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Donato Z, Syros A, Milner J, Pandya S, Tandron M, Hernandez G. "Sawbones": A pilot study assessing simulation-based orthopedic training for medical students. J Orthop 2023; 44:66-71. [PMID: 37700780 PMCID: PMC10493496 DOI: 10.1016/j.jor.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Intro Simulation-based training has become a valuable new tool in medical education across the country. The Orthopedic Surgery Interest Group (OSIG) at the University of Miami Miller School of Medicine organized a benchtop training workshop known as "Sawbones" to give medical students essential exposure to basic techniques and instruments commonly used in orthopedic surgery. This pilot study seeks to investigate the participating students' perceptions of this workshop as part of a potential longitudinal intervention. Methods A total of 30 medical students (MS1-MS4) with a documented interest in orthopedic surgery were randomly selected via email invitation to participate in this workshop. Students first had a lecture-based training session with faculty on an overview of screw fixation. Participants then formed groups that were headed by an orthopedic resident or attending and took turns fixing fractures on model bones made of synthetic material. Following the session, students were sent an anonymous Qualtrics survey to assess their satisfaction with the workshop. Results A total of 22 students (73%), responded to the survey. On a ten-point scale, the average reported interest in orthopedics was 9.2 (SD 0.4). All students (n = 22, 100%) reported that they would like more hands-on orthopedic experiences as a component of their medical education. Nineteen students (86.4%) reported that this training increased their interest in pursuing a career in orthopedic surgery and twenty-one (95.5%) further stated that they would recommend this training to other students. Discussion Based on the results of this pilot study, Sawbones was promising at engaging students in orthopedics, providing a team environment, and introducing students to orthopedic skills and instrumentation. Providing these sessions in a longitudinal manner could provide opportunities for mentorship and better prepare students for a residency in orthopedics. We recommend a program like Sawbones to better address the lack of Orthopedic exposure in medical school.
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Affiliation(s)
- Zachary Donato
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Alina Syros
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Jacob Milner
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Shivani Pandya
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Marissa Tandron
- University of Miami/Jackson Health Systems Department of Orthopedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Giselle Hernandez
- University of Miami/Jackson Health Systems Department of Orthopedic Surgery, 1611 NW 12th Ave #303, Miami, FL, 33136, 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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Referral patterns to a pediatric orthopedic clinic: pediatric orthopedic surgeons are primary care musculoskeletal medicine physicians. J Pediatr Orthop B 2022; 31:613-618. [PMID: 35608407 DOI: 10.1097/bpb.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2004, Reeder and in 2012, Schwend reported that inappropriate nonsurgical referrals to pediatric orthopedic clinics create a misuse of resources. Additional authors have called for re-emphasis and additional training in musculoskeletal medicine for primary care physicians (PCP) to improve the confidence, knowledge and performance when managing musculoskeletal conditions. The current study compares the diagnoses referred to a pediatric orthopedic clinic with diagnoses recommended for referral by the American Academy of Pediatrics (AAP) guidelines to determine if any improvement in the quality of referrals has occurred since Reeder and Schwend's article. A chart review of new referrals to a pediatric orthopedic clinic during a 3-month-period was performed. Data were collected on age, sex, referring diagnosis, referral source, final diagnosis and treatment. In total 230 new consults were evaluated. The referral source was a PCP in 169 (73.5%) cases, 30 (13%) self-referrals by a parent, 19 (8.3%) from another orthopedic surgeon, 9 (3.9%) from a neurologist and 3 (1.3%) from another specialist. Fifty percent of referrals met the criteria outlined in the AAP guidelines for referral to a pediatric orthopedic specialist and 48% were classified as primary care musculoskeletal conditions. During the 15 years since the publication of Reeder's study and despite a limited re-emphasis on musculoskeletal education, the percent of inappropriate referrals to a pediatric orthopedic clinic remains unchanged at 50%. We support an expanded musculoskeletal educational effort aimed at the medical, resident and pediatrician level, online decision-making aids, and implementation of a standardized referral form with the specific criteria of the AAP included.
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[Translated article] Skills and knowledge in musculoskeletal medicine in medical graduates prior to their incorporation into the residency system of the National Health System. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Roselló-Añón A, Colado Domínguez J, García Laguarta J, Sangüesa Nebot M, Doménech-Fernández J. Aptitudes y conocimientos en medicina musculoesquelética en licenciados en medicina previos a su incorporación al sistema de residencia del Sistema Nacional de Salud. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022. [DOI: 10.1016/j.recot.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Poacher AT, Bhachoo H, Weston J, Shergill K, Poacher G, Froud J. Undergraduate education of trauma and orthopaedic surgery in the UK. Bone Jt Open 2022; 3:549-556. [PMID: 35818794 PMCID: PMC9350698 DOI: 10.1302/2633-1462.37.bjo-2022-0044.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aims Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK. Methods This review summarizes the relevant literature from the last 20 years in the UK. Articles were selected from database searches using MEDLINE, EMBASE, ERIC, Cochrane, and Web of Science. A total of 16 papers met the inclusion criteria. Results The length of exposure to T&O is declining; the mean total placement duration of two to three weeks is significantly less than the four- to six-week minimum advised by most relevant sources. The main teaching methods described in the literature included didactic lectures, bedside teaching, and small group case-based discussions. Students preferred interactive, blended learning teaching styles over didactic methods. This improvement in satisfaction was reflected in improvements in student assessment scores. However, studies failed to assess competencies in clinical skills and examinations, which is consistent with the opinions of UK foundation year doctors, approximately 40% of whom report a “poor” understanding of orthopaedics. Furthermore, the majority of UK doctors are not exposed to orthopaedics at the postgraduate level, which only serves to amplify the disparity between junior and generalist knowledge, and the standards expected by senior colleagues and professional bodies. Conclusion There is a deficit in undergraduate orthopaedic training within the UK which has only worsened in the last 20 years, leaving medical students and foundation doctors with a potentially significant lack of orthopaedic knowledge. Cite this article: Bone Jt Open 2022;3(7):549–556.
