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Peeler J, Mann S, Orchard T, Yu J. Inadequacies in Undergraduate Musculoskeletal Education-A Survey of Nationally Accredited Allopathic Medical Programs in Canada. Am J Phys Med Rehabil 2024; 103:624-631. [PMID: 38207210 DOI: 10.1097/phm.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
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.
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Affiliation(s)
- Jason Peeler
- From the Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (JP, TO); Division of Orthopaedics, Department of Surgery, Queen's University, Kingston, Canada (SM); and Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada (JY)
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Figueras JH, Chan D, Maheshwer B, Erwin J, Thomson C, Dixon T, Grawe BM, Thompson AR. Development of an Orthopedic Surgery Anatomy Curricular Model for Fourth Year Medical Students Using a Modified Delphi Method. JOURNAL OF SURGICAL EDUCATION 2023; 80:1403-1411. [PMID: 37598058 DOI: 10.1016/j.jsurg.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/24/2023] [Accepted: 07/01/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The purpose of this study was to develop anatomy-focused learning outcomes that can be used to design a fourth-year elective for students matriculating into orthopedic surgery residencies. DESIGN A series of proposed learning outcomes (N=72) was developed using the ACGME Orthopedic Milestones 2.0 as a framework. In 2021, these were converted into a survey asking participants to rate the importance of each outcome on a 5-point Likert scale. The modified Delphi Method was used to refine the list of outcomes until group consensus was achieved. The consensus was defined using a conservative 3-tier approach. SETTING Eighteen academic centers with an associated orthopedic surgery residency. PARTICIPANTS Twenty-six orthopedic surgeons (ranging from 1 to 42 years in practice). RESULTS Of the 72 learning outcomes from the first-round survey, 25 met consensus criteria. Of the 62 learning outcomes from the second-round survey, 45 met consensus criteria. All learning outcomes that met consensus criteria after the second-round survey were stratified into low-yield (n = 8), intermediate-yield (n = 34), and high-yield (n = 28) categories. CONCLUSION Using a modified Delphi Method, this study elicited feedback from experts in the field of orthopedic surgery to develop a framework for a fourth-year elective focused on anatomical concepts important for students applying to residencies in orthopedic surgery. The product of this process affords a great deal of flexibility when utilizing the results of this study in institution-specific curricular development.
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Affiliation(s)
- Jorge H Figueras
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Dorothy Chan
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bhargavi Maheshwer
- Case Western Reserve/University Hospitals Cleveland Medical Center Orthopedic Surgery, Cleveland, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jace Erwin
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cameron Thomson
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tonya Dixon
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian M Grawe
- Department of Orthopedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew R Thompson
- Case Western Reserve/University Hospitals Cleveland Medical Center Orthopedic Surgery, Cleveland, Ohio; Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio
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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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Coleman N, Beasley M, Briskin S, Chapman M, Cuff S, Demorest RA, Halstead M, Hornbeck K, Kinsella SB, Logan K, Liu R, Mooney C, Myers RA, Ruparell S, Santana J, Walter KD, Waterbrook AL, Wolf SF. Musculoskeletal and Sports Medicine Curriculum Guidelines for Pediatric Residents. Curr Sports Med Rep 2021; 20:218-228. [PMID: 33790194 DOI: 10.1249/jsr.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Musculoskeletal (MSK) and sports-related conditions are relatively common in the pediatric population. Pediatric residencies should provide residents with the knowledge and skills to assess and manage both acute and chronic MSK and sports injuries and complaints. Residents should develop the competencies and attitudes to safeguard and promote a healthy and active lifestyle for youth. Programs can use a variety of educational tools, both in the clinic and on the field, to provide a well-rounded MSK curriculum throughout the residency years. This article provides a review of general pediatric sports medicine curriculum guidelines and suggested implementation strategies.
