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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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BSc RG, Štrkalj G, Prvan T, Pather N. Musculoskeletal anatomy core syllabus for Australian chiropractic programs: A pilot study. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:117-123. [PMID: 35561322 PMCID: PMC9536235 DOI: 10.7899/jce-21-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 09/13/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study is to conduct a pilot survey to determine core anatomy content for chiropractic curriculum based on the perception of chiropractors and anatomy educators involved in teaching in an Australian chiropractic program. METHODS A survey of anatomical structures previously used in a medical survey, with similar criteria for synthesizing responses, was used and classified according to whether the respondents rated an item as essential, important, acceptable, or not required in a chiropractic program. The item was scored as core if ≥60% of respondents rated it essential, recommended if 30%-59% rated it essential, not recommended if 20%-29% rated it essential, or not core if <20% rated it essential. RESULTS The respondents rated 81.6% of all musculoskeletal concepts as core and 18.4% as recommended, 88.8% of the vertebral column items as core, and 11.2% of the items as recommended, 69.4% upper limb and pectoral girdle items as core, 23.7% of items as recommended, 5.5% as not recommended and 1.3% as not core items for inclusion, 85.3% of all lower limb and pelvic girdle items as core, 14.4% as recommended and 0.3% not recommended. CONCLUSION Chiropractors and anatomists involved in teaching in an Australian chiropractic program rated most musculoskeletal items as essential for inclusion in a chiropractic teaching program to ensure adequate preparation for safe practice and to promote alignment with the standards of anatomy education delivered into the clinical professions.
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Mulcaire-Jones E, Barker AM, Beck JP, Lawrence P, Cannon GW, Battistone MJ. Impact of a Musculoskeletal "Mini-Residency" Professional Development Program on Knee Magnetic Resonance Imaging Orders by Primary Care Providers. J Clin Rheumatol 2022; 28:245-249. [PMID: 35358112 PMCID: PMC9336568 DOI: 10.1097/rhu.0000000000001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US Department of Veterans Affairs has created a portfolio of educational programs to train primary care providers (PCPs) in the evaluation and management of common musculoskeletal (MSK) conditions. Appropriate resource utilization for evaluation of knee pain, including limiting unnecessary magnetic resonance imaging (MRI) studies, is an important theme of these initiatives. The objective of this study was to report the utilization of knee MRI by PCP providers before and after the MSK education program and to determine the appropriateness of these MRI orders. METHODS Twenty-six PCPs participated in the MSK Mini-Residency educational program held in Salt Lake City between April 2012 and October 2014. Knee MRI orders submitted by these providers 12 months before and 12 months after their participation were reviewed. Magnetic resonance imaging orders were categorized as "inappropriate," "probably inappropriate," or "possibly appropriate," based on accepted guidelines for knee MRI utilization. Differences in the numbers of precourse and postcourse MRI orders for each of these categories were compared using Student t test. RESULTS Following our program, MRI orders decreased from 130 (precourse) to 93 (postcourse), a reduction of 28% ( p = 0.04). This reduction was observed entirely within the "inappropriate" and "probably inappropriate" categories; the number of orders categorized as "possibly appropriate" increased, but not significantly. CONCLUSIONS The MSK Mini-Residency training program was a successful educational intervention and was associated with a reduction in inappropriate knee MRI utilization for some participants, while keeping appropriate MRI utilization stable.
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Affiliation(s)
| | - Andrea M. Barker
- Veterans Affairs Salt Lake City Health Care System
- Departments of Family and Preventive Medicine
| | | | | | - Grant W. Cannon
- Veterans Affairs Salt Lake City Health Care System
- Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Michael J. Battistone
- Veterans Affairs Salt Lake City Health Care System
- Division of Rheumatology, University of Utah, Salt Lake City, UT
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Parekh Y, Romeo P, Baskar D, Chandra A, Filtes P, Varghese B, McPartland T, Katt BM. Orthopaedic Surgery Boot Camp: An Immersion Course for Medical Students. Cureus 2022; 14:e24806. [PMID: 35686269 PMCID: PMC9169982 DOI: 10.7759/cureus.24806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Yu JC, Rashid M, Davila-Cervantes A, Hodgson CS. Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design. TEACHING AND LEARNING IN MEDICINE 2022; 34:123-134. [PMID: 34459349 DOI: 10.1080/10401334.2021.1954930] [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: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
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 .
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Affiliation(s)
- Jaime C Yu
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Davila-Cervantes
- Office of Lifelong Learning, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carol S Hodgson
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Kettle C, McKay L, Cianciolo AM, Kareha SM, Ruggeri CE. A novel movement system screen for primary care providers: a multisite, observational study. J Osteopath Med 2022; 122:159-166. [PMID: 34997837 DOI: 10.1515/jom-2021-0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Movement of the human body is essential for the interaction of an individual within their environment and contributes to both physical and emotional quality of life. Movement system disorders (MSDs) are kinesiopathologic conditions that result from either altered movement patterns, trauma, or pathology. A screening tool may facilitate earlier diagnosis and treatment of acute MSDs. This tool could prevent progression to chronic conditions, leading to better patient outcomes and quality of life. OBJECTIVES Our study evaluated whether a screening tool would be able to accurately screen individuals for MSDs, explore comorbidities that may predict the prevalence of MSDs, and identify why people do not discuss these problems with their primary care provider (PCP). METHODS A multisite, observational study in a primary care setting. Data were analyzed to determine the psychometric properties of the screening question. Logistic regression was performed to explore the relationship of comorbidities with MSDs. Thematic analysis was performed to explore why patients do not discuss these issues with their PCP. RESULTS The point prevalence of MSDs was determined to be 78%. The sensitivity of the screening question was determined to be good (70%). Arthritis, obesity, sleep disorders, and gastroesophageal reflux disease (GERD) were significant predictors for an MSD. Thematic analysis regarding why patients do not discuss the MSD with their physician revealed: (1) the perceived lack of importance of the problem; (2) the lack of access to healthcare, and (3) the acuity of the problem. CONCLUSIONS Screening for an MSD and associated comorbidities could prevent the transition of acute conditions to chronic conditions. If PCPs can identify predictors and factors associated with an MSD, they may be able to screen for MSDs more effectively. Earlier identification of MSDs may facilitate earlier treatment and prevent costs associated with resulting chronic disorders and persistent pain and disability.
