first and fourth-year students.
Conclusions. The TBT seems to be a straightforward and easy-to-apply instrument, and provides an objective view of the level of knowledge acquired at different stages of podiatry studies.
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Truntzer J, Lynch A, Kruse D, Prislin M. Musculoskeletal education: an assessment of the clinical confidence of medical students. PERSPECTIVES ON MEDICAL EDUCATION 2014; 3:238-244. [PMID: 24865889 PMCID: PMC4078053 DOI: 10.1007/s40037-014-0124-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Musculoskeletal (MSK) conditions account for nearly 15-30 % of encounters in a primary care practice. Yet, studies demonstrate that medical students and residents lack the knowledge and confidence to care for many MSK conditions. This study addresses the design of focused MSK educational practices towards improving students' knowledge, interest, and confidence for conducting MSK examinations. Students attending a voluntary educational symposium on sports medicine were recruited to participate. The symposium was directed toward teaching elements of the MSK exam. Participants completed validated pre- and post-workshop surveys that assessed confidence in performing MSK examinations as well as satisfaction and perceived importance of MSK education. Additionally, mean survey responses from a convenience group of students who did not participate in the symposium were compared against the intervention group. Thirteen students participated in the educational symposium. Hundred and nine students completed the general survey. In the non-intervention group, students demonstrated knowledge and confidence improvements through the second year of medical school but did not show similar improvement in subsequent years. No difference in MSK confidence scores between fourth-year students going into high versus low MSK focused specialities was observed. In the intervention group students demonstrated improvements in confidence with respect to the knee, shoulder and ankle exams (p < 0.01). Areas not covered such as concussions and neuromuscular impairments failed to show significant change. Current core clinical training, at least at our school, does not achieve satisfactory levels of knowledge and confidence with respect to caring for MSK conditions. However, a focused didactic and skill development intervention does produce significant improvements. Follow-up is needed to determine whether these improvements are sustained.
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Affiliation(s)
- Jeremy Truntzer
- University of California, Irvine, CA USA
- Present Address: Department of Orthopaedics, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903 USA
| | - Alison Lynch
- Department of Family Medicine, University of California, San Diego, CA USA
| | - David Kruse
- Sports Medicine Physician, Orthopaedic Specialty Institute, Orange, CA USA
- Department of Family Medicine, University of California, Irvine, CA USA
| | - Michael Prislin
- Department of Family Medicine, Student Affairs School of Medicine, University of California, Irvine, CA USA
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Théroux J, Grimard G, Beauséjour M, Labelle H, Feldman DE. Knowledge and management of Adolescent Idiopathic Scoliosis among family physicians, pediatricians, chiropractors and physiotherapists in Québec, Canada: An exploratory study. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:251-9. [PMID: 23997251 PMCID: PMC3743651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Health professionals (HPs) are likely to encounter adolescent idiopathic scoliosis (AIS) patients. Best practice dictates that early detection leads to better decision making regarding optimal management. The aim of our study was to appraise the basic knowledge, evaluation and management skills concerning AIS care among family physicians, pediatricians, chiropractors, and physiotherapists. METHODS A semi-structured questionnaire including 3 clinical scenarios was developed. Telephone interviews were conducted with 51 HPs to assess their knowledge of the clinical signs, risk factors, and management options of AIS and their preferences in clinical guidelines for AIS care. RESULTS The majority of HPs (70-90%) would refer the patient who required prompt referral, but only 38-60% actually rated the case as requiring prompt referral. Forty percent of HPs (predominantly physiotherapists and family physicians) stated that they would not be comfortable providing AIS patient follow-up. Access to specialized care was considered a problem, and nearly all believed that establishment of clinical guidelines would be beneficial. CONCLUSIONS Considerable gaps exist regarding the knowledge of the clinical signs and risk factors of AIS. The importance of a patient in need of a prompt referral is recognized by the majority of the HPs, but they believe that there are problems regarding accessibility to a specialist. Interprofessional collaboration is discussed as a promising approach to improve the management of AIS.