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Affiliation(s)
- Nailah Coleman
- Children's National Hospital, The Goldberg Center for Community Pediatric Health, Washington, DC
| | - Michael Beasley
- Boston Children's Hospital, Sports Medicine Division, Boston, MA
| | - Susannah Briskin
- Rainbow Babies and Children's Hospital, Division of Sports Medicine, Solon, OH
| | | | - Steven Cuff
- Nationwide Children's Hospital, Sports Medicine, Westerville, OH
| | - Rebecca A Demorest
- Webster Orthopedics, Pediatric and Young Adult Sports Medicine, Dublin, CA
| | | | - Kimberly Hornbeck
- Medical College of Wisconsin, Children's Wisconsin Primary Care Sports Medicine, Milwaukee, WI
| | | | - Kelsey Logan
- Cincinnati Children's Hospital Medical Center, Division of Sports Medicine, Cincinnati, OH
| | - Ruikang Liu
- Penn State Health-Children's Hospital, Department of Pediatrics, Hershey, PA
| | | | - Rebecca A Myers
- University of Colorado, Department of Family Medicine, Longmont, CO
| | - Sonia Ruparell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Chicago, IL
| | - Jonathan Santana
- Baylor College of Medicine, Department of Pediatrics, Section of Adolescent and Sports Medicine, Houston, TX
| | - Kevin D Walter
- Medical College of Wisconsin, Departments of Orthopaedic Surgery & Pediatrics, Children's Wisconsin Primary Care Sports Medicine, Delafield, WI
| | - Anna L Waterbrook
- The University of Arizona, Department of Emergency Medicine, Tucson, AZ
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Martins DE, Roncati ACKP, Rocha RO, Freire MP. Inadequacies of musculoskeletal medicine curriculum for undergraduate medical students: a cross-sectional study. SAO PAULO MED J 2020; 138:229-234. [PMID: 32578743 PMCID: PMC9671231 DOI: 10.1590/1516-3180.2019.0526.r1.19022020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders account for up to one in four of general-practice consultations and almost one third of complaints in primary-care clinical practice. However, an insufficient amount of time and importance is given to their teaching in most medical schools. OBJECTIVE To evaluate the acquisition of musculoskeletal competences in our institution, in order to identify flaws and propose changes to correct and improve the musculoskeletal curriculum. DESIGN AND SETTING Cross-sectional study conducted in São Paulo, Brazil. METHODS First to fifth-year medical students were enrolled in a survey using the Freedman and Bernstein musculoskeletal examination, in order to evaluate the acquisition of musculoskeletal competencies. Categorical data were analyzed using the chi-square test. Continuous data were analyzed using one-way analysis of variance (ANOVA). The level of significance was set as P < 0.05. RESULTS A total of 545 students completed the questionnaire: from year 2, 115/167 (29.6%); from year 3, 118/138 (30.4%); from year 4, 98/130 (25.3%); and from year 5, 57/110 (14.7%). None of the students achieved the pass mark (established as 70%). The level of confidence in performing musculoskeletal examination was very low (3.7 ± 2.2; n = 386) and bore no relationship to the percentage of correct answers in the questionnaire (r = 0.331; 95% confidence interval, CI: 0.239-0.417; P < 0.001). CONCLUSION Undergraduate teaching is the only exposure most general practitioners have to orthopedic problems. Universities are concerned about the adequacy of the musculoskeletal programs taught in their institutions. Student scores were found to be unsatisfactory in all the topics evaluated.
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Affiliation(s)
- Delio Eulalio Martins
- MSc, PhD. Professor and Coordinator, Universidade Anhembi Morumbi, São Paulo (SP), Brazil.
| | | | - Robson Oliveira Rocha
- PhD. Coordinator of Medical Course, Universidade Anhembi Morumbi, São Paulo (SP), Brazil.
| | - Marcos Paulo Freire
- PhD. Director, School of Health Sciences, Universidade Anhembi Morumbi, São Paulo (SP), Brazil.