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Affiliation(s)
| | - Hari Bhachoo
- Cardiff University School of Medicine, Cardiff, UK
| | - Jack Weston
- Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Joe Froud
- Cardiff University School of Medicine, Cardiff, UK
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Kwiatkowski A, Shakoor N, Manadan A, Block JA, Khandelwal S. Incorporating interactive workshops into bedside teaching: completion of a multi-modal rheumatology rotation significantly increases internal medicine residents' competency and comfort with comprehensive knee examinations. BMC MEDICAL EDUCATION 2022; 22:355. [PMID: 35538536 PMCID: PMC9092684 DOI: 10.1186/s12909-022-03425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents' competency and comfort with knee examinations when compared to the rotation alone. METHODS Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. RESULTS Fifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025). CONCLUSION An elective in rheumatology augmented residents' MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.
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Affiliation(s)
- Alysia Kwiatkowski
- Division of Allergy, Immunology & Rheumatology, The State University of New York at Buffalo, Buffalo, NY, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Augustine Manadan
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Sonali Khandelwal
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
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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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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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McDaniel CM, Forlenza EM, Kessler MW. Effect of Shortened Preclinical Curriculum on Medical Student Musculoskeletal Knowledge and Confidence: An Institutional Survey. JOURNAL OF SURGICAL EDUCATION 2020; 77:1414-1421. [PMID: 32747324 DOI: 10.1016/j.jsurg.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Musculoskeletal education is underrepresented in American medical school curricula, and many medical schools have recently shifted toward a condensed preclinical period. Given that musculoskeletal diseases represent a large and growing social and economic burden, it is imperative that medical students be properly prepared to care for patients with musculoskeletal disorders, regardless of intended specialty. METHODS A survey was sent to all medical students enrolled full-time at our institution during the 2018 to 2019 academic year. First year students had not yet received musculoskeletal instruction, second-year students had completed a shortened musculoskeletal curriculum of 49 total hours, and third- and fourth-year respondents had completed a longer 78 hour musculoskeletal curriculum. Respondents were asked to rank their confidence in their musculoskeletal knowledge, their interest in orthopaedics, followed by the well-validated Freedman and Bernstein musculoskeletal knowledge assessment and a demographics section asking had respondents completed an orthopaedic surgery clinical rotation, if they had other clinical orthopaedic experience, class year, intended clinical specialty, and gender. RESULTS There were 179 responses to the survey, comprising 53 first-year, 54 second-year, and 72 third- and fourth-year students. The longer musculoskeletal curriculum was associated with significantly improved performance compared to the shorter musculoskeletal curriculum (p < 0.0001). Completion of a clinical orthopedics rotation was associated with significantly improved performance than not completing a rotation (p < 0.001), regardless of if non-rotators had other orthopedic experience (p = 0.001) or if they did not (p < 0.001). There was no difference in score (p = 0.94) or musculoskeletal knowledge confidence (p = 0.09) between males and females. Intending to pursue orthopedics was associated with significantly higher scores (p < 0.001) and significantly higher confidence (p = 0.02). CONCLUSIONS As shortening preclinical musculoskeletal curricula worsens musculoskeletal performance, medical schools should consider requiring orthopedic clinical rotations to maintain musculoskeletal competency of graduates.
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Affiliation(s)
- Claire M McDaniel
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Enrico M Forlenza
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Michael W Kessler
- Department of Orthopaedics, Medstar Georgetown University Hospital, Washington, District of Columbia
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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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Sheppard E, Smyth M, Dow T, Haupt TS, McVeigh S. The Effect of a 2-Week Pre-clerkship Residency Exploration Program on Specialty Interest and Understanding of Physical Medicine and Rehabilitation. Arch Rehabil Res Clin Transl 2019; 2:100035. [PMID: 33543064 PMCID: PMC7853399 DOI: 10.1016/j.arrct.2019.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the effect the Pre-clerkship Residency Exploration Program (PREP) had on student career interest and improving understanding of physical medicine and rehabilitation (PMR). Design During a 2-week program, students were exposed to a PMR elective, workshop, career presentation, and panel discussion with PMR residents. Interest and understanding were assessed using pre- and postprogram questionnaires. Setting PREP was held at a Canadian medical school during the summer between the second and third years of undergraduate medical training. Participants Second-year medical student participants (N=40) (26 women and 14 men, aged 20 to >30 y) were randomly selected from 74 applicants at a Canadian medical school. Interventions Of the 40 program participants, 20 participated in a PMR elective and specialty-specific workshop. The full cohort of 40 participants participated in the PMR career presentation and PMR resident panel discussion. Main Outcome Measure Primary outcome measure was an increase in understanding of the PMR specialty. Results Understanding of the roles and responsibilities of physiatrists increased significantly, with larger trends in those with greater exposure time. After PREP, comfort level in common PMR procedures also significantly increased. Higher exposure time was correlated with an increased top 3 career selection. Student interest in PMR did not significantly change after the program. Conclusion Although no statistically significant effects were found from the 2-week PREP in this population in terms of career choice, benefits were found in the participants comfort with PMR procedures and understanding the roles and responsibilities of physiatrists. A brief exposure as part of a 2-week summer elective is beneficial for career decision planning and may be feasible to implement in medical curricula.
