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Kenmoku T, Sho S, Suzuki T, Suzuki J, Suzuki R, Sakaguchi M, Saito A, Kohata A, Takaso M. Investigating interest in orthopedic surgery within an entire medical faculty: A cross-sectional study. J Orthop Sci 2021; 26:704-708. [PMID: 32826137 DOI: 10.1016/j.jos.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/31/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Discrepancies exist between the magnitude of musculoskeletal problems and the competency of physicians practicing musculoskeletal medicine, which likely stems from medical school-level educational deficiencies. Therefore, inadequate orthopedic surgery education during medical school may affect the number of students aspiring to practice orthopedic surgery. However, the motivating factors underlying medical students' selection of a career specialty are largely unknown. This study aims to use a survey to examine the motivations of medical students who consider orthopedic surgery as a potential career specialty. METHODS A questionnaire survey was administered to medical students in our medical faculty. The results were stratified on the basis of gender, year, and experience as a patient; results were then compared between students who wished to practice orthopedic surgery and those who did not consider it a potential specialty. RESULTS Of the 499 students who responded to the questionnaire, 47% considered orthopedic surgery as their career specialty. Being male and having experienced orthopedic surgery as a patient were significant factors influencing the aspiration to practice orthopedic surgery (p < 0.001). In addition, the motivation for choosing orthopedic surgery was academic interest for 55% of students. In the first and fifth years, more than half of the students preferred an orthopedic surgery specialty. The percentage of fifth-year students who were candidates for orthopedic surgery as their career specialty significantly exceeded that of students in other years (p = 0.03). However, the percentage of students considering orthopedic surgery decreased in the sixth year. CONCLUSION Our findings suggest that orthopedic surgeons should provide a clearer, more informative job description to attract female medical students' attention and change their negative perception of orthopedic surgery. Furthermore, including education that incorporates experiences closer to clinical practice at the medical-school level is important for increasing the number of candidates for orthopedics.
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Affiliation(s)
- Tomonori Kenmoku
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Shintaro Sho
- Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Junya Suzuki
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryutaro Suzuki
- Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Aki Saito
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Ayana Kohata
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Bernstein J. Not the Last Word: Thought for Food. Clin Orthop Relat Res 2021; 479:242-245. [PMID: 33394760 PMCID: PMC7899713 DOI: 10.1097/corr.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Joseph Bernstein
- J. Bernstein, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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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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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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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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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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Factors Motivating Medical Students in Selecting a Career Specialty: Relevance for a Robust Orthopaedic Pipeline. J Am Acad Orthop Surg 2017; 25:527-535. [PMID: 28574944 DOI: 10.5435/jaaos-d-16-00533] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Selection of a career specialty by medical students is a complex and individualized decision. Our goals were to understand the factors that influenced medical students in selecting their career specialty, identify the stage at which this decision was made, and understand the role of demographics, mentors, and curricula in this process. METHODS Medical students from 10 institutions participated in a web-based survey. Results were stratified by sex, race/ethnicity, and level of interest in orthopaedic surgery. RESULTS A total of 657 students responded to the survey. Specialty content (mean rating, 8.4/10) and quality of life/lifestyle/stress level (7.5/10) were the primary motivating factors in selecting a specialty. Interest in orthopaedic surgery was lower in women than in men (2.7 versus 3.9; P < 0.01) and was equivalent among race/ethnicity groups. Although 27% of students reported moderate or extensive medical school curriculum exposure to orthopaedics, this education did not sway them toward the specialty. CONCLUSIONS Levels of interest in orthopaedics among medical students may be lower than generally assumed. Increasing the attractiveness of the specialty will require a multifaceted approach, including recognition of lifestyle factors, adjustments in the orthopaedic clerkship to make the specialty more appealing, mentorship by orthopaedic faculty, and conversion of high levels of interest in the specialty among minority medical students into successful residency applications. LEVEL OF EVIDENCE IV.
