Musculoskeletal education: a curriculum evaluation at one university

Revitalizing Medical Education Delivery through Teacher-Led Curriculum Critiques: A Narrative Review

A teacher in a medical college is like a compass who has the responsibility and the power to guide budding medical students in their educational journey to become effective and efficient members of the healthcare team. The purpose of the current review is to justify the significance of curriculum evaluation, explore the role of teacher in the capacity of curriculum evaluator, enlist various methods and tools to perform curriculum evaluation, and identify the challenges and suggest potential solutions to overcome them. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 16 articles were selected based upon their suitability with the current review objectives and analyzed. Keywords used in the search include curriculum evaluation in the title alone only (viz. curriculum [ti] AND medical [ti]; curriculum evaluation [ti] AND methods [ti]; curriculum evaluation [ti] AND approaches [ti]; curriculum evaluation [ti]). A number of strategies can be employed to perform the evaluation of the medical curriculum, ranging from obtaining feedback from medical students at the end of each professional phase to assessing content, teaching methods, assessment, and attainment of learning outcomes. The process of evaluation of medical curriculum by teachers is a complex and challenging one and needs careful planning and execution of different aspects. These identified challenges clearly provide evidence that teachers have to be given the necessary training, resources, and institutional support to enable them to conduct effective medical curriculum evaluation. In conclusion, teachers in their capacity as curriculum evaluators remain the most important stakeholder in ensuring continuous improvement in the quality of education delivered to students. Owing to their in-depth awareness of classroom dynamics, the learning process, and the awareness about unique needs of students, their involvement in curriculum evaluation can ensure alignment between the delivered curriculum and the needs of the society.

A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education

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.

Relationship between students' perceptions of the adequacy of M1 and M2 curricula and their performance on USMLE step 1 examination

BACKGROUND

Performance on United States Medical Licensing Exam® (USMLE®) Step 1 examination (Step 1) is an important milestone for medical students. It is necessary for their graduation, and selection to interview for the National Resident Match Program®. Success on Step 1 examination requires content alignment, and continuous evaluation and improvement of preclinical curriculum. The purpose of this research was to observe the association between students' perceptions of deficits in the curriculum based on core disciplines and organ systems in relation to students' performance in those disciplines and systems on USMLE® Step 1 examination.

METHODS

An anonymous survey with closed-ended and open-ended questions was sent to 174 medical students, the class of 2018 (77), and 2019 (97) within 2-3 weeks of taking Step 1 examination. Students' feedback as well as students' performance on Step 1 examination were organized into disciplines and organ systems to allow for more specific curriculum analyses. The closed-ended questions provide three selections (yes, no and not sure) regarding students' agreement to the adequacy of M1 and M2 curricula to prepare students for Step 1 examination. Students' responses on the closed-ended questions were reviewed in conjunction with their Step 1 performance. The open-ended feedback was qualitatively analyzed for emergent themes or similarity with closed-ended questions in identifying any shortcoming of the curriculum.

RESULTS

The data show an apparent relationship between students' evaluations and students' performance on Step 1 examinations. A high percentage of students' disagreement of the curriculum adequacy was also reflected in a lower performance on Step 1 examination. Additionally, the themes that emerged from the qualitative analysis have confirmed the areas of curricular deficiency.

CONCLUSION

The data collected from this research provides insight into the degree of usefulness of students' evaluations as a way of assessing curriculum deficits in preparing students for their Step 1 examination.

A physician-physiotherapist collaborative model in a family medicine teaching clinic

Persons with musculoskeletal disorders frequently seek care in family medicine clinics. However, musculoskeletal education provided in medical schools is often considered insufficient. The implementation of a collaborative model that integrates physiotherapists into teaching clinics may benefit the musculoskeletal training of medical residents. This paper describes a model developed in a family medicine teaching clinic by examining the interprofessional educational and collaborative activities implemented in this model. The model allowed to provide physiotherapy services, involve the physiotherapist in the training of family medicine residents and enhance interprofessional collaboration, particularly for the management of persons with musculoskeletal disorders.