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Affiliation(s)
- Emily Sheppard
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Smyth
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Dow
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sonja McVeigh
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Physical Medicine & Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
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A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education. Clin Rheumatol 2019; 39:627-642. [DOI: 10.1007/s10067-019-04544-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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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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Kakazu R, Schumaier A, Minoughan C, Grawe B. Poor Readability of AOSSM Patient Education Resources and Opportunities for Improvement. Orthop J Sports Med 2018; 6:2325967118805386. [PMID: 30480008 PMCID: PMC6240975 DOI: 10.1177/2325967118805386] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Appropriate education on the disease processes associated with orthopaedic pathology can affect patient expectations and functional outcome. Hypothesis Patient education resources from the American Orthopaedic Society for Sports Medicine (AOSSM) are too complex for comprehension by the average orthopaedic patient. Study Design Cross-sectional study. Methods Patient education resources provided by the AOSSM were analyzed with software that provided 10 readability scores as well as opportunities for improving readability. The readability scores were compared with the recommended eighth-grade reading level. Results A total of 39 patient education resources were identified and evaluated. The mean ± SD reading grade-level scores were as follows: Coleman-Liau Index, 12.5 ± 1.11; New Dale-Chall Readability Formula, 10.9 ± 1.37; Flesch-Kincaid Grade Level, 9.9 ± 1.06; FORCAST Readability Formula, 11.4 ± 0.51; Fry Readability Formula, 12.8 ± 2.79; Gunning Fog Index, 11.9 ± 1.37; Raygor Readability Index, 13.1 ± 2.37; Simple Measure of Gobbledygook, 12.3 ± 0.90; Automated Readability Index, 11.2 ± 1.18; and New Automated Readability Index, 10.6 ± 1.27. After averaging the reading grade-level scores, only 1 patient education resource was found to be written at an 8th- to 9th-grade level, and 14 (36%) were written above a 12th-grade level. All scores were significantly different from the eighth-grade level (P < .0065). The percentage of complex words and long words were 19.6% ± 2.67% and 41.4% ± 3.18%, respectively. Conclusion Patient education resources provided by the AOSSM are at a significantly higher reading level than recommended. Simple changes can drastically improve these scores to increase health literacy and possibly outcome.
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Affiliation(s)
- Rafael Kakazu
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Adam Schumaier
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Chelsea Minoughan
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Brian Grawe
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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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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Walrod BJ, Schroeder A, Conroy MJ, Boucher LC, Bockbrader M, Way DP, McCamey KL, Hartz CA, Jonesco MA, Bahner DP. Does Ultrasound-Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First-Year Medical Students? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:225-232. [PMID: 28795411 DOI: 10.1002/jum.14322] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/27/2017] [Accepted: 04/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills. METHODS Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests. RESULTS All students performed significantly better on the knee examination, irrespective of instructional group (F = 14.9; df = 1.25; P = .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t = -3.0; df = 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t = -2.8; df = 25; P = .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures. CONCLUSIONS The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks.
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Affiliation(s)
- Bryant J Walrod
- Department of Family Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Mark J Conroy
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Laura C Boucher
- Department of Athletic Training Division, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Marcia Bockbrader
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David P Way
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kendra L McCamey
- Department of Family Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Clinton A Hartz
- Department of Family Medicine, OSU Sports Medicine at Lewis Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael A Jonesco
- Department of Family Medicine, Jameson Crane Sports Medicine Institute, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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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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Stansfield RB, Diponio L, Craig C, Zeller J, Chadd E, Miller J, Monrad S. Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam. BMC MEDICAL EDUCATION 2016; 16:268. [PMID: 27741946 PMCID: PMC5065081 DOI: 10.1186/s12909-016-0780-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/27/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. METHODS A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students' ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson's correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. RESULTS Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a discriminatory finding correlated with the ability to perform the associated maneuver correctly, with the exception of the ability to perform maneuvers needed to diagnose a torn anterior cruciate ligament of the knee. Neither the ability to anticipate or perform was predictive of identifying correct diagnoses for the different cases. CONCLUSIONS A novel musculoskeletal OSCE, based on principles of the hypothesis-driven physical examination, was able to identify significant deficiencies in examination skills needed to diagnose common disorders of the shoulder, back and knee amongst graduating medical students. In addition, the OSCE demonstrated that accurate anticipation of discriminatory examination findings correlates with ability to perform the associated maneuver; however, the ability to anticipate exceeds the ability to perform. Students do not appear to be using the physical exam to inform their diagnostic reasoning. The findings of this study have implications for both assessment and teaching of the musculoskeletal exam.
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Affiliation(s)
| | - Lisa Diponio
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Cliff Craig
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - John Zeller
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Edmund Chadd
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Joshua Miller
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Seetha Monrad
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
- 1560 E. Maple Rd, Troy, MI 48083 USA
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Walker R, Phieffer LS, Bishop JY. Four Successive Years of Trauma-Based Objective Structured Clinical Evaluations: What Have We Learned? JOURNAL OF SURGICAL EDUCATION 2016; 73:648-654. [PMID: 27156387 DOI: 10.1016/j.jsurg.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/04/2016] [Accepted: 03/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE We studied 4 years of data from our objective structured clinical examination (OSCE) to determine whether residents improved skills in the trauma physical examination (PE). Our hypothesis was that residents would improve with each year of training, and that resident scores would also improve over time, with each year of OSCE testing. DESIGN We developed 2 polytrauma scenarios and alternated yearly. Residents were graded on PE, history taking, and professionalism. Scenarios simulated trauma cases residents could encounter during training. We compared each year for any significant (p < 0.05) changes overall and between postgraduate years. SETTING The Ohio State University Wexner Medical Center. PARTICIPANTS Orthopedic faculty and residents. RESULTS Across years 2010 to 2013, we saw no significant improvement in PE skills. History-taking skills trended upwards, but this was not significant, and communication skills significantly improved. CONCLUSIONS We expected after instituting a trauma OSCE that we would see an improvement in residents' PE skills, which we did not. We observed an overall improvement in ability to interact and communicate with patients and ask appropriate questions.