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Abstract
BACKGROUND Local drug delivery devices offer a promising method for delivering vancomycin and amikacin for musculoskeletal wounds. However, current local delivery devices such as beads and sponges do not necessarily allow for full coverage of a wound surface with eluted antibiotics and do not address the need for reducing the antibiotic diffusion distance to help prevent contamination by bacteria or other microorganisms. We blended chitosan/polyethylene glycol (PEG) pastes/sponges to increase biocompatibility and improve antibiotic coverage within the wound. QUESTIONS/PURPOSES (1) Are blended chitosan/PEG pastes biodegradable? (2) Are the blended pastes biocompatible? (3) How much force does paste require for placement by injection? (4) Will the pastes elute active antibiotics to inhibit bacteria in vitro? (5) Can the pastes prevent infection in a preclinical model with hardware? METHODS Our blended paste/sponge formulations (0.5% acidic, 1% acidic, and acidic/neutral) along with a control neutral 1% chitosan sponge were tested in vitro for degradability, cytocompatibility, injectability tested by determining the amount of force needed to inject the pastes, elution of antibiotics, and activity tested using zone of inhibition studies. Along with these studies, in vivo models for biocompatibility and infection prevention were tested using a rodent model and an infected mouse model with hardware, respectively. By evaluating these characteristics, an improved local drug delivery device can be determined. RESULTS All three of the paste formulations evaluated were almost fully degraded and with 6 days of degradation, the percent remaining being was less than that of the control sponge (percent remaining: control 99.251% ± 1.0%; 0.5% acidic 1.6% ± 2.1%, p = 0.002; 1% acidic 1.7% ± 1.6%, p = 0.002; acidic/neutral 2.3% ± 1.7%, p = 0.010). There was good biocompatibility because cell viability in vitro was high (control 100.0 ± 14.3; 0.5% acidic formulation at 79.4 ± 12.6, p < 0.001; 1% acidic formulation at 98.6 ± 6.1, p = 0.993; acidic/neutral formulation at 106.7 ± 12.8, p = 0.543), and in vivo inflammation was moderate (control 2.1 ± 1.2; 0.5% acidic 3.3 ± 0.2, p = 0.530; 1% acidic 2.5 ± 0.9, p = 0.657; acidic/neutral 2.9 ± 1.1, p = 0.784). Force required to inject the 0.5% acidic and 1% acidic pastes was less than the acidic/neutral paste used as a control (control 167.7 ± 85.6; 0.5% acidic 41.3 ± 10.7, p = 0.070; 1% acidic 28.0 ± 7.0, p = 0.940). At 72 hours, all paste formulations exhibited in vitro activity against Staphylococcus aureus (control 2.6 ± 0.8; 0.5% acidic 98.1 ± 33.5, p = 0.002; 1% acidic 87.3 ± 17.2, p = 0.006; acidic/neutral 83.5 ± 14.3, p = 0.010) and Pseudomonas aeruginosa (control 163.0 ± 1.7; 0.5% acidic 85.7 ± 83.6, p = 0.373; 1% acidic 38.0 ± 45.1, p = 0.896; acidic/neutral 129.7 ± 78.0, p = 0.896). Also, the paste formulations were able to prevent the infection with 100% clearance on the implanted hardware and surrounding tissue with the control being a 0.5% acidic paste group without antibiotics (control 4 × 104 ± 4.8 × 104; 0.5% acidic 0.0 ± 0.0, p value: 0.050; 1% acidic 0.0 ± 0.0, p = 0.050; acidic/neutral 0.0 ± 0.0, p = 0.050). CONCLUSIONS The preliminary studies demonstrated promising results for the blended chitosan/PEG pastes with antibiotics provided degradability, biocompatibility, injectability, and infection prevention for musculoskeletal-type wounds. CLINICAL RELEVANCE The preliminary studies with the chitosan paste delivered antibiotics to a contaminated musculoskeletal wound with hardware and prevented infection. More studies in a complex musculoskeletal wound and dosage studies are needed for continued development.
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Boutefnouchet T, Budair B. The perceptions and attitudes of medical students towards trauma and orthopaedic teaching: a cross-sectional study. SICOT J 2017; 3:8. [PMID: 28176671 PMCID: PMC5297328 DOI: 10.1051/sicotj/2016045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/05/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives: This study aimed to identify how undergraduate students perceive learning opportunities available to them and to determine whether students with an interest in trauma and orthopaedic (T&O) surgery have different perceptions and attitudes towards learning. Methods: All fourth year medical students from the University of Birmingham Medical School (UK) were surveyed regarding their career intentions and their attitudes towards the teaching received in trauma and orthopaedic surgery. The questionnaire was designed to capture student perception of learning environments, core knowledge and career motivations. Results: Of the 157 respondents, 35 (22.3%) expressed an interest in a career in trauma and orthopaedic surgery. Medical students who reported educational value for trauma and orthopaedic surgery revealed that bedside teaching with a consultant was perceived extremely useful by 57.8% (n = 89). A similar ranking was awarded to small group teaching seminars and bedside teaching with a junior doctor or trainee by 54.5% (n = 85) and 51.6% (n = 79) of students, respectively. In contrast, trauma meetings and operating theatre learning environments were perceived to be of low educational value. Seeing patients within the clinical setting and the quality of teaching received were reported as the most motivating factors in career interest towards trauma and orthopaedic surgery, rated 43.9% (n = 69) and 35% (n = 55), respectively. Conclusions: Perceptions of educational benefit derived from each learning environment vary among undergraduate medical students. Overall the most valuable learning environment perceived by the students is formal patient-based teaching. Despite diverging speciality choices students demonstrate similar learning needs.
