Early musculoskeletal classroom education confers little advantage to medical student knowledge and competency in the absence of clinical experiences: a retrospective comparison study

Inadequacies in Undergraduate Musculoskeletal Education-A Survey of Nationally Accredited Allopathic Medical Programs in Canada

OBJECTIVE

The aim of the study is to document the current state of musculoskeletal (MSK) medicine education across nationally accredited undergraduate medical programs.

DESIGN

A cross-sectional survey design was used to gather curricular data on the following three musculoskeletal themes: (1) anatomy education, (2) preclinical education, and (3) clerkship education.

RESULTS

The survey had a 100% response rate with all 14 English-language medical schools in Canada responding. The mean time spent teaching musculoskeletal anatomy was 29.8 hrs (SD ± 13.7, range = 12-60), with all but one program using some form of cadaveric-based instruction. Musculoskeletal preclinical curricula averaged 58.0 hrs (SD ± 53.4, range = 6-204), with didactic lectures, case-based learning, and small group tutorials being the most common modes of instruction. Curricular content varied greatly, with only 25% of "core or must-know" musculoskeletal topics being covered in detail by all programs. Musculoskeletal training in clerkship was required by only 50% of programs, most commonly being 2 wks in duration.

CONCLUSIONS

Results document the large variability and curricular inadequacies that exist in musculoskeletal education across nationally accredited allopathic programs and highlight the need for the identification and implementation of more consistent musculoskeletal curricular content and educational standards by all nationally accredited medical programs.

The Current State of Undergraduate Trauma and Orthopedics Training in Saudi Arabia: A Survey-Based Study of Sixth-Year Medical Students' and Interns' Learning Experience and Subjective Clinical Competence

Background and objective Students frequently complain about the lack of practical skill learning and the poor quality of the medical school curriculum. In light of this, the purpose of this study was to assess the learning experience and subjective clinical competence of final-year medical students and interns in the field of orthopedics in Saudi Arabia (SA). Methods A cross-sectional observational descriptive study utilizing an electronically validated survey was conducted, which included the following six main sections: introduction, demographics, self-assessment of competency regarding certain orthopedic skills, clinical experience in orthopedics, orthopedics curriculum assessment, and choice of future career specialty. Results The total number of participants was 794. Among them, 33% (n=160) and 37.1% (180) had attended no "trauma meetings" or "operating room (OR)" sessions respectively, and only 21.9% (n=106) had attended more than five clinics. Subjective competence in history taking was highest (mean: 8.925 ±1.299) among students who had received more than four weeks of orthopedic rotation and attended more than six clinics. The students who had completed more than four weeks of orthopedic rotation and more than six bedside sessions scored the highest in terms of subjective competence in handling orthopedic patients in primary care settings (mean: 8.014 ±1.931). Conclusion The survey indicates that the amount of orthopedic training provided by institutions varies, with some students receiving less training than recommended. However, longer rotations lead to greater perceived orthopedic competence. Students and interns with more exposure to orthopedics through curriculum and elective rotations demonstrated a greater interest in pursuing orthopedics as a future career.

Musculoskeletal education in undergraduate medical curricula-A systematic review

Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.

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

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.

Orthopaedic Surgery Boot Camp: An Immersion Course for Medical Students

Introduction

There is a substantial need for orthopaedic surgery-specific boot camps due to the limited orthopaedic and musculoskeletal education in medical school, which inadequately prepares medical students for their orthopaedic surgery sub-internships. The aim of this study is to identify the impact of the novel orthopaedic surgery boot camp on medical students’ confidence with key orthopaedic topics.

Methods

A cross-sectional study was conducted using an anonymous online survey distributed to medical students attending the novel orthopaedic surgery boot camp. The boot camp consisted of a four-day immersion course into the basics of orthopaedic surgery principles through both didactic and skills-based educational series. The medical students’ confidence in orthopaedic surgery clinical and technical skills were assessed by comparing the students’ survey responses before and after attending each of the sessions.

Results

Twelve fourth-year medical students and 15 second-year medical students attended the boot camp. All the sessions attended by the medical students were statistically significant in improving their confidence in the subject matter and skills-based training. Hundred percent (100%) of the fourth-year medical students recommend future orthopaedic surgery-bound medical students to attend this boot camp.

Conclusion

A dedicated orthopaedic surgery boot camp focused on clinical and technical skills plays a key role in increasing medical students’ confidence with key orthopaedic topics by providing an opportunity to practice these skills in a supervised environment with real-time feedback. This novel boot camp can provide a framework for creating a longitudinal course for medical students to augment the musculoskeletal education taught in medical school education.

Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design

Phenomenon: The development of foundational clinical skills, such as physical examination, is essential to becoming a competent clinician. Musculoskeletal medicine is often considered a specialized area of practice despite the high prevalence of musculoskeletal conditions in the general population and presenting to general clinical practices. Prior work has shown that medical learners and practicing clinicians have low confidence in these skills but understanding of the student perspective on why these skills are more difficult to acquire is unclear.Approach: Our study was guided by social constructivist learning theory to explore the learner experience and present their perspectives. Qualitative analysis investigated the difference between learning musculoskeletal physical examination versus other body systems, using the voices from 11 semi-structured focus group interviews. Participants included third-year medical students across two academic cohorts at one institution. Our analysis was grounded in the principles of phenomenology and used triangulation and reflexivity to provide rigorous analysis.Findings: Students provided rich and insightful perspectives regarding their experiences in learning musculoskeletal physical examination techniques. Four themes were developed from our data: a) the need for opportunities for both supervised and self-directed practice; b) assessment and competence as motivations for learning; c) the need for a different approach to the content and structure of musculoskeletal medicine and its associated examination techniques; and d) the need for distinct expertise and technical skill from musculoskeletal examination teachers.Insights: This study provides a valuable lens to critically reflect on existing curriculum and pedagogical approaches to musculoskeletal examination skills. Lessons from this study may be applicable to curriculum design in general, especially the teaching of physical examination skills, such as how it is taught and integrated with other content (including anatomy), how much practice is required, who teaches physical examination skills, and what faculty development is needed to standardize teaching. Promoting a learner-centered approach to the teaching and learning of these clinical skills will be beneficial to all stakeholders, especially to our future physicians and their patients.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1954930 .

Musculoskeletal Educational Resources for the Aspiring Orthopaedic Surgeon

Musculoskeletal (MSK) education is underemphasized in medical school curricula, which can lead to decreased confidence in treating MSK conditions and suboptimal performance on orthopaedic surgery elective rotations or subinternships. Given the low amount of formalized education in MSK medicine, students aiming to learn about orthopaedic surgery must gain much of their foundational knowledge from other resources. However, there are currently no centralized introductory educational resources to fill this need. We provide a framework for navigating the different types of resources available for trainees and highlight the unaddressed needs in this area.

Knowledge of peripheral artery disease: What do the public, healthcare practitioners, and trainees know?

This systematic review evaluated the knowledge and awareness of peripheral artery disease (PAD) within the general public (including patients with peripheral vascular disease), nonspecialist healthcare professionals (nsHCP), and trainees (medical students and trainee doctors). Relevant articles were identified from electronic databases using key search terms: ‘peripheral artery disease’; ‘limb ischaemia’; ‘intermittent claudication’; ‘knowledge’; ‘understanding’; ‘public’; ‘medical professional’. The heterogeneous results were described narratively. A lack of knowledge and understanding of PAD (disease awareness) were identified in all groups. Among nsHCPs, factors which affect knowledge include the level of training, early clinical exposure and the presence of family members with cardiovascular/vascular disease. Within the general public, knowledge and awareness was improved if a family member/friend had a diagnosis, or following a patient-centred consultation with any HCP. Public campaigns are proven effective in improving disease knowledge/awareness in conditions such as stroke alongside sustained patient education. These may provide future avenues to improve PAD knowledge and awareness, in order to effectively manage risk factors and minimise delayed or missed diagnosis of PAD. (PROSPERO registration number: CRD42018117304)

Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants

BACKGROUND

Use of ultrasonography has revolutionized diagnosis of musculoskeletal disorders. Until now, few studies have investigated usefulness of a short-period workshop for musculoskeletal ultrasound (MSKUS) education. In this research, we attempted to explore (1) whether the physicians felt it useful to attend this type of courses for improving knowledge of sonoanatomy and scanning skills, (2) if the attendees' perceived confidence in musculoskeletal diagnoses by using ultrasound increased following the program and (3) whether differences existed in perceived usefulness and confidence regrading different sessions of the course.

METHODS

The target participants of the courses were postgraduate physicians without limitation of their specialties. The attendees' responses to questionnaires before and after the course were reviewed. The workshop contained didactic and practical sessions on 6 major joints in accordance with the scanning protocols of EURO-MUSCULUS/USPRM. The course usefulness and perceived confidence in MSKUS examination were evaluated using a 5-point Likert scale. Data relevant to participants' pre-workshop confidence levels were also analyzed. If any participant attended the course for more than 1 time, only their first survey was used for analysis.

RESULTS

The study included 156 participants. The average rating for the course usefulness ranged between 4 (useful) to 5 (very useful). There was no difference in perceived usefulness between the didactic and hands-on practical sessions. Participants' perceived confidence significantly increased after the workshop but appeared to be lowest for evaluation on the hip joint. Previous experience in performing MSKUS (in years) was consistently associated with the level of pre-workshop confidence.

CONCLUSION

A short period ultrasound workshop might be useful regarding making musculoskeletal diagnoses by using ultrasound based on an increase in post-workshop confidence in MSKUS examinations. The perceived confidence of hip scanning was lower than that of other joints after the course, indicating inadequacy of education in hip sonoanatomy and intensity of hand-on practice in the present program. An increase in the faculty-to-student ratio or length of practice in the hip section should be implemented in the future course.