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Affiliation(s)
- Robert Walker
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura S Phieffer
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julie Y Bishop
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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DiGiovanni BF, Sundem LT, Southgate RD, Lambert DR. Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum. Clin Orthop Relat Res 2016; 474:901-7. [PMID: 26282389 PMCID: PMC4773350 DOI: 10.1007/s11999-015-4511-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend. QUESTIONS/PURPOSES The purposes of this study were: (1) to assess the presence and duration of required or selective instruction in a MSK medicine specialty within the clinical years of undergraduate medical education; and (2) to assess the current state of requirements of clinical clerkships or rotations in other surgical and nonsurgical fields for comparison with the initial findings. METHODS The web sites of all 141 US medical schools were assessed to determine the content of their clinical curricula for the 2014-2015 academic year; five were excluded because they had not yet had a graduating class by the conclusion of the 2014-2015 academic year. Complete information on required rotations was obtained through the schools' web sites for all 136 (100%) medical schools. For selective experience during the surgery clerkships, complete information was available for 130 of the remaining 136 (96%) web sites. RESULTS Mean (in weeks, ± SD) duration of core clerkships were as follows: internal medicine (10 ± 2), surgery (8 ± 2), pediatrics (7 ± 1), obstetrics/gynecology (6 ± 1), and psychiatry (5 ± 1). Other common required clerkships were: family medicine (required in 96% [131 of 136] of schools, mean duration of 6 ± 2 weeks), neurology (81% [110], 4 ± 1), and emergency medicine (55% [75], 3 ± 1). Required MSK instruction, at a mean of 2 ± 1 weeks, was only present in 15% (20 of 136) of medical schools. In addition, clinical MSK instruction was offered as a selective (eg, students pick from a selection of subspecialties such as orthopaedics, plastics, or urology during a general surgery clerkship) in 34% (44 of 130) of all medical schools. This is less than other non-core specialties: geriatrics/ambulatory care (required in 40% [54 of 136] of schools, mean duration of 3 ± 1 weeks), critical care (30% [41], mean of 3 ± 1 weeks), radiology (26% [35], mean of 3 ± 1 weeks), anesthesiology (23% [31], mean of 2 ± 1 weeks), and other surgical subspecialties (19% [26], mean of 3 ± 1weeks). CONCLUSIONS Traditional core clerkships continue to be well represented in the clinical years, whereas three newer specialties have gained a larger presence: family medicine, neurology, and emergency medicine; these comprise the "big eight" of clinical clerkships. Given the high prevalence and burden of MSK disorders, required experience in MSK medicine continues to be underrepresented. Further discussion at a national level is needed to determine appropriate representation of MSK medicine specialties during the clinical years.
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Affiliation(s)
- Benedict F. DiGiovanni
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
| | - Leigh T. Sundem
- Office of Medical Student Education, School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
| | - Richard D. Southgate
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642 USA
| | - David R. Lambert
- Office of Medical Student Education, School of Medicine and Dentistry, University of Rochester, Rochester, NY USA
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Perrig M, Berendonk C, Rogausch A, Beyeler C. Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study. BMC MEDICAL EDUCATION 2016; 16:35. [PMID: 26821664 PMCID: PMC4731988 DOI: 10.1186/s12909-016-0554-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 01/22/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. METHODS All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. RESULTS At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2. CONCLUSIONS Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.
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Affiliation(s)
- Martin Perrig
- />Department of General Internal Medicine, University Hospital of Berne, Berne, Switzerland
| | - Christoph Berendonk
- />Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010 Berne, Switzerland
| | - Anja Rogausch
- />Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010 Berne, Switzerland
| | - Christine Beyeler
- />Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010 Berne, Switzerland
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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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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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Schiff A, Salazar D, Vetter C, Andre J, Pinzur M. Results of a near-peer musculoskeletal medicine curriculum for senior medical students interested in orthopedic surgery. JOURNAL OF SURGICAL EDUCATION 2014; 71:734-737. [PMID: 24776870 DOI: 10.1016/j.jsurg.2014.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/17/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION It has been previously demonstrated that medical students do not achieve an adequate musculoskeletal knowledge base on graduation from American medical schools. Several curriculums have been developed to address this measured deficit. Students entering orthopedic surgery residencies have a better musculoskeletal knowledge foundation than their peers but still fail to achieve an acceptable level of proficiency on graduation from medical school. METHODS Fourth-year medical students participating in senior elective rotations in orthopedic surgery over a 2-year period were given a series of lectures developed and presented by post graduate year 3 orthopedic surgery residents. Students completed a validated musculoskeletal competency examination and a survey following the conclusion of their experience, evaluating the effect of this curriculum. RESULTS A total of 71 students over 2 years participated in the near-peer curriculum, with all students completing the validated test. The mean score for the students was 83.6%. Of the 71 students, 60 (84.5%) scored more than the previously published passing rate of 73.1%. There was no correlation identified with the mean test scores and the number of previous orthopedic surgery rotations. From the survey, 96% of the students rated the near-peer curriculum as appropriate for their level, whereas 75% noted that their own medical school's musculoskeletal curriculum was too advanced for their level of training. CONCLUSION A series of lectures was developed by midlevel orthopedic residents for students interested in pursuing a career in orthopedic surgery. After participation in the curriculum, students scored 30-percentage points higher than a previously published test. This study demonstrates that a resident-initiated, near-peer curriculum increases the fundamental knowledge level of students entering orthopedic surgery. An added benefit appeared to be the skills obtained by the residents who created and delivered the lecture series.
