Curriculum Reform and New Technology to Fill the Void of Musculoskeletal Education in Medical School Curriculum

Orthopedics and Traumatology Skill Matrix for Musculoskeletal System Approach by Medical Graduates

Objective  This study aimed to build a matrix of orthopedics and traumatology skills focusing on the musculoskeletal system for graduates of a medical course in Brazil. Methods  The study used the e-Delphi methodology to retrieve opinions anonymously. The first proposal included 42 items determined at a bibliographical review and their epidemiological relevance. This proposal was available via Google Forms, and we sent it using the instant messaging application WhatsApp. We grouped the panel of 26 specialists into three categories: Orthopedics and Traumatology professors, Primary Care doctors, and Emergency Physicians. We reached a consensus after three rounds, with at least 75% agreement between the items initially presented. We also considered the following four indicators: prerequisite, essential, desirable, and advanced skills. Results  We created a matrix with 34 musculoskeletal system-related skills, including diagnostic and management actions for all age groups. Conclusion  We devised a skill matrix in Orthopedics and Traumatology for medical graduation for complete or partial use according to the institutional curriculum.

Transforming musculoskeletal anatomy learning with haptic surface painting

Anatomical body painting has traditionally been utilized to support learner engagement and understanding of surface anatomy. Learners apply two-dimensional representations of surface markings directly on to the skin, based on the identification of key landmarks. Esthetically satisfying representations of musculature and viscera can also be created. However, established body painting approaches do not typically address three-dimensional spatial anatomical concepts. Haptic Surface Painting (HSP) is a novel activity, distinct from traditional body painting, and aims to develop learner spatial awareness. The HSP process is underpinned by previous work describing how a Haptico-visual observation and drawing method can support spatial, holistic, and collaborative anatomy learning. In HSP, superficial and underlying musculoskeletal and vascular structures are located haptically by palpation. Transparent colors are then immediately applied to the skin using purposive and cross-contour drawing techniques to produce corresponding visual representations of learner observation and cognition. Undergraduate students at a United Kingdom medical school (n = 7) participated in remote HSP workshops and focus groups. A phenomenological study of learner perspectives identified four themes from semantic qualitative analysis of transcripts: Three-dimensional haptico-visual exploration relating to learner spatial awareness of their own anatomy; cognitive freedom and accessibility provided by a flexible and empowering learning process; altered perspectives of anatomical detail, relationships, and clinical relevance; and delivery and context, relating to curricular integration, session format, and educator guidance. This work expands the pedagogic repertoire of anatomical body painting and has implications for anatomy educators seeking to integrate innovative, engaging, and effective learning approaches for transforming student learning.

What to Teach in Small Animal Veterinary Orthopedics: A Survey of Practicing Veterinarians to Inform Curriculum Development

Competency-based veterinary education focuses on the knowledge and clinical skills required to generate a productive and confident practitioner. Accurate identification of clinically relevant core competencies enables academic institutions to prioritize which new and foundational information to cover in the limited time available. The goal of this study was to aggregate the opinions of veterinary practitioners about small animal core competencies in veterinary orthopedics. An online 20-question survey was distributed with questions regarding respondent demographics, education, practice type, caseload, involvement in orthopedic procedures, access to referral hospitals, frequency of orthopedic condition presentation and procedure performance, and proposed percent allocation of various orthopedic curriculum topics. Responses were included from 721 respondents, largely first-opinion veterinarians (81%, n = 580/721). The majority (58%; n = 418/721) of respondents performed less than 10% of the orthopedic surgeries themselves and, 37% (n = 266/721) reported never performing orthopedic surgery; of those performing surgeries, 78% (n = 354/455) performed less than six orthopedic procedures monthly. The five most common orthopedic conditions seen included: generalized osteoarthritis, patellar luxation, cranial cruciate ligament disease, hip dysplasia/arthritis, and muscle/tendon injuries. Median respondent scores for the percentage which a topic should comprise in an ideal orthopedic curriculum were 20% each for 'orthopedic exam' and for 'non-surgical orthopedic knowledge', 15% each for 'non-surgical orthopedic skills,' 'orthopedic imaging (radiographs),' and 'surgical orthopedic knowledge,' 10% for 'surgical orthopedic skills,' and 2% for 'advanced orthopedic imaging.' Based on these results, a curriculum focusing on the most clinically relevant orthopedic conditions with an emphasis on diagnosis establishment and non-surgical treatments is proposed.

Twelve tips for developing a systematic acute care curriculum for medical students

There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students' reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals.

Randomized Controlled Study of a Training Program for Knee and Shoulder Arthrocentesis on Procedural Simulators with Assessment on Cadavers

Objective

The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis.

Methods

Two groups of 15 medical students were each trained to perform a single joint arthrocentesis (“knee group” and “shoulder group”) on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered “competent on the cadaver” if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study.

Results

Twenty‐two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver’s knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver’s shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students’ confidence level in arthrocentesis increased significantly during the study, as did the students’ theoretical knowledge.

Conclusion

Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.