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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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Benjamin JC, Groner J, Walton J, Noritz G, Gascon GM, Mahan JD. A Blended Curriculum to Improve Resident Physical Exam Skills for Patients With Neuromuscular Disability. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10792. [PMID: 30800992 PMCID: PMC6354795 DOI: 10.15766/mep_2374-8265.10792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/24/2018] [Indexed: 06/01/2023]
Abstract
Introduction Children with neuromuscular disabilities (NMD) receive care in a wide variety of clinical settings. Residents lack training to develop physical examination skills for evaluating patients with NMD. We devised a curriculum to teach residents how to examine patients with NMD using a systematic and simplified approach. Methods Creation of this resource was a response to a survey of final-year residents that revealed the need for education focused on developing physical examination skills. The curriculum has four components-multimedia PowerPoint with embedded video, knowledge assessment, clinical exam (CEX) assessment, and module feedback-and was completed by 37 residents over an 8-month period from January to September 2016. We utilized knowledge assessment, direct clinical skills observation using the CEX, and module-feedback responses as part of the evaluation. Results All 37 residents completed the curriculum, with an overall knowledge score of greater than 80%. Residents demonstrated most of the desired patient care behaviors on the CEX assessment and provided positive feedback on the quality, usefulness, and applicability of the module, in addition to requesting more curricula to develop their physical examination skills. Discussion The CEX assessment provided a unique opportunity for faculty feedback on residents' physical exam performance. After completing the module, residents achieved high scores in most areas of the standardized CEX and were able to conduct the NMD physical exam in a sensitive manner. The assessment highlighted the need to improve residents' skills of detecting abnormal clinical findings and communicating with the patient during the physical exam.
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Affiliation(s)
- Jennifer C. Benjamin
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine; Assistant Professor, Department of Pediatrics, Texas Children's Hospital
| | - Judith Groner
- Academic Pediatrics Fellowship Director, Ohio State University College of Medicine; Clinical Professor of Pediatrics, Division of Ambulatory Pediatrics, Nationwide Children's Hospital; Clinical Professor of Pediatrics, Division of Ambulatory Pediatrics, Ohio State University College of Medicine
| | - Jennifer Walton
- Co-Director, Williams Syndrome Program, Nationwide Children's Hospital; Co-Director, Williams Syndrome Program, Ohio State University College of Medicine; DBP Resident Rotation Director, Nationwide Children's Hospital; DBP Resident Rotation Director, Ohio State University College of Medicine; Assistant Professor of Clinical Pediatrics, Department of Developmental and Behavioral Pediatrics, Nationwide Children's Hospital; Assistant Professor of Clinical Pediatrics, Department of Developmental and Behavioral Pediatrics, Ohio State University College of Medicine
| | - Garey Noritz
- Medical Director, Complex Health Care Program, Nationwide Children's Hospital; Medical Director, Complex Health Care Program, Ohio State University College of Medicine; Medical Director, Cerebral Palsy Program, Nationwide Children's Hospital; Medical Director, Cerebral Palsy Program, Ohio State University College of Medicine; Associate Professor, Department of Developmental and Behavioral Pediatrics, Nationwide Children's Hospital; Associate Professor, Department of Developmental and Behavioral Pediatrics, Ohio State University College of Medicine
| | - Gregg M. Gascon
- Advanced Analytics Consultant, Ohio State University Health Plan; Assistant Professor of Biomedical Informatics, Ohio State University College of Medicine
| | - John D. Mahan
- Associate Director, Center for Faculty Advancement, Mentoring and Engagement (FAME), Ohio State University College of Medicine; Professor, Department of Pediatrics, Ohio State University College of Medicine; Program Director, Pediatric Residency Fellowship Program, Nationwide Children's Hospital; Program Director, Pediatric Residency Fellowship Program, Ohio State University College of Medicine; Program Director, Pediatric Nephrology Fellowship Program, Nationwide Children's Hospital; Program Director, Pediatric Nephrology Fellowship Program, Ohio State University College of Medicine
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Benjamin J, Groner J, Walton J, Noritz G, Gascon GM, Mahan JD. Learning in a Web-Based World: An Innovative Approach to Teach Physical Examination Skills in Patients with Neurodisability. Acad Pediatr 2018. [PMID: 29518544 DOI: 10.1016/j.acap.2018.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite increasing numbers of patients with neurodisability, residents lack training to develop physical examination skills. Following a blended educational intervention combining online and bedside teaching, residents demonstrated desired patient-care behaviors on standardized clinical exam assessment.