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Affiliation(s)
- Adam Schiff
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois.
| | - Dane Salazar
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Christopher Vetter
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - John Andre
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Michael Pinzur
- Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois
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Abstract
OBJECTIVES Emergency medicine (EM) physicians are frequently responsible for evaluating and treating patients with urgent or emergent musculoskeletal conditions, so it is critical that they achieve a basic level of proficiency in musculoskeletal medicine. However, inadequacies in musculoskeletal education have previously been documented among medical students, residents, and attending physicians in a number of specialties. The goal of this study was to assess the proficiency with musculoskeletal medicine among EM physicians in particular. METHODS A validated musculoskeletal medicine competency examination was administered to the EM residents and faculty at a university-affiliated level 1 trauma center. Demographic data and satisfaction with musculoskeletal education were also surveyed. RESULTS Twenty-three EM residents and 21 attending physicians completed the survey. Thirty-five percent of residents and 43% of attending physicians failed to demonstrate proficiency on the examination. Pass rates were not significantly different among junior residents, senior residents, or attending physicians. Twenty-three percent of respondents indicated that they were dissatisfied with their musculoskeletal education. CONCLUSIONS Significant deficiencies in musculoskeletal education exist among EM physicians in training and attending staff. Given the frequency with which these physicians evaluate and treat acute musculoskeletal conditions, additional resources should be committed to their training.
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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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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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Innovative Virtual Interactive Teaching Tool “Arthur” for Clinical Diagnosis of Musculoskeletal Diseases. J Clin Rheumatol 2012; 18:151-2. [DOI: 10.1097/rhu.0b013e31824ee6ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Griesser MJ, Beran MC, Flanigan DC, Quackenbush M, Van Hoff C, Bishop JY. Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training. JOURNAL OF SURGICAL EDUCATION 2012; 69:180-189. [PMID: 22365863 DOI: 10.1016/j.jsurg.2011.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/23/2011] [Accepted: 07/31/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents. DESIGN Prospective, uncontrolled, observational. SETTING A major Midwestern tertiary referral center and academic medical center. PARTICIPANTS The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE. RESULTS Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%. CONCLUSIONS We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.
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Affiliation(s)
- Michael J Griesser
- Department of Orthopedics, Ohio State University, Columbus, OH 43221, USA
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O'Dunn-Orto A, Hartling L, Campbell S, Oswald AE. Teaching musculoskeletal clinical skills to medical trainees and physicians: a Best Evidence in Medical Education systematic review of strategies and their effectiveness: BEME Guide No. 18. MEDICAL TEACHER 2012; 34:93-102. [PMID: 22288986 DOI: 10.3109/0142159x.2011.613961] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) complaints make up 12-20% of primary health visits and are a source of significant expenditures and morbidity. Despite this, MSK examination is an area of weakness among practising physicians. Several studies have highlighted the need for increased MSK physical exam teaching. However, increased teaching time alone does not guarantee improvement in these skills. Thus, we aimed to identify interventions that are effective in promoting transfer of MSK clinical skills. METHODS The review protocol was approved by the Best Evidence in Medical Education (BEME) organization. A comprehensive search was conducted and systematic review methods were applied. Data were not pooled statistically due to heterogeneity. RESULTS About 5089 titles were screened; 24 studies were included. Eighteen of 24 studies focused on undergraduate medical education. Five of nine studies favoured patient educator. Five of six studies favoured interactive small groups, two of four studies favoured computer-assisted learning, and two of two studies favoured peer learning. Individual studies demonstrated effectiveness of reminder sheets and Gait Arms Legs Spine teaching, respectively. CONCLUSIONS This study supports the use of different instructional methods that engage learners and provide meaningful learning contexts. The majority of the studies support patient educators and interactive small group teaching.
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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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Henrickson M. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics. Pediatr Rheumatol Online J 2011; 9:23. [PMID: 21846336 PMCID: PMC3170606 DOI: 10.1186/1546-0096-9-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 08/16/2011] [Indexed: 11/10/2022] Open
Abstract
For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier.Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care.A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills.Changing demographics and persistent reimbursement disparities will require workplace innovation and legislative reform. Reimbursement reform is utterly essential to extending patient access to subspecialty care. In practice settings characterized by a proportion of Medicaid-subsidized patients in excess of the national average (> 41%), institutional support is vital. Accelerating access to care will require the most efficient deployment of existing, limited resources. Practice redesign of such resources can also improve access, e.g., group appointments and an escalating role for physician extenders. Multidisciplinary, team-oriented care and telemedicine have growing evidence basis as solutions to limited access to pediatric rheumatology services.
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Affiliation(s)
- Michael Henrickson
- Division of Rheumatology, MLC 4010, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA.