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Affiliation(s)
- Tarek Boutefnouchet
- University Hospital Birmingham, Queen Elizabeth Hospital, Edgbaston, Mindelsohn Way, Birmingham B15 2WB, UK - School of Medicine and Dentistry, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Basil Budair
- University Hospital Birmingham, Queen Elizabeth Hospital, Edgbaston, Mindelsohn Way, Birmingham B15 2WB, UK - School of Medicine and Dentistry, The University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Lam K, Barker B, Sepdham D. Senior Medical Student-Led Interactive Small-Group Module on Acute Fracture Management. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10463. [PMID: 31008241 PMCID: PMC6464481 DOI: 10.15766/mep_2374-8265.10463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Medical students receive insufficient training in musculoskeletal diagnosis and management. To address this deficiency, a senior medical student at our institution designed and moderated small-group interactive discussions with third-year medical students on acute fracture management during their family medicine clerkship. METHODS In these sessions, students learned how to diagnose and comprehensively work up a case of a suspected fracture, how to effectively communicate findings from physical exam and X-ray, and when to appropriately consult a surgeon for treatment. RESULTS This module was piloted with a total of 14 students in two separate small groups. One hundred percent of students regarded the module as very useful, and there was a 50% improvement in pre- versus posteducational assessment. DISCUSSION Our experience suggests that students can quickly improve clinical skills for fracture management in a focused smallgroup interactive session. In addition, these sessions can be effectively designed and implemented by senior medical students. This module may be used with either clinical or preclinical students, but we believe that this information would be best received by clinical students on family medicine, emergency medicine, or orthopedic rotations.
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Affiliation(s)
- Kenrick Lam
- Resident, Department of Orthopedics, University of Texas Southwestern Medical Center
| | - Blake Barker
- Assistant Professor, Department of Internal Medicine, University of Texas Southwestern Medical Center
| | - Dan Sepdham
- Associate Professor, Department of Family and Community Medicine, University of Texas Southwestern Medical Center
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Villaseñor-Ovies P, Navarro-Zarza JE, Saavedra MÁ, Hernández-Díaz C, Canoso JJ, Biundo JJ, Kalish RA, de Toro Santos FJ, McGonagle D, Carette S, Alvarez-Nemegyei J. A survey of anatomical items relevant to the practice of rheumatology: upper extremity, head, neck, spine, and general concepts. Clin Rheumatol 2016; 35:3025-3030. [PMID: 27539219 DOI: 10.1007/s10067-016-3378-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/06/2016] [Indexed: 11/25/2022]
Abstract
This study aimed to identify the anatomical items of the upper extremity and spine that are potentially relevant to the practice of rheumatology. Ten rheumatologists interested in clinical anatomy who published, taught, and/or participated as active members of Clinical Anatomy Interest groups (six seniors, four juniors), participated in a one-round relevance Delphi exercise. An initial, 560-item list that included 45 (8.0 %) general concepts items; 138 (24.8 %) hand items; 100 (17.8 %) forearm and elbow items; 147 (26.2 %) shoulder items; and 130 (23.2 %) head, neck, and spine items was compiled by 5 of the participants. Each item was graded for importance with a Likert scale from 1 (not important) to 5 (very important). Thus, scores could range from 10 (1 × 10) to 50 (5 × 10). An item score of ≥40 was considered most relevant to competent practice as a rheumatologist. Mean item Likert scores ranged from 2.2 ± 0.5 to 4.6 ± 0.7. A total of 115 (20.5 %) of the 560 initial items reached relevance. Broken down by categories, this final relevant item list was composed by 7 (6.1 %) general concepts items; 32 (27.8 %) hand items; 20 (17.4 %) forearm and elbow items; 33 (28.7 %) shoulder items; and 23 (17.6 %) head, neck, and spine items. In this Delphi exercise, a group of practicing academic rheumatologists with an interest in clinical anatomy compiled a list of anatomical items that were deemed important to the practice of rheumatology. We suggest these items be considered curricular priorities when training rheumatology fellows in clinical anatomy skills and in programs of continuing rheumatology education.