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Affiliation(s)
- Jean Théroux
- Research Center, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Guy Grimard
- Research Center, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Marie Beauséjour
- Research Center, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
- Institut de recherche en santé publique, Université de Montréal, Montréal, Canada
| | - Hubert Labelle
- Research Center, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
- Faculté de médecine, Université de Montréal, Montréal, Canada
| | - Debbie Ehrmann Feldman
- École de réadaptation, Université de Montréal, Montréal, Canada
- Institut de recherche en santé publique, Université de Montréal, Montréal, Canada
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Beattie KA, MacIntyre NJ, Cividino A. Screening for signs and symptoms of rheumatoid arthritis by family physicians and nurse practitioners using the Gait, Arms, Legs, and Spine musculoskeletal examination. Arthritis Care Res (Hoboken) 2013; 64:1923-7. [PMID: 22623367 DOI: 10.1002/acr.21740] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/07/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of the Gait, Arms, Legs, and Spine (GALS) examination to screen for signs and symptoms of rheumatoid arthritis (RA) when used by family physicians and nurse practitioners. METHODS Participating health care professionals (2 rheumatologists, 3 family physicians, and 3 nurse practitioners) were trained to perform the GALS examination by viewing an instructional DVD and attending a training workshop. One week after training, the health care professionals performed the GALS examination on 20 individuals with RA and 21 individuals without RA. All participants were recruited through 2 rheumatology practices, and each participant was assessed by 4 health care professionals. The health care professionals were asked to record whether observed signs and symptoms were potentially consistent with a diagnosis of RA. The health care professionals understood the study objective to be their agreement on GALS findings among one another and were unaware that one-half of the participants had RA. Sensitivity and specificity were calculated to determine the ability of the GALS examination to screen for RA using the rheumatologist as the standard for comparison. RESULTS Sensitivity and specificity values varied from 60-100% and 70-82%, respectively, for the 3 family physicians, and 60-90% and 73-100%, respectively, for the 3 nurse practitioners. CONCLUSION Following a very short training period, family physicians and nurse practitioners appeared to be able to use the GALS examination as a screening tool for RA signs and symptoms, particularly for identifying an individual with positive results who will benefit from further investigation or rheumatology referral.
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Day CS, Bernstein J, Boyer MI. Educating medical students in musculoskeletal surgery and medicine-how to get a course up and running at your institution: AOA critical issues. J Bone Joint Surg Am 2012; 94:e1761-6. [PMID: 23224396 DOI: 10.2106/jbjs.k.01378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Charles S Day
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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Knobe M, Carow JB, Ruesseler M, Leu BM, Simon M, Beckers SK, Ghassemi A, Sönmez TT, Pape HC. Arthroscopy or ultrasound in undergraduate anatomy education: a randomized cross-over controlled trial. BMC MEDICAL EDUCATION 2012; 12:85. [PMID: 22958784 PMCID: PMC3473305 DOI: 10.1186/1472-6920-12-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 09/06/2012] [Indexed: 05/10/2023]
Abstract
BACKGROUND The exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake. METHODS Second-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student's perceptions were evaluated using Likert scale-based items. RESULTS The ASK-group (n = 70, age 23.4 (20-36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20-53) yrs.) and the CON-group (n = 88, 22.8 (20-33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001). CONCLUSIONS The additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - John Bennet Carow
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Miriam Ruesseler
- Department of Trauma Surgery, Medical Faculty, Johann Wolfgang Goethe Hospital, Frankfurt University, 7 Theodor Stern Kai, Frankfurt am Main 60590, Germany
| | - Benjamin Moritz Leu
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Melanie Simon
- Dean' office for study affairs, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Stefan K Beckers
- AIXTRA – Aix-la-Chapelle Centre for Interdisciplinary Training in Medical Education, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Alireza Ghassemi
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Tolga T Sönmez
- Department of Oral and Maxillofacial and Plastic Facial Surgery, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, Medical Faculty, RWTH Aachen University, 30 Pauwelsstreet, Aachen 52074, Germany
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Gunz AC, Canizares M, Mackay C, Badley EM. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediatric: a population-based study. BMC Musculoskelet Disord 2012; 13:98. [PMID: 22691633 PMCID: PMC3493363 DOI: 10.1186/1471-2474-13-98] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 05/24/2012] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted. METHODS Analysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates. RESULTS 122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions. CONCLUSION One in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD.
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Affiliation(s)
- Anna C Gunz
- Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
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Nottidge TE, Ekrikpo U, Ifesanya AO, Nnabuko RE, Dim EM, Udoinyang CI. Pre-internship Nigerian medical graduates lack basic musculoskeletal competency. INTERNATIONAL ORTHOPAEDICS 2012; 36:853-6. [PMID: 22278398 DOI: 10.1007/s00264-012-1485-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Our aim was to assess the basic musculoskeletal competency of pre-internship graduates from Nigerian medical schools. METHODS We administered the Freedman and Bernstein basic musculoskeletal competency examination to 113 pre-internship graduates from seven Nigerian medical schools over a three year period from 2008 to 2010 at the University of Uyo Teaching Hospital. Five specialist residents took the examination to test criteria relevance. RESULTS All graduates failed this test, obtaining scores ranging from 7% to 67%. The duration of the orthopaedic posting, and observation of operative fracture fixation, were not significant determinants of the score. The two final-year specialist residents each had a marginal pass in the examination. CONCLUSION Basic musculoskeletal competency among pre-internship Nigerian medical-school graduates is inadequate.