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Bernstein J, Garcia GH, Guevara JL, Mitchell GW. Progress report: the prevalence of required medical school instruction in musculoskeletal medicine at decade's end. Clin Orthop Relat Res 2011; 469:895-7. [PMID: 20683689 PMCID: PMC3032845 DOI: 10.1007/s11999-010-1477-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 07/07/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND In a 2003 report, required courses in musculoskeletal medicine were found in only 65 of the 122 medical schools in the United States. Since then, national efforts to promote musculoskeletal medicine education were led by the US Bone and Joint Decade, the American Medical Association, the Association of American Medical Colleges, the American Academy of Orthopaedic Surgeons, and the National Board of Medical Examiners, among others. Whether these efforts resulted in any changes in curricula is unclear. QUESTIONS/PURPOSES We assessed the change, if any, in the prevalence of required instruction in musculoskeletal medicine, which might be attributed to these reform efforts. METHODS Curriculum requirements were ascertained by an email survey sent to all 127 medical schools in the United States and from the schools' websites. The presence of a preclinical course or block dedicated to musculoskeletal medicine was noted. Likewise, the requirement for a clerkship in a musculoskeletal discipline (comprising orthopaedic surgery, rheumatology, or physical medicine) was recorded. RESULTS One hundred of the 127 medical schools in the United States had required preclinical courses in musculoskeletal medicine. Among the schools without such a course, six had a required musculoskeletal clerkship. Thus, 106 schools had some requirement, with only 21 (17%) lacking required instruction in musculoskeletal medicine. This rate compares favorably with the 47% rate (57 of the 122 schools) reported previously. CONCLUSION The prevalence of required instruction in musculoskeletal medicine is greater compared with the prevalence reported in previous studies. Musculoskeletal medicine appears to have attained a more prominent place in the curriculum at most schools.
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Affiliation(s)
- Joseph Bernstein
- Department of Orthopedic Surgery, Veterans Hospital, Philadelphia, PA
USA ,Department of Orthopaedic Surgery, University of Pennsylvania, School of Medicine, 424 Stemmler Hall, Philadelphia, PA 19104 USA
| | - Grant Hoerig Garcia
- Department of Orthopaedic Surgery, University of Pennsylvania, School of Medicine, 424 Stemmler Hall, Philadelphia, PA 19104 USA
| | - Jose Luis Guevara
- University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA
USA
| | - Grant W. Mitchell
- Department of Orthopaedic Surgery, University of Pennsylvania, School of Medicine, 424 Stemmler Hall, Philadelphia, PA 19104 USA
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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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Williams SC, Gulihar A, Dias JJ, Harper WM. A new musculoskeletal curriculum: has it made a difference? ACTA ACUST UNITED AC 2010; 92:7-11. [PMID: 20044672 DOI: 10.1302/0301-620x.92b1.23136] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study assessed whether undergraduate performance improved following the introduction in 2006 of a musculoskeletal teaching programme lasting for seven weeks. Different methods were used to deliver knowledge and skills in trauma and orthopaedic surgery, rheumatology and allied specialties. The programme combined four main elements: traditional firm-based teaching, weekly plenary sessions, a task-based workbook and additional specialist clinics. The block of 139 students who attended in its first year were assessed using a multiple choice question examination just before their final examinations in 2008. They showed a 6% improvement in performance over a control group of 130 students assessed in 2005 before the programme had commenced. There was no difference in performance between the students assessed in 2005 and a second group of 46 students from 2008 who did not attend the new teaching programme. Performance was improved by providing more focused musculoskeletal training using available resources, as well as increasing the length of the programme.
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Affiliation(s)
- S C Williams
- University Hospitals of Leicester NHS Trust, England.
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Adegbehingbe OO, Fatusi AO, Adegbenro CA, Adeitan OO, Abass GO, Akintunde AO. Musculoskeletal disorders: epidemiology and treatment seeking behavior of secondary school students in a nigerian community. Indian J Community Med 2009; 34:140-4. [PMID: 19966961 PMCID: PMC2781122 DOI: 10.4103/0970-0218.51231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 10/26/2008] [Indexed: 11/06/2022] Open
Abstract
Background: Epidemiological information paucity exists on musculoskeletal disorders (MSD) among secondary school students in Nigeria. We aimed to determine the prevalence, pattern, and treatment seeking behaviors (TSB) of MSD in Southwest, Nigeria. Materials and Methods: A school-based cross-sectional study was conducted in four randomly selected secondary schools in Ile-Ife in 2007. All the students were screened for MSD using an interviewer-administered questionnaire and physical examination, which involved the use of a scoliometer and a goniometer. Affected children were recommended for follow-up treatment and a plain radiography taken. Results: A total of 133 students had 204 MSD representing a 3.0% prevalence among the 4,441students screened. Eighty-one (60.9%) students had congenital disorders and 52 (39.1%) were acquired. The lower limbs (93.1%) were most commonly affected and 87 (65.4%) students presented with a knee deformity. Other abnormalities were limb length discrepancy 6.8%, scoliosis 4.4%, Pes planus 3.9%, and poliomyelitis 2.9%. A total of 100 students (75.2%) had no form of treatment, 18.8% receive treatment in the hospital, 3.7% received treatment in a traditional healing home and 2.3% received treatment in a church. Age, family, and school type were significant factors (P<0.05) in health-seeking behavior. The factors affecting treatment outcome were the place of treatment, hospital specific treatment, and reasons for stopping treatment. Conclusion: Treatable cases constitute a large proportion of MSD among secondary school students, but TSB was generally poor. Parental socio-economic and health services factors were related to the health-seeking behavior. Strengthening of school health services and improved linkage with orthopedic services, community education on MSD, and education of all cadres of health professionals are recommended.
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Affiliation(s)
- Olayinka O Adegbehingbe
- Department of Orthopaedic Surgery and Traumatology, Obafemi, Awolowo University, College of Health Sciences, Faculty of Clinical Sciences, Ile Ife, Osun State, Nigeria
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Al-Nammari SS, James BK, Ramachandran M. The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom. ACTA ACUST UNITED AC 2009; 91:1413-8. [PMID: 19880882 DOI: 10.1302/0301-620x.91b11.22445] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine whether the foundation programme for junior doctors, implemented across the United Kingdom in 2005, provides adequate training in musculoskeletal medicine. We recruited 112 doctors on completion of their foundation programme and assessed them using the Freedman and Bernstein musculoskeletal examination tool. Only 8.9% passed the assessment. Those with exposure to orthopaedics, with a career interest in orthopaedics, and who felt that they had gained adequate exposure to musculoskeletal medicine obtained significantly higher scores. Those interested in general practice as a career obtained significantly lower scores. Only 15% had any exposure to orthopaedics during the foundation programme and only 13% felt they had adequate exposure to musculoskeletal medicine. The foundation programme currently provides inadequate training in musculoskeletal medicine. The quality and quantity of exposure to musculoskeletal medicine during the foundation programme must be improved.