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Affiliation(s)
- Pablo Villaseñor-Ovies
- Hospital Ángeles de Tijuana, Tijuana, BC, Mexico
- Universidad Autónoma de Baja California, Mexicali, Mexico
| | - José Eduardo Navarro-Zarza
- Hospital General de Chilpancingo Raymundo Abarca Alarcón, Chilpancingo, Gro, Mexico
- Universidad Autónoma de Guerrero, Acapulco, Gro, Mexico
| | - Miguel Ángel Saavedra
- Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Cristina Hernández-Díaz
- Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, México, DF, Mexico
| | - Juan J Canoso
- Centro Médico ABC, México, DF, Mexico
- Tufts Medical School, Boston, MA, USA
| | | | - Robert A Kalish
- Tufts Medical School, Boston, MA, USA
- Tufts Medical Center, Boston, MA, USA
| | - Francisco Javier de Toro Santos
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario A Coruña (CHUAC), Sergas, Universidad La Coruña (UDC), Coruña, Spain
| | - Dennis McGonagle
- UK National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Simon Carette
- Division of Rheumatology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - José Alvarez-Nemegyei
- Unidad de Investigación, Hospital Regional de Alta Especialidad de la Península de Yucatán, Mérida, Yucatán, Mexico
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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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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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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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Shah VS, Dooley-Hash SS, Craig CL, Zeller JL. A Five-Year Institutional Study of the Effectiveness of Fourth-Year Clinical Anatomy in Promoting Musculoskeletal Education. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ce.2014.521213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bishop JY, Awan HM, Rowley DM, Nagel RW. Development and validation of a musculoskeletal physical examination decision-making test for medical students. JOURNAL OF SURGICAL EDUCATION 2013; 70:451-460. [PMID: 23725932 DOI: 10.1016/j.jsurg.2013.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/13/2013] [Accepted: 03/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees. DESIGN We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate. SETTING Academic medical center in the Midwestern United States. PARTICIPANTS Orthopedic residents, chairmen, and medical students. RESULTS Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, p<0.001). The physical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, p<0.001), but were not significantly different for either class. CONCLUSIONS The physical examination decision-making test was found to be internally consistent in exposing the deficiencies of musculoskeletal education skills of our medical students and differentiated between ability levels in musculoskeletal physical examination decision-making (residents vs recently instructed musculoskeletal students vs 1 year post-musculoskeletal instruction).
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Affiliation(s)
- Julie Y Bishop
- Department of Orthopaedics, Ohio State University Medical Center, Columbus, Ohio 43221, USA.
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A supplemental video teaching tool enhances splinting skills. Clin Orthop Relat Res 2013; 471:649-54. [PMID: 23054528 PMCID: PMC3549149 DOI: 10.1007/s11999-012-2638-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/26/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ability to apply casts and splints is a technical skill that requires practice and understanding of basic principles of musculoskeletal medicine. A video in which a given procedure is simulated on a dummy can represent reality under controlled conditions. A decrease in physician competency in musculoskeletal medicine is the result of educational deficiencies at the medical school level. QUESTIONS/PURPOSES We asked whether (1) a supplemental video educational program enhances performance of medical students' musculoskeletal clinical skills and (2) factors such as the proportion of orthopaedic professors to students, sex, age, and previous scores of medical students affected the clinical skills of medical students. METHODS We allocated 474 medical students into one of two groups: all participants received 90 minutes of lecture instruction on how to splint and cast but one group viewed the supplemental instructional video and the other did not. There were no differences in terms of sex, age, basic science exam scores, or grade point average of the groups. Thirteen specific skills in splinting an injured limb were evaluated. We recorded grade point averages. We developed a 10-point scoring system and graded each student on their splinting skills 6 months after the lectures. RESULTS The medical students who watched the video had an average score of 7.6, whereas the control group's average score was 2.0. We observed a positive association between watching the educational video and clinical exam score. A higher professor-to-student ratio was associated with lower student Objective Structured Clinical Examination score. CONCLUSIONS Our observations suggest a supplemental video instructional program improved the performance of musculoskeletal clinical skills in comparison to only a traditional lecture series.
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Lau BHF, Lafave MR, Mohtadi NG, Butterwick DJ. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary Acute Knee Injury Clinic. BMC Health Serv Res 2012; 12:445. [PMID: 23216946 PMCID: PMC3537717 DOI: 10.1186/1472-6963-12-445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 11/21/2012] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC). The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. METHODS This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group) and a new model, the C-AKIC (i.e. experimental group). This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ). RESULTS Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p <.001). CONCLUSIONS The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The combined results from this study show that the C-AKIC is an appropriate, effective, and efficient model of clinical care for patients presenting with acute knee injuries.