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Affiliation(s)
- Jennifer Benjamin
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
| | - Judith Groner
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Jennifer Walton
- Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Garey Noritz
- Developmental and Behavioral Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Gregg M Gascon
- Ohio Health Group Clinically Integrated Network, Columbus, Ohio
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
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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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Kelly M, Feeley I, Boland F, O'Byrne JM. Undergraduate Clinical Teaching in Orthopedic Surgery: A Randomized Control Trial Comparing the Effect of Case-Based Teaching and Bedside Teaching on Musculoskeletal OSCE Performance. JOURNAL OF SURGICAL EDUCATION 2018; 75:132-139. [PMID: 28720423 DOI: 10.1016/j.jsurg.2017.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 06/11/2017] [Accepted: 06/19/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Musculoskeletal (MSK) complaints are the second most common reason for a hospital outpatient appointment in the US, and account for 19.5% of general practice consultations. Previous studies have shown that passive teaching in medical school does not imbue students with an adequate degree of confidence in MSK evaluation. The aim of this study was to conduct a randomized control trial to compare the effect of the gold standard small group tutorial of bedside teaching against case-based teaching (CBT) in relation to orthopedic surgery in medical students. METHODS All third-year medical students at our institution were invited to participate in a randomized control trial comparing CBT and bedside tutorials in relation to MSK. The primary outcome was student performance in an Objective Structured Clinical Examination (OSCE). Participants were randomized into 2 groups, receiving either a bedside tutorial or a case-based tutorial. Participants were then assigned self-directed learning before undergoing a final OSCE assessment. Student feedback was attained through a poststudy questionnaire. RESULTS Complete data was acquired for 96 study participants (n = 45 CBT; n = 51 bedside tutorial). The results of a linear regression model used to assess differences in the final OSCE scores, adjusting for the baseline OSCE score, gender, age, previous problem-based learning exposure and whether English was their first language or not showed no evidence of a difference between the bedside teaching group and the CBT group (mean difference: 0.34; 95% confidence interval: -3.79 to 4.47; p = 0.872). Almost all (95%) of the study participants felt that CBT was an important component in their learning. CONCLUSION There was no difference in OSCE performance between groups. The introduction of CBT before clinical placement in medical school could accentuate the clinical skills of students before transition into the apprenticeship model of clinical attachment.
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Affiliation(s)
- Martin Kelly
- Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Iain Feeley
- Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John M O'Byrne
- Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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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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Lam K, Barker B, Sepdham D. Senior Medical Student-Led Interactive Small-Group Module on Acute Fracture Management. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10463. [PMID: 31008241 PMCID: PMC6464481 DOI: 10.15766/mep_2374-8265.10463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Medical students receive insufficient training in musculoskeletal diagnosis and management. To address this deficiency, a senior medical student at our institution designed and moderated small-group interactive discussions with third-year medical students on acute fracture management during their family medicine clerkship. METHODS In these sessions, students learned how to diagnose and comprehensively work up a case of a suspected fracture, how to effectively communicate findings from physical exam and X-ray, and when to appropriately consult a surgeon for treatment. RESULTS This module was piloted with a total of 14 students in two separate small groups. One hundred percent of students regarded the module as very useful, and there was a 50% improvement in pre- versus posteducational assessment. DISCUSSION Our experience suggests that students can quickly improve clinical skills for fracture management in a focused smallgroup interactive session. In addition, these sessions can be effectively designed and implemented by senior medical students. This module may be used with either clinical or preclinical students, but we believe that this information would be best received by clinical students on family medicine, emergency medicine, or orthopedic rotations.