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Affiliation(s)
- S S Al-Nammari
- Department of Trauma & Orthopaedics, 2nd Floor, John Harrison House, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK
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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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O AO, O FA, A AC, O LAO, O AG, Akintomiwa A. Musculoskeletal disorders: epidemiology and treatment seeking behavior of secondary school students in a nigerian community. Indian J Community Med 2009; 34:52-6. [PMID: 19876456 PMCID: PMC2763647 DOI: 10.4103/0970-0218.44520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Epidemiological information paucity exists on musculoskeletal disorders (MSD) among secondary school students in Nigeria. We aimed to determine prevalence, pattern, and treatment seeking behaviors (TSB) of MSD in south-west Nigeria. Materials and Methods: A school-based cross sectional study was conducted in four randomly selected secondary schools in Ile-Ife in 2007. All the students were screened for MSD using interviewer-administered questionnaire and physical examination, which involved use of scoliometer and goniometer. Affected children were recommended for treatment and plain radiography taken. Results: A total of 133 students had 204 MSD representing 3.0% prevalence among the 4,441students screened. Eighty-one (60.9%) students had congenital disorders and 52 (39.1%) were acquired. The lower limbs (93.1%) were most commonly affected and 87 (65.4%) students presented with knee deformity. Other abnormalities were limb length discrepancy 6.8%, scoliosis 4.4%, pes planus 3.9%, and poliomyelitis 2.9%. One hundred students (75.2%) had no form of treatment, 18.8% receive treatment in the hospital, 3.7% in traditional healing home and 2.3% in church. Age, family, and school type were significant factors (P < 0.05) in health seeking behavior. The factors affecting treatment outcome were the place of treatment, hospital specific treatment, and reasons for stopping treatment. Conclusion: Treatable cases constitute a large proportion of MSD among secondary school students, but TSB was generally poor. Parental socio-economic and health services factors were related to the health seeking behavior. Strengthening of school health services and improved linkage with orthopedic services, community education on MSD, and education of all cadres of health professionals are recommended.
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Affiliation(s)
- Adegbehingbe Olayinka O
- Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University, College of Health Sciences, Faculty of Clinical Sciences, Ile Ife, Osun State, Nigeria
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Modica RF, Thundiyil JG, Chou C, Diab M, Von Scheven E. Teaching musculoskeletal physical diagnosis using a web-based tutorial and pathophysiology-focused cases. MEDICAL EDUCATION ONLINE 2009; 14:13. [PMID: 20165527 DOI: 10.3402/meo.v14i.4508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the effectiveness of an experimental curriculum on teaching first-year medical students the musculoskeletal exam as compared to a traditional curriculum. BACKGROUND Musculoskeletal complaints are common in the primary care setting. Practitioners are often deficient in examination skills and knowledge regarding musculoskeletal diseases. There is a lack of uniformity regarding how to teach the musculoskeletal examination among sub-specialists. We propose a novel web-based approach to teaching the musculoskeletal exam that is enhanced by peer practice with pathophysiology-focused cases. We sought to assess the effectiveness of an innovative musculoskeletal curriculum on the knowledge and skills of first-year medical students related to musculoskeletal physical diagnosis as compared to a traditional curriculum. The secondary purpose of this study was to assess satisfaction of students and preceptors exposed to this teaching method. METHODS This quasi-experimental study was conducted at a single LCME-accredited medical school and included a convenience sample from 2 consecutive classes of medical students during the musculoskeletal portion of their physical diagnosis class. We conducted a needs assessment of the traditional curriculum used to teach musculoskeletal examination. The needs assessment informed the development of an experimental curriculum. One class (control group) received the traditional curriculum while the second class (experimental group) received the experimental curriculum, consisting of a web-based musculoskeletal tutorial, pathophysiology-focused cases, and facilitator preparation. We used multiple-choice questions and musculoskeletal OSCE scores to assess differences between knowledge and skills in the 2 groups. RESULTS The sample consisted of 140 students in each medical school class. There were no statistically significant differences between the 2 groups. One hundred seven students from the control group and 120 students from the experimental group took the multiple-choice examination. The average score was 66% (95% CI= 59.7-72.3) for the control group and 66% (95% CI = 60.5-71.5) for the experimental group. There was no difference between the median musculoskeletal OSCE scores between the 2 groups. The experimental group was satisfied with the new teaching method and gained the additional benefit of a persistent resource. CONCLUSIONS This web-based experimental curriculum was as effective as the traditional curriculum for teaching the musculoskeletal exam. Additionally, users were satisfied with the web-based training and benefited from a persistent resource.
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Affiliation(s)
- Renee F Modica
- Department of Pediatrics, University of Florida, Gainesville, Florida 32610-0296, USA.