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Affiliation(s)
- Breda H F Lau
- Department of Physical Education and Recreational Studies, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB T3E 6K6, Canada.
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Vioreanu MH, O’Daly BJ, Shelly MJ, Devitt BM, O’Byrne JM. Design, implementation and prospective evaluation of a new interactive musculoskeletal module for medical students in Ireland. Ir J Med Sci 2012; 182:191-9. [DOI: 10.1007/s11845-012-0855-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
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20
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Valenza MC, Castro-Martín E, Valenza G, Guirao-Piñeiro M, De-la-Llave-Rincón AI, Fernández-de-las-Peñas C. Comparison of Third-Year Medical and Physical Therapy Students' Knowledge of Anatomy Using The Carpal Bone Test. J Manipulative Physiol Ther 2012; 35:121-6. [DOI: 10.1016/j.jmpt.2011.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/09/2011] [Accepted: 10/27/2011] [Indexed: 10/14/2022]
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Monrad SU, Zeller JL, Craig CL, DiPonio LA. Musculoskeletal education in US medical schools: lessons from the past and suggestions for the future. Curr Rev Musculoskelet Med 2011; 4:91-8. [PMID: 21710142 PMCID: PMC3261253 DOI: 10.1007/s12178-011-9083-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the prevalence of musculoskeletal disorders in the United States, physicians have received inadequate training during medical school on how to examine, diagnose, and manage these conditions. This article provides an overview of the existing literature on undergraduate medical musculoskeletal education, including learning objectives, researched methodology, and currently utilized assessment tools. A discussion of challenges to and suggested approaches for the implementation of medical school musculoskeletal curricula is presented.
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Affiliation(s)
- Seetha U. Monrad
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Taubman Center SPC 5358, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA
| | - John L. Zeller
- Departments of Orthopaedic Surgery, Emergency Medicine, and Medical Education, University of Michigan Medical School, Ann Arbor, MI USA
| | - Clifford L. Craig
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI USA
| | - Lisa A. DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI USA
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Clark ML, Hutchison CR, Lockyer JM. Musculoskeletal education: a curriculum evaluation at one university. BMC MEDICAL EDUCATION 2010; 10:93. [PMID: 21143996 PMCID: PMC3012667 DOI: 10.1186/1472-6920-10-93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 12/12/2010] [Indexed: 05/28/2023]
Abstract
BACKGROUND The increasing burden of illness related to musculoskeletal diseases makes it essential that attention be paid to musculoskeletal education in medical schools. This case study examines the undergraduate musculoskeletal curriculum at one medical school. METHODS A case study research methodology used quantitative and qualitative approaches to systematically examine the undergraduate musculoskeletal course at the University of Calgary (Alberta, Canada) Faculty of Medicine. The aim of the study was to understand the strengths and weaknesses of the curriculum guided by four questions: (1) Was the course structured according to standard principles for curriculum design as described in the Kern framework? (2) How did students and faculty perceive the course? (3) Was the assessment of the students valid and reliable? (4) Were the course evaluations completed by student and faculty valid and reliable? RESULTS The analysis showed that the structure of the musculoskeletal course mapped to many components of Kern's framework in course design. The course had a high level of commitment by teachers, included a valid and reliable final examination, and valid evaluation questionnaires that provided relevant information to assess curriculum function. The curricular review identified several weaknesses in the course: the apparent absence of a formalized needs assessment, course objectives that were not specific or measurable, poor development of clinical presentations, small group sessions that exceeded normal 'small group' sizes, and poor alignment between the course objectives, examination blueprint and the examination. Both students and faculty members perceived the same strengths and weaknesses in the curriculum. Course evaluation data provided information that was consistent with the findings from the interviews with the key stakeholders. CONCLUSIONS The case study approach using the Kern framework and selected questions provided a robust way to assess a curriculum, identify its strengths and weaknesses and guide improvements.