Anatomy integration blueprint: A fourth-year musculoskeletal anatomy elective model

Current undergraduate medical school curricular trends focus on both vertical integration of clinical knowledge into the traditionally basic science-dedicated curricula and increasing basic science education in the clinical years. This latter type of integration is more difficult and less reported on than the former. Here, we present an outline of a course wherein the primary learning and teaching objective is to integrate basic science anatomy knowledge with clinical education. The course was developed through collaboration by a multi-specialist course development team (composed of both basic scientists and physicians) and was founded in current adult learning theories. The course was designed to be widely applicable to multiple future specialties, using current published reports regarding the topics and clinical care areas relying heavily on anatomical knowledge regardless of specialist focus. To this end, the course focuses on the role of anatomy in the diagnosis and treatment of frequently encountered musculoskeletal conditions. Our iterative implementation and action research approach to this course development has yielded a curricular template for anatomy integration into clinical years. Key components for successful implementation of these types of courses, including content topic sequence, the faculty development team, learning approaches, and hidden curricula, were developed. We also report preliminary feedback from course stakeholders and lessons learned through the process. The purpose of this report is to enhance the current literature regarding basic science integration in the clinical years of medical school.

One week with the experts: a short course improves musculoskeletal undergraduate medical education

BACKGROUND

Musculoskeletal problems constitute a considerable workload across all medical and surgical disciplines. There is a mismatch between the burden of musculoskeletal medicine seen by non-orthopaedists clinically and the amount of time afforded it in undergraduate training. Recent initiatives to address this include the United States Bone and Joint Decade and curricular innovations that demonstrate a benefit from improved instruction. Such curricular interventions are usually situated within a wider program reform and last a short time. Gaining institutional support and securing curricular time are challenging. This article shows the positive evaluation of a brief, intense course on musculoskeletal medicine.

METHODS

A one-week course was offered to 154 medical students. The study took place in Ireland, where the student body comprises a mix of graduate students and undergraduate students, who enter medical school directly from second-level education. This course comprised brief didactic talks, case-based small group work, and physical examination skills demonstration. Attitudes toward musculoskeletal medicine prior to the course were elicited. The course was evaluated using pre-course and post-course standardized cognitive tests. Long-term retention was evaluated by end-of-year extended matching questions and an objective standardized clinical examination station. The test results between undergraduate and graduate students and student rating of musculoskeletal medicine as important or less important were compared.

RESULTS

Complete data were available for 125 students (81%). Seventy-four percent of students rated musculoskeletal medicine to be of major or critical importance to their career. There was a significant difference (p < 0.001, r = 0.678) in the mean score of the standardized cognitive test between the pre-course test and the post-course test; the mean performance score (and standard deviation) was 48.2% ± 14.2% (range, 17% to 79%), with a pass rate of 3.3%, for the pre-course test and 75.3% ± 15.02% (range, 32% to 100%), with a pass rate of 61%, for the post-course test. At the end of the year, 69.9% of students passed the extended matching questions and 96.7% passed an objective standardized clinical examination station. Graduate students performed better on the post-course standardized cognitive test score (p < 0.001) and objective standardized clinical examination (p < 0.05). Students who rated musculoskeletal medicine as important did not perform better than those who rated it as less important (p = 0.334).

CONCLUSIONS

We report a favorable evaluation of a short, intense course on musculoskeletal medicine and suggest that the introduction of basic concepts of musculoskeletal medicine is feasible within established curricula.

Rheumatoid arthritis in Saudi Arabia

The status of rheumatoid arthritis (RA) in Saudi Arabia (SA) was examined from various perspectives based on a systematic literature review and the authors' personal experiences. In this regard, database and journal search were conducted to identify studies on RA in SA, yielding a total of 43 articles. Although efforts have been made to promote RA research in SA, current studies mostly represent only a few centers and may not accurately portray the national status of RA care. Notably, biological therapies were introduced early for almost all practicing rheumatologists in SA (government and private). However, no national guidelines regarding the management of RA have been developed based on local needs and regulations. Also, while efforts were made to establish RA data registries, they have not been successful. Taken together, this analysis can contribute to the planning of future guidelines and directives for RA care in SA. 