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Affiliation(s)
- Kenrick Lam
- Resident, Department of Orthopedics, University of Texas Southwestern Medical Center
| | - Blake Barker
- Assistant Professor, Department of Internal Medicine, University of Texas Southwestern Medical Center
| | - Dan Sepdham
- Associate Professor, Department of Family and Community Medicine, University of Texas Southwestern Medical Center
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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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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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Al-Nammari SS, Pengas I, Asopa V, Jawad A, Rafferty M, Ramachandran M. The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom. J Bone Joint Surg Am 2015; 97:e36. [PMID: 25834088 DOI: 10.2106/jbjs.n.00488] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Musculoskeletal symptoms are common reasons for patients seeking medical attention. Basic competency in musculoskeletal medicine is therefore essential for all clinicians. To our knowledge, this is the first assessment of the competency in musculoskeletal medicine of medical students in the United Kingdom. METHODS Medical students were enrolled after passing final university examinations and being awarded degrees of Bachelor of Medicine, Bachelor of Surgery (MBBS) or Medicinae Baccalaureus, Baccalaureus Chirurgiae (MBChB) in 2013 and were assessed with use of the Freedman and Bernstein musculoskeletal cognitive examination tool. RESULTS Two hundred and thirty students were recruited, of whom 210 were suitable for inclusion. Only 21% (forty-four students) passed the assessment. Mandatory exposure to musculoskeletal medicine during medical school consisted of orthopaedics for 100% of participants for a mean duration of 2.65 weeks, rheumatology for 96% of participants for a mean duration of 2.5 weeks, and sports medicine for 1% of participants for a mean duration of two weeks. There was a significant difference (p = 0.002) in scores between those with career interests in musculoskeletal specialties (69.3%) and the rest of the cohort (54.9%). There was also a significant difference (p = 0.001) in scores between participants with career interests in general practice (42%) and the rest of the cohort (56%). Only 40% of participants considered themselves competent in musculoskeletal medicine. Fifty-five percent thought that musculoskeletal conditions would be an important component of their future practice. CONCLUSIONS Our findings suggest that medical schools may be currently failing to ensure that medical students have a basic competence in musculoskeletal medicine. Further investigation is warranted to fully assess the current training provided by U.K. medical schools in musculoskeletal medicine, and appropriate steps must be taken to improve the quantity and quality of training in musculoskeletal medicine in the United Kingdom.
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Affiliation(s)
- Shafic Said Al-Nammari
- Centre for Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. E-mail address for S.S. Al-Nammari:
| | - Ioannis Pengas
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Vipin Asopa
- St. Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Ali Jawad
- Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, United Kingdom
| | - Michael Rafferty
- University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Manoj Ramachandran
- Centre for Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. E-mail address for S.S. Al-Nammari:
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Murphy RF, LaPorte DM, Wadey VMR. Musculoskeletal education in medical school: deficits in knowledge and strategies for improvement. J Bone Joint Surg Am 2014; 96:2009-14. [PMID: 25471916 DOI: 10.2106/jbjs.n.00354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Improvements in medical student physical examination skills and performance on validated musculoskeletal competency examinations correspond with undergraduate curricular reform.➤ Curricular reform success in the United States has been achieved by multidisciplinary collaboration.➤ International efforts are focused on improving medical student physical examination skills through patient partners and structured clinical examinations.➤ Technologies such as simulators and online learning tools are effective and well received.