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Modica RF, Thundiyil JG, Chou C, Diab M, Von Scheven E. Teaching musculoskeletal physical diagnosis using a web-based tutorial and pathophysiology-focused cases. MEDICAL EDUCATION ONLINE 2009; 14:13. [PMID: 20165527 PMCID: PMC2779618 DOI: 10.3885/meo.2009.res00301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To assess the effectiveness of an experimental curriculum on teaching first-year medical students the musculoskeletal exam as compared to a traditional curriculum. BACKGROUND Musculoskeletal complaints are common in the primary care setting. Practitioners are often deficient in examination skills and knowledge regarding musculoskeletal diseases. There is a lack of uniformity regarding how to teach the musculoskeletal examination among sub-specialists. We propose a novel web-based approach to teaching the musculoskeletal exam that is enhanced by peer practice with pathophysiology-focused cases. We sought to assess the effectiveness of an innovative musculoskeletal curriculum on the knowledge and skills of first-year medical students related to musculoskeletal physical diagnosis as compared to a traditional curriculum. The secondary purpose of this study was to assess satisfaction of students and preceptors exposed to this teaching method. METHODS This quasi-experimental study was conducted at a single LCME-accredited medical school and included a convenience sample from 2 consecutive classes of medical students during the musculoskeletal portion of their physical diagnosis class. We conducted a needs assessment of the traditional curriculum used to teach musculoskeletal examination. The needs assessment informed the development of an experimental curriculum. One class (control group) received the traditional curriculum while the second class (experimental group) received the experimental curriculum, consisting of a web-based musculoskeletal tutorial, pathophysiology-focused cases, and facilitator preparation. We used multiple-choice questions and musculoskeletal OSCE scores to assess differences between knowledge and skills in the 2 groups. RESULTS The sample consisted of 140 students in each medical school class. There were no statistically significant differences between the 2 groups. One hundred seven students from the control group and 120 students from the experimental group took the multiple-choice examination. The average score was 66% (95% CI= 59.7-72.3) for the control group and 66% (95% CI = 60.5-71.5) for the experimental group. There was no difference between the median musculoskeletal OSCE scores between the 2 groups. The experimental group was satisfied with the new teaching method and gained the additional benefit of a persistent resource. CONCLUSIONS This web-based experimental curriculum was as effective as the traditional curriculum for teaching the musculoskeletal exam. Additionally, users were satisfied with the web-based training and benefited from a persistent resource.
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Affiliation(s)
- Renee F Modica
- Department of Pediatrics, University of Florida, Gainesville, Florida 32610-0296, USA.
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Evidence of educational inadequacies in region-specific musculoskeletal medicine. Clin Orthop Relat Res 2008; 466:2542-7. [PMID: 18636305 PMCID: PMC2584311 DOI: 10.1007/s11999-008-0379-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 06/24/2008] [Indexed: 01/31/2023]
Abstract
Recent studies suggest US medical schools are not effectively addressing musculoskeletal medicine in their curricula. We examined if there were specific areas of weakness by analyzing students' knowledge of and confidence in examining specific anatomic regions. A cross-sectional survey study of third- and fourth-year students at Harvard Medical School was conducted during the 2005 to 2006 academic year. One hundred sixty-two third-year students (88% response) and 87 fourth-year students (57% response) completed the Freedman and Bernstein cognitive mastery examination in musculoskeletal medicine and a survey eliciting their clinical confidence in examining the shoulder, elbow, hand, back, hip, knee, and foot on a one to five Likert scale. We specifically analyzed examination questions dealing with the upper extremity, lower extremity, back, and others, which included more systemic conditions such as arthritis, metabolic bone diseases, and cancer. Students failed to meet the established passing benchmark of 70% in all subgroups except for the others category. Confidence scores in performing a physical examination and in generating a differential diagnosis indicated students felt below adequate confidence (3.0 of 5) in five of the seven anatomic regions. Our study provides evidence that region-specific musculoskeletal medicine is a potential learning gap that may need to be addressed in the undergraduate musculoskeletal curriculum.
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Bernstein J, King T, Lawry GV. Musculoskeletal medicine educational reform in the Bone and Joint Decade. ACTA ACUST UNITED AC 2007; 57:1109-11. [PMID: 17907229 DOI: 10.1002/art.23001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wadey VMR, Halpern J, Younger ASE, Dev P, Olshen RA, Walker D. Orthopaedic surgery core curriculum: foot and ankle reconstruction. Foot Ankle Int 2007; 28:831-7. [PMID: 17666177 DOI: 10.3113/fai.2007.0831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to develop a core curriculum for orthopaedic surgery and to conduct a national survey to assess the importance of 281 curriculum items. Attention was focused on 45 items pertaining to the foot and ankle. METHODS A 281-item curriculum was developed. A content review and cross-sectional survey of a random selection of orthopaedic surgeons with primary nonacademic affiliations was completed. Data were analyzed descriptively and quantitatively using histograms, modified Hotelling's T(2)-statistic, and the Benjamini-Hochberg procedure. Our analyses assumed that each respondent answered questions independently of the answers of any other respondent but that the answers to different questions by the same respondent might be dependent. RESULTS Of the 156 orthopaedic surgeons contacted, 131 (86%) participated in this study. Eighty-two percent (37 of 45) of the items were ranked by respondents with an average mean score higher than 3.5/4.0 and 42 higher than 3.0/40, thus suggesting that 93% of the items are important or probably important to know by the end of residency (p <or= 0.07). CONCLUSION This study demonstrated agreement on the importance of 93% of the items that pertain to foot and ankle reconstruction to be included in a core curriculum for orthopaedic surgery. The ability to make diagnoses and to manage common fractures, soft-tissue conditions, and arthritic conditions of the foot and ankle are very important for residents to know upon graduation from their residency programs. The exceptions to these are the ability to perform primary and revision arthroplasty of the ankle.
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Affiliation(s)
- Veronica M R Wadey
- Department of Surgery, The Faculty of Medicine, University of Toronto, Ontario, Canada.
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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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