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Affiliation(s)
- Timothy Eyo Nottidge
- Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, University of Uyo, Uyo, Akwa-Ibom State, Nigeria.
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Sirisena D, Begum H, Selvarajah M, Chakravarty K. Musculoskeletal examination--an ignored aspect. Why are we still failing the patients? Clin Rheumatol 2010; 30:403-7. [PMID: 21165754 DOI: 10.1007/s10067-010-1632-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/14/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
Over the past two decades, rheumatologists from around the world have not only championed the musculoskeletal system examination but also modified the undergraduate teaching curriculum. This has led to the development and adoption of the gait, arms, legs and spine (GALS) screening along with regional examination techniques. The purpose of this study is to review current practice, determining the frequency of patient exposure to appropriate examination and confidence of junior doctors when dealing with MSK conditions. Two district-general hospitals (non-teaching) and one teaching hospital in North-East London were chosen. At each site, 50 patient notes were reviewed from the acute admission wards for medicine and surgery and the medical assessment unit. Factors considered included whether GALS screenings had taken place, documentation of MSK examinations and assessment of confidence of junior doctors in assessing MSK conditions. GALS screenings were performed for 4% of patients on the medical assessment unit, 7% of acute medical and 0% of acute surgical patients on admission. Examination of the MSK system yielded better results with 16%, 22% and 10% on each of the respective wards. Interviews with junior doctors found 10% routinely screening for MSK conditions, despite 87% feeling confident in taking MSK histories. This prospective audit of clinical practice highlights that patients failed to have a minimal assessment of the MSK system through GALS screenings. When examining the MSK system, results were somewhat better, although still fewer than expected. It is curious that the majority of junior doctors in training felt confident in dealing with MSK disease but few did it in practice. This begs the question of whether current teaching curricula and strategies are adequate. At a time where there is ever-increasing national momentum to address issues on obesity and cardiovascular health, our patients are still deprived of a standard MSK examination by the medical faculty.
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Affiliation(s)
- Dinesh Sirisena
- Exercise Physiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Abou-Raya A, Abou-Raya S. The inadequacies of musculoskeletal education. Clin Rheumatol 2010; 29:1121-6. [PMID: 20607334 DOI: 10.1007/s10067-010-1527-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/21/2010] [Accepted: 06/17/2010] [Indexed: 11/28/2022]
Abstract
Adequate knowledge and clinical competency are essential for sound rheumatology practice. The aim of this study was the assessment of the adequacy of rheumatology education at the primary care level. Two hundred and ninety-seven primary care physicians participated in this cross-sectional survey. Participants were asked to complete a question survey and to take a previously validated rheumatology examination. The participants rated rheumatology education as important but rated the time spent on rheumatology education as poor. More than 80% of the participants reported a low level of confidence in performing a musculoskeletal physical examination. Of the participants, 75% scored 65% or less in the validated rheumatology examination. The findings of the present study indicate that medical education in rheumatology is inadequate at both the basic and clinical levels. The competence level of graduating physicians in musculoskeletal problem solving is inadequate. Furthermore, the time devoted to rheumatology education and training is disproportionately low compared to the frequency of musculoskeletal complaints encountered in general practice.
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Affiliation(s)
- Anna Abou-Raya
- Rheumatology Department, Faculty of Medicine, University of Alexandria, 12 Heliopolis Street, Camp Cesar, Alexandria, Egypt.
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Day CS, Ahn CS, Yu Y. The addition of an upper-extremity curriculum in medical school education and its assessment. J Hand Surg Eur Vol 2009; 34:797-9. [PMID: 19786404 DOI: 10.1177/1753193409347500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study assessed the impact of changes made to address the inadequate upper-extremity education through preclinical medical school curriculum reform. After the administration of a new upper-extremity curriculum, which also increased the time devoted to three preclinical medical school courses from 7.25 to 21.25 hours, second-year medical students were evaluated for mastery of these concepts through a national validated objective examination, and attitude and skill through clinical confidence and subjective surveys. After implementation of the new upper-extremity curriculum, students had significantly greater confidence in their ability to perform a physical examination but not in identifying differential diagnoses of the upper-extremity. Students were more satisfied with the amount of time spent on the musculoskeletal system but their performance in the national examination did not change.
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Affiliation(s)
- C S Day
- Beth Israel Deaconess Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA.
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Day CS, Yu YR, Yeh AC, Newman LR, Arky R, Roberts DH. Musculoskeletal preclinical medical school education: meeting an underserved need. J Bone Joint Surg Am 2009; 91:733-9. [PMID: 19255239 DOI: 10.2106/jbjs.h.01305] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Charles S Day
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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