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Affiliation(s)
- Marcia L Clark
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta Edmonton, Alberta Canada
| | | | - Jocelyn M Lockyer
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta Canada
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Bernstein J, Kenniston JA, Nydick JA, Zgonis MH, Beredjiklian PK. Levels of evidence are low for clinical management questions on the orthopaedic in-training examination. J Bone Joint Surg Am 2010; 92:508-11. [PMID: 20124084 DOI: 10.2106/jbjs.i.00530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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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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Abstract
BACKGROUND Basic musculoskeletal knowledge is essential to the practice of medicine. The purpose of this study was to assess the adequacy of musculoskeletal knowledge of medical students. MATERIALS AND METHODS The validated basic competency examination in musculoskeletal medicine devised by Freidman and Bernstein was administered to final year medical students just prior to their final professional examination. Participants were also required to assess their confidence at making a musculoskeletal physical examination and diagnosis as well as comment on the adequacy of time in the curriculum devoted to Orthopedics. RESULTS The response rate was 83% (40/48). The average cognitive examination score was 48.3%. Two participants (5%) obtained a score of >/= 73.1%, the recommended mean passing score. Seventeen students (42.5%) felt orthopedic clinical cases were the most difficult to perform a physical examination and diagnose. Thirteen students (32.5%) felt that the time devoted to orthopedics in the medical curriculum was inadequate. CONCLUSIONS Ninety-five percent of the students failed to show basic musculoskeletal competency. A change in medical curriculum and teaching methods is required to address this problem.
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Affiliation(s)
- Jagdish Menon
- Department of Orthopaedics, Jawaharlal Institute of Medical Education and Research (JIPMER), Pondicherry - 605 006, India,Address for correspondence: Dr. Jagdish Menon, Department of Orthopaedics, Jawaharlal Institute of Medical education and research (JIPMER), Pondicherry - 605 006, India. E-mail:
| | - Dilip K Patro
- Department of Orthopaedics, Jawaharlal Institute of Medical Education and Research (JIPMER), Pondicherry - 605 006, India
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Bilderback K, Eggerstedt J, Sadasivan KK, Seelig L, Wolf R, Barton S, McCall R, Chesson AL, Marino AA. Design and implementation of a system-based course in musculoskeletal medicine for medical students. J Bone Joint Surg Am 2008; 90:2292-300. [PMID: 18829928 DOI: 10.2106/jbjs.g.01676] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The amount of time devoted to musculoskeletal medicine in the typical undergraduate curriculum is disproportionately low compared with the frequency of musculoskeletal complaints that occur in a general practice. Consequently, whether because of the quantity or quality of the education, the competence level of graduating physicians regarding musculoskeletal problems is inadequate. Our purposes were to design a self-contained, system-based course in musculoskeletal medicine for medical students in the preclinical years and to measure the level of competence achieved by a class of first-year medical students who took the course. METHODS The course was formulated by faculty from the departments of orthopaedic surgery, anatomy, and rheumatology and included elements of both objectives-based and problem-centered curricular models. The clinical lectures were preceded by pertinent anatomy lectures and dissections to provide a context for the clinical information. The lectures on basic science were designed to rationalize and explicate clinical practices. Small-group activities were incorporated to permit engagement of the students in critical thinking and problem-solving. A general musculoskeletal physical examination was taught in two two-hour-long small-group sessions with the orthopaedic residents serving as instructors. Cognitive competency was evaluated with use of comprehensive anatomy laboratory and written examinations, the latter of which included a validated basic competency examination in musculoskeletal medicine. Process-based skills were evaluated in the small-group meetings and in a timed, mock patient encounter in which each student's ability to perform the general musculoskeletal physical examination was assessed. RESULTS The course lasted six weeks and consisted of forty-four lecture hours, seventeen hours of small-group meetings, and twenty-eight hours of anatomy laboratory. The average student score on the basic competency examination was 77.8%, compared with 59.6% for a historical comparison group (p < 0.05). Each student demonstrated the ability to adequately perform a general musculoskeletal physical examination in twenty minutes. The survey of student opinion after the course indicated a high level of student satisfaction. CONCLUSIONS The main features of the course were: (1) an emphasis on both cognitive and process-based knowledge; (2) more contact hours and broader content than in previously described courses in musculoskeletal medicine; (3) the use of small groups to focus on problem-solving and physical examination competencies; (4) basic-science content directly related to clinical goals. These features might be used at other institutions that employ a system-based curriculum for the preclinical years to help improve competence in musculoskeletal medicine.