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Affiliation(s)
- Robert F Murphy
- University of Tennessee - Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104. E-mail address for R.F. Murphy:
| | - Dawn M LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street, 5th Floor, JH Outpatient Center (JHOC), Baltimore, MD 21287
| | - Veronica M R Wadey
- Sunnybrook Health Sciences Centre, 43 Wellesley Street, East Suite 327, Toronto, ON M4Y 1H1, Canada
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Lazarus MD, Kauffman GL, Kothari MJ, Mosher TJ, Silvis ML, Wawrzyniak JR, Anderson DT, Black KP. Anatomy integration blueprint: A fourth-year musculoskeletal anatomy elective model. ANATOMICAL SCIENCES EDUCATION 2014; 7:379-388. [PMID: 24591484 DOI: 10.1002/ase.1439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/10/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Michelle D Lazarus
- Department of Neural and Behavioral Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania
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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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Navarro-Zarza JE, Hernández-Díaz C, Saavedra MA, Alvarez-Nemegyei J, Kalish RA, Canoso JJ, Villaseñor-Ovies P. Preworkshop knowledge of musculoskeletal anatomy of rheumatology fellows and rheumatologists of seven North, Central, and South American countries. Arthritis Care Res (Hoboken) 2014; 66:270-6. [PMID: 23983095 DOI: 10.1002/acr.22114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/07/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To report the baseline knowledge of clinical anatomy of rheumatology fellows and rheumatologists from Argentina, Chile, Ecuador, El Salvador, Mexico, the US, and Uruguay. METHODS The invitation to attend a workshop in clinical anatomy was an open call by national rheumatology societies in 4 countries or by invitation from teaching program directors in 3 countries. Prior to the workshop, a practical test of anatomic structures commonly involved in rheumatic diseases was administered. The test consisted of the demonstration of these structures or their function in the participant's or instructor's body. At one site, a postworkshop practical test was administered immediately after the workshop. RESULTS There were 170 participants (84 rheumatology fellows, 61 rheumatologists, and 25 nonrheumatologists). The overall mean ± SD number of correct answers was 46.6% ± 19.9% and ranged from 32.5-67.0% by country. Rheumatology fellows scored significantly higher than nonrheumatologists. Questions related to anatomy of the hand scored the lowest of the regions surveyed. CONCLUSION Rheumatology fellows and rheumatologists showed a deficit in knowledge of musculoskeletal anatomy that is of central importance in rheumatologic assessment and diagnosis. This gap may hinder accurate and cost-effective rheumatologic diagnosis, particularly in the area of regional pain syndromes. Presently, widespread use of musculoskeletal ultrasound (MSUS) by rheumatologists may be premature, since a key component of expert-level MSUS is the integration of an accurate knowledge of anatomy with the views obtained with the ultrasound probe.
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Affiliation(s)
- José E Navarro-Zarza
- Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, Mexico
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Kelly M, Bennett D, Bruce-Brand R, O'Flynn S, Fleming P. One week with the experts: a short course improves musculoskeletal undergraduate medical education. J Bone Joint Surg Am 2014; 96:e39. [PMID: 24599211 DOI: 10.2106/jbjs.m.00325] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Martina Kelly
- Department of Family Medicine, University of Calgary, 3330 Hospital Drive, Calgary, T2N 2N1, Alberta, Canada. E-mail address:
| | - Deirdre Bennett
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. E-mail address for D. Bennett: . E-mail address for S. O'Flynn:
| | - Robert Bruce-Brand
- Department of Trauma and Orthopedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. E-mail address for R. Bruce-Brand: . E-mail address for P. Fleming:
| | - Siun O'Flynn
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland. E-mail address for D. Bennett: . E-mail address for S. O'Flynn:
| | - Pat Fleming
- Department of Trauma and Orthopedic Surgery, Cork University Hospital, Wilton, Cork, Ireland. E-mail address for R. Bruce-Brand: . E-mail address for P. Fleming:
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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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Vioreanu MH, O’Daly BJ, Shelly MJ, Devitt BM, O’Byrne JM. Design, implementation and prospective evaluation of a new interactive musculoskeletal module for medical students in Ireland. Ir J Med Sci 2012; 182:191-9. [DOI: 10.1007/s11845-012-0855-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
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McNicoll L, Fulton AT, Ritter D, Besdine RW. Cadaver treasure hunt: introducing geriatrics concepts in the anatomy class. J Am Geriatr Soc 2012; 60:962-6. [PMID: 22568595 DOI: 10.1111/j.1532-5415.2012.03951.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to develop an educational program introducing geriatrics to medical students during anatomy. Observational study of an educational intervention in medical school was the design utilized. First-year medical students in an anatomy laboratory were participants. The program consists of a lecture and a workshop. First, a geriatrics lecture early in the course presents demographic data on the cadavers, followed by comparison with national data on leading causes of death. Second, there is a "treasure hunt" in the anatomy laboratory conducted by geriatricians. Each geriatrician spends 45 minutes with one-four-student cadaver group at a time, reviewing anatomical findings and facilitating a discussion of clinical correlations and implications. A list of common anatomical findings, aging- and disease-related, is distributed to the students as an aid in identifying findings of interest. Students have been surprised to learn that the mean age of the 24 cadavers exceeded 80 years (mean 81, median 85 for 2 years), and that causes of death mirrored national data. The students begin understanding aging and appreciate the valuable resource of cadavers. The students acquire a new holistic perspective regarding their cadavers that is not apparent during the dissections. Students and faculty find the experience valuable in understanding the interplay of disease and aging. Evaluations have been mostly positive (82-87% positive responses). The anatomy lecture and "treasure hunt" experience are unique strategies for using cadavers to introduce geriatrics principles into the medical school.
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Affiliation(s)
- Lynn McNicoll
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island 02903, USA.
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Beran MC, Awan H, Rowley D, Samora JB, Griesser MJ, Bishop JY. Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents. J Bone Joint Surg Am 2012; 94:e36. [PMID: 22438009 DOI: 10.2106/jbjs.k.00518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum. METHODS We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills. RESULTS The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%. CONCLUSIONS We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.
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Affiliation(s)
- Matthew C Beran
- Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA
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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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Nottidge TE, Ekrikpo U, Ifesanya AO, Nnabuko RE, Dim EM, Udoinyang CI. Pre-internship Nigerian medical graduates lack basic musculoskeletal competency. INTERNATIONAL ORTHOPAEDICS 2012; 36:853-6. [PMID: 22278398 DOI: 10.1007/s00264-012-1485-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Our aim was to assess the basic musculoskeletal competency of pre-internship graduates from Nigerian medical schools. METHODS We administered the Freedman and Bernstein basic musculoskeletal competency examination to 113 pre-internship graduates from seven Nigerian medical schools over a three year period from 2008 to 2010 at the University of Uyo Teaching Hospital. Five specialist residents took the examination to test criteria relevance. RESULTS All graduates failed this test, obtaining scores ranging from 7% to 67%. The duration of the orthopaedic posting, and observation of operative fracture fixation, were not significant determinants of the score. The two final-year specialist residents each had a marginal pass in the examination. CONCLUSION Basic musculoskeletal competency among pre-internship Nigerian medical-school graduates is inadequate.
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Affiliation(s)
- Timothy Eyo Nottidge
- Department of Orthopaedics and Traumatology, Faculty of Clinical Sciences, University of Uyo, Uyo, Akwa-Ibom State, Nigeria.