Physiological referrals for paediatric musculoskeletal complaints: A costly problem that needs to be addressed

BACKGROUND/OBJECTIVE

Referrals to paediatric orthopedists for physiologically normal conditions consume limited resources and delay care for patients. The goal of the present study was to formally define such referrals and determine their prevalence.

METHODS

A retrospective review evaluated consecutive referrals to a single tertiary paediatric orthopedic centre over two eight-month periods. Referrals from family physicians and paediatricians were retained for analysis. Physiological referrals were defined as a final orthopedic diagnosis of 'within physiological norms'; and no scheduled follow up.

RESULTS

Physiological conditions represented 22.5% of referrals. The type of referring physician did not determine referral quality. Flat foot, intoeing and genu varum/valgum exhibited physiological referral rates that exceeded 40%.

CONCLUSION

Physiological referrals constitute a large portion of the outpatient paediatric orthopedic practice and represent a substantial unnecessary cost to the Canadian medical system. Future strategies to improve referral quality should target undergraduate and postgraduate musculoskeletal education.

Sensitivity of standardised musculoskeletal examination of the hand and wrist joints in detecting arthritis in comparison to ultrasound findings in patients attending rheumatology clinics

The aim of this study is to standardise the muscuoloskeletal (MSK) examination of the hand and wrist joints and to determine the sensitivity of this standard exam to diagnose arthritis in comparison to ultrasound (US) findings. A standardised approach to MSK examination of the hand and wrist joints was formulated. It consists of inspection, followed by screening exam based on active range of motion testing, and then using specific techniques to detect clinical swelling and tenderness. The scissor and squeeze techniques for metacarpophalangeal (MCP) joints, 4-finger technique for the proximal interphalangeal (PIP) joints and 2-thumb technique for the wrist joints. Patients aged 18-75 years with symptoms suggestive of inflammatory arthritis for more than 3 months were included in the study from two centres. Two rheumatologists conducted MSK examination, while a grayscale with power Doppler US was performed by two ultrasonographers recording signs of arthritis (effusion, proliferation and hyperaemia) on the same day of visit. Statistical analysis was carried out to compare MSK examination findings in detecting swelling and tenderness to US examination findings. A total of 2,112 joints were assessed both clinically and with US. Using a standard MSK examination by a rheumatologist to detect clinical swelling showed the following sensitivities as compared to US findings: 4-finger technique of 69 % in third PIP, the scissor technique of 74 % in second MCP and 70 % in third MCP, and the 2-thumb technique of 80 % at the wrist joint. The MCP squeeze technique showed sensitivity of 66 % for tenderness. A standard MSK examination with its described techniques is a sensitive tool if used appropriately to diagnose clinical arthritis as compared to US.

A survey validation and analysis of undergraduate medical biochemistry practical curriculum in maharashtra, India

In order to review the strengths and weaknesses of medical biochemistry practical curriculum for undergraduates and to generate ideas to improve it, a questionnaire was sent to 50 biochemistry faculty members selected (through simple random sampling method) from 42 medical colleges of Maharashtra, India. 39 responded to the questionnaire, representing a 78% response rate. The internal consistency of the questionnaire sections was found to be satisfactory (>0.7). The respondents did not agree that the ongoing curriculum was in alignment with learning outcomes (8%), that it encouraged active learning (28%), helped to apply knowledge to clinical situations (18%) and promoted critical thinking and problem solving skills (28%). There were a number of qualitative experiments that were rated 'irrelevant'. Qualitative and quantitative experiments related to recent advances were suggested to be introduced by the respondents. Checklists for the practicals and new curriculum objectives provided in the questionnaire were also approved. The results of the curriculum evaluation suggest a need for re-structuring of practical biochemistry curriculum and introduction of a modified curriculum with more clinical relevance.