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Affiliation(s)
- Karl Bilderback
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center-Shreveport, PO Box 33932, Shreveport, LA 71130-3932, USA
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Chehade MJ, Bachorski A. Development of the Australian Core Competencies in Musculoskeletal Basic and Clinical Science project - phase 1. Med J Aust 2008; 189:162-5. [PMID: 18673105 DOI: 10.5694/j.1326-5377.2008.tb01952.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 03/12/2008] [Indexed: 11/17/2022]
Abstract
Musculoskeletal conditions are a major contributor to the burden of disease globally and their impact is predicted to increase. Consistent with findings in other countries, the current standard of musculoskeletal education in Australian medical schools is inadequate to meet today's musculoskeletal care requirements. A national multidisciplinary approach unifying the key musculoskeletal clinical and basic science disciplines has been adopted to provide clear, evidence-based education guidelines that are specifically aimed at priority musculoskeletal conditions; a direct link is therefore established between community health care needs and education at a national level. This "top-down" approach provides the potential for a far more effective and efficient delivery of musculoskeletal education by allowing the identification of the key basic knowledge and skills required to achieve core competencies and by providing appropriate direction for students. The Australian Core Competencies in Musculoskeletal Basic and Clinical Science are being developed for medical schools to incorporate into their curricula, with the ultimate aim of improving the standard of health care for Australians with musculoskeletal conditions.
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Affiliation(s)
- Mellick J Chehade
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Day CS, Yeh AC, Franko O, Ramirez M, Krupat E. Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2007; 82:452-7. [PMID: 17457065 DOI: 10.1097/acm.0b013e31803ea860] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess medical students' knowledge and clinical confidence in musculoskeletal medicine as well as their attitudes toward the education they receive in this specialty. METHOD A cross-sectional survey of students in all four years of Harvard Medical School was conducted during the 2005-2006 academic year. Participants were asked to fill out a 30-question survey and a nationally validated basic competency exam in musculoskeletal medicine. RESULTS The response rate was 74% (449/608). Medical students rated musculoskeletal education to be of major importance (3.8/5) but rated the amount of curriculum time spent on musculoskeletal medicine as poor (2.1/5). Third-year students felt a low to adequate level of confidence in performing a musculoskeletal physical examination (2.7/5) and failed to demonstrate cognitive mastery in musculoskeletal medicine (passing rate on competency exam: 7%), whereas fourth-year students reported a similar level of confidence (2.7/5) and exhibited a higher passing rate (26%). Increasing exposure to the subject by taking clinical electives resulted in greater clinical confidence and enhanced performance on the exam (P < .001). Students' feedback suggested that musculoskeletal education can be better integrated into the preclinical curriculum, more time should be spent in the field, and more focus should be placed on common clinical conditions. CONCLUSIONS These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field. Implementing a four-year integrated musculoskeletal curriculum is one way that medical schools can address this concern.
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Affiliation(s)
- Charles S Day
- Musculoskeletal Curriculum, Harvard Medical School, Orthopedic Hand Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
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Humphreys BK, Sulkowski A, McIntyre K, Kasiban M, Patrick AN. An examination of musculoskeletal cognitive competency in chiropractic interns. J Manipulative Physiol Ther 2007; 30:44-9. [PMID: 17224355 DOI: 10.1016/j.jmpt.2006.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 07/19/2006] [Accepted: 07/29/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study investigates the cognitive competency of final-year chiropractic students in musculoskeletal medicine. METHODS The face, content, and criterion validity of the Basic Clinical Examination (BCE) for musculoskeletal medicine were tested for use in chiropractic education. After validity testing, the BCE was administered in a cross-sectional design to all fourth year students (154) attending the Canadian Memorial Chiropractic College. RESULTS Twenty percent (5 questions) of the BCE was deemed not relevant or outside of the scope of practice by criterion experts. One hundred twenty-three (80%) fourth year chiropractic interns participated in the cross-sectional study. Interns achieved a 51.2% passing rate (mean score, 73.2%; 95% confidence interval, 82%-71.8%) for the 25-item BCE, whereas the criterion experts achieved a 100% passing rate. For the modified 20-item BCE, the interns' mean score was 80.8%, whereas the criterion experts' mean score rose to 92.8%. CONCLUSIONS Most final-year chiropractic interns at this college were [corrected] found to be competent in musculoskeletal medicine as assessed by the Basic Competency Examination. This is in contradiction to previous work with medical students, recent medical graduates, nonorthopedic staff physicians, osteopathic students, and physical therapy students. Chiropractic clinicians with postgraduate training showed considerably better results than chiropractic interns. Problems pertaining to the content validity (relevance and scope of practice for chiropractors) of the BCE need to be addressed.