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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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Queally JM, Cummins F, Brennan SA, Shelly MJ, O'Byrne JM. Assessment of a new undergraduate module in musculoskeletal medicine. J Bone Joint Surg Am 2011; 93:e9. [PMID: 21266636 DOI: 10.2106/jbjs.j.01220] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the high prevalence of musculoskeletal disorders seen by primary care physicians, numerous studies have demonstrated deficiencies in the adequacy of musculoskeletal education at multiple stages of medical education. The aim of this study was to assess a newly developed module in musculoskeletal medicine for use at European undergraduate level (i.e., the medical-school level). METHODS A two-week module in musculoskeletal medicine was designed to cover common musculoskeletal disorders that are typically seen in primary care. The module incorporated an integrated approach, including core lectures, bedside clinical examination, and demonstration of basic practical procedures. A previously validated examination in musculoskeletal medicine was used to assess the cognitive knowledge of ninety-two students on completion of the module. A historical control group (seventy-two students) from a prior course was used for comparison. RESULTS The new module group (2009) performed significantly better than the historical (2006) control group in terms of score (62.3% versus 54.3%, respectively; p < 0.001) and pass rate (38.4% versus 12.5%, respectively; p = 0.0002). In a subgroup analysis of the new module group, students who enrolled in the graduate entry program (an accelerated four-year curriculum consisting of students who have already completed an undergraduate university degree) were more likely to perform better in terms of average score (72.2% versus 57%, respectively; p < 0.001) and pass rates (70.9% versus 21.4%, respectively; p < 0.001) compared with students who had enrolled via the traditional undergraduate route. In terms of satisfaction rates, the new module group reported a significantly higher satisfaction rate than that reported by the historical control group (63% versus 15%, respectively; p < 0.001). CONCLUSIONS In conclusion, the musculoskeletal module described in this paper represents an educational advance at undergraduate (i.e., medical-school) level as demonstrated by the improvement in scores in a validated examination. As pressure on medical curricula grows to accommodate advancing medical knowledge, it is important to continue to improve, assess, and consolidate the position of musculoskeletal medicine in contemporary medical education.
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Affiliation(s)
- Joseph M Queally
- Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in Ireland, Ireland.
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Sirisena D, Begum H, Selvarajah M, Chakravarty K. Musculoskeletal examination--an ignored aspect. Why are we still failing the patients? Clin Rheumatol 2010; 30:403-7. [PMID: 21165754 DOI: 10.1007/s10067-010-1632-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/14/2010] [Accepted: 11/23/2010] [Indexed: 10/18/2022]
Abstract
Over the past two decades, rheumatologists from around the world have not only championed the musculoskeletal system examination but also modified the undergraduate teaching curriculum. This has led to the development and adoption of the gait, arms, legs and spine (GALS) screening along with regional examination techniques. The purpose of this study is to review current practice, determining the frequency of patient exposure to appropriate examination and confidence of junior doctors when dealing with MSK conditions. Two district-general hospitals (non-teaching) and one teaching hospital in North-East London were chosen. At each site, 50 patient notes were reviewed from the acute admission wards for medicine and surgery and the medical assessment unit. Factors considered included whether GALS screenings had taken place, documentation of MSK examinations and assessment of confidence of junior doctors in assessing MSK conditions. GALS screenings were performed for 4% of patients on the medical assessment unit, 7% of acute medical and 0% of acute surgical patients on admission. Examination of the MSK system yielded better results with 16%, 22% and 10% on each of the respective wards. Interviews with junior doctors found 10% routinely screening for MSK conditions, despite 87% feeling confident in taking MSK histories. This prospective audit of clinical practice highlights that patients failed to have a minimal assessment of the MSK system through GALS screenings. When examining the MSK system, results were somewhat better, although still fewer than expected. It is curious that the majority of junior doctors in training felt confident in dealing with MSK disease but few did it in practice. This begs the question of whether current teaching curricula and strategies are adequate. At a time where there is ever-increasing national momentum to address issues on obesity and cardiovascular health, our patients are still deprived of a standard MSK examination by the medical faculty.
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Affiliation(s)
- Dinesh Sirisena
- Exercise Physiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
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Wilson FC, Esther RJ. Development and use of a second-year musculoskeletal organ-system curriculum: a forty-year experience. J Bone Joint Surg Am 2010; 92:e14. [PMID: 20810850 DOI: 10.2106/jbjs.i.01514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Frank C Wilson
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7055, USA
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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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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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