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Affiliation(s)
- B Kim Humphreys
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
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Cook C, Brismée JM, Sizer PS. Factors associated with physiotherapists' confidence during assessment of clinical cervical and lumbar spine instability. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2006; 10:59-71. [PMID: 16146324 DOI: 10.1002/pri.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Physiotherapists commonly encounter patients with complaints of vague, indistinguishable neck and back pain, such as clinical spine instability. Since confidence is a component of expert clinical practice, we were interested in measuring expert clinicians' confidence in diagnosing and assessing clinical spine instability. The aims of the present study were to factor out the common 'identifiers' associated with physiotherapists' objective, physical diagnosis and assessment of clinical spine instability, and to determine the association of reported diagnostic confidence to these identifiers. METHOD The study used data from a Delphi instrument for the factor analysis and a survey of APTA Board-certified orthopaedic specialists for report of confidence. Using an ologit regression analysis, the identifier themes and clinical background characteristics were associated with confidence in diagnosis of clinical spine instability. RESULTS Only clinical cervical spine instability obtained significant findings. The identifier 'observable or palpable abnormalities of motion during movement assessment in clinical practice' was positively associated with reported confidence in diagnosis, as was the influence of manual therapy background models: Cyriax, Maitland, McKenzie, NAIOMPT, Osteopathic, Paris and other. Male gender yielded negative association with reported confidence. No factors were associated with reported lumbar confidence. CONCLUSIONS Multiple backgrounds of physiotherapists demonstrate confidence in detecting clinical spine instability using observable or palpable methods to detect abnormal movements.
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Affiliation(s)
- Chad Cook
- Duke University, North Carolina, USA.
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Abstract
In their study, Freedman and Bernstein suggested that 80% of a group of graduates from many of the best medical schools in the United States were deficient in their knowledge of basic facts and concepts in musculoskeletal medicine. How do these results compare with results from students attending a medical school with a long-standing dedicated program to musculoskeletal education? Does additional clinical experience in musculoskeletal medicine improve understanding of the basic facts and concepts introduced in a second-year course? A modified version of an exam used to assess the competency of incoming interns at the University of Pennsylvania was used to assess the competency of medical students during various stages of their training at the University of Washington. Despite generally improved levels of competency with each year at medical school, less than 50% of fourth-year students showed competency. Students who completed a musculoskeletal clinical elective scored higher and were more competent (78%) than students who did not take an elective. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient and that competency increased when learning was reinforced during the clinical years.
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Affiliation(s)
- Gregory A Schmale
- Children's Hospital and Regional Medical Center, University of Washington, Seattle, 98105, USA.
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Childs JD, Whitman JM, Sizer PS, Pugia ML, Flynn TW, Delitto A. A description of physical therapists' knowledge in managing musculoskeletal conditions. BMC Musculoskelet Disord 2005; 6:32. [PMID: 15963232 PMCID: PMC1177956 DOI: 10.1186/1471-2474-6-32] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 06/17/2005] [Indexed: 11/20/2022] Open
Abstract
Background Physical therapists increasingly provide direct access services to patients with musculoskeletal conditions, and growing evidence supports the cost-effectiveness of this mode of healthcare delivery. However, further evidence is needed to determine if physical therapists have the requisite knowledge necessary to manage musculoskeletal conditions. Therefore, the purpose of this study was to describe physical therapists' knowledge in managing musculoskeletal conditions. Methods This study utilized a cross-sectional design in which 174 physical therapist students from randomly selected educational programs and 182 experienced physical therapists completed a standardized examination assessing knowledge in managing musculoskeletal conditions. This same examination has been previously been used to assess knowledge in musculoskeletal medicine among medical students, physician interns and residents, and across a variety of physician specialties. Results Experienced physical therapists had higher levels of knowledge in managing musculoskeletal conditions than medical students, physician interns and residents, and all physician specialists except for orthopaedists. Physical therapist students enrolled in doctoral degree educational programs achieved significantly higher scores than their peers enrolled in master's degree programs. Furthermore, experienced physical therapists who were board-certified in orthopaedic or sports physical therapy achieved significantly higher scores and passing rates than their non board-certified colleagues. Conclusion The results of this study may have implications for health and public policy decisions regarding the suitability of utilizing physical therapists to provide direct access care for patients with musculoskeletal conditions.
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Affiliation(s)
- John D Childs
- US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, TX, USA
| | - Julie M Whitman
- Department of Physical Therapy, Regis University, Denver, CO, USA
| | - Phillip S Sizer
- Department of Physical Therapy, Texas Tech University, Lubbock, TX, USA
| | - Maria L Pugia
- Department of Physical Therapy, Los Angeles Air Force Base, Los Angeles, CA, USA
| | - Timothy W Flynn
- Department of Physical Therapy, Regis University, Denver, CO, USA
| | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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