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Affiliation(s)
- Christine Kettle
- Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, PA, USA.,Physical Therapy at St. Luke's, St. Luke's University Health Network, Allentown, PA, USA
| | - Lauren McKay
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
| | | | - Stephen M Kareha
- Physical Therapy at St. Luke's, St. Luke's University Health Network, Bethlehem, PA, USA.,Department of Physical Therapy, DeSales University, Center Valley, PA, USA
| | - Cara E Ruggeri
- Department of Internal Medicine, St. Luke's University Health Network, Bethlehem, PA, USA.,Clinical Associate Professor (Adjunct), Lewis Katz School of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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Peeler J. Efficacy of an intensive 2-week musculoskeletal anatomy course in a medical education setting. Ann Anat 2021; 239:151802. [PMID: 34265385 DOI: 10.1016/j.aanat.2021.151802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/22/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
There is little consistency in student contact hours and teaching activities used in medical curriculums across North America, and controversy exists regarding the most efficient or effective way to teach musculoskeletal (MSK) anatomy in medical school. The purpose of this investigation was to retrospectively examine academic performance and levels of course satisfaction among first year medical students who had completed an intensive 2-week MSK anatomy course during the pre-clerkship portion of their Association of Faculties of Medicine in Canada accredited undergraduate medical program. Course data from formative and summative student evaluations, as well as end-of-course satisfaction surveys were analyzed for a homogenous group of 549 first-year medical students over a 5-year period. Data indicated that student's academic performance on both formative and summative evaluations for the 2-week MSK anatomy course were consistently high, and not significantly different from the results for other system-based 1st year anatomy courses delivered over longer durations. Likert data from end-of-course surveys also suggested that student feedback regarding the course was overwhelmingly positive, and that the 2-week MSK anatomy course had the highest level of overall satisfaction when compared to all other first-year anatomy courses. These results can be used to help in the design and implementation of MSK anatomy courses within medical curriculums, and contribute to a growing body of literature which is focused on examining the effect of curricular design on MSK anatomy learning in a medical education setting.
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Affiliation(s)
- Jason Peeler
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada; Pan Am Clinic, Winnipeg, Manitoba, Canada.
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Wang T, Xiong G, Lu L, Bernstein J, Ladd A. Musculoskeletal Education in Medical Schools: a Survey in California and Review of Literature. MEDICAL SCIENCE EDUCATOR 2021; 31:131-136. [PMID: 34457873 PMCID: PMC8368391 DOI: 10.1007/s40670-020-01144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Though musculoskeletal complaints account for roughly one-quarter of primary care and emergency department visits, only 2% of US medical school curriculum is devoted to musculoskeletal disease. Many graduating students demonstrate poor knowledge and report low confidence in treating musculoskeletal disorders. This study defines the current state of musculoskeletal curriculum of medical schools in detail to identify variations and potential shortcomings. METHODS All eleven medical schools in California were invited to participate in an in-depth survey detailing the design and content of their musculoskeletal curriculum. RESULTS A response rate of 100% was achieved. Overall, schools devoted an average of 58.7 h to musculoskeletal medicine, of which more than half was spent covering anatomy. The primary instructor for musculoskeletal medicine was a clinician in four schools (36.4%). Six schools offered a dedicated musculoskeletal physical exam course. No schools required students to complete a clinical rotation in musculoskeletal medicine. There was high variability among institutions when evaluating core subject coverage. DISCUSSION There is large variation in the content and structure of musculoskeletal instruction among California medical schools. Increased curricular time, integration of preclinical and clinical experiences, greater specialist participation, and standardized objectives may provide more consistent and comprehensive musculoskeletal education. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01144-3.
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Affiliation(s)
- Tim Wang
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Grace Xiong
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Laura Lu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
| | - Joseph Bernstein
- University of Pennsylvania School of Medicine, Philadelphia, PA USA
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St, Pavilion C, 4th Floor, Redwood City, CA 94063 USA
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Bowers R, Neuberger D, Williams C, Kneer L, Sussman W. The Impact of an Ultrasound Curriculum on the Accuracy of Resident Joint Line Palpation. PM R 2020; 13:1261-1265. [PMID: 33340274 DOI: 10.1002/pmrj.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Ultrasound education has been used as a tool to help improve physical examination skills. However, its utility in increasing accuracy of joint line palpation has yet to be investigated. OBJECTIVE To evaluate the accuracy of resident palpation and identification of the lateral knee joint line before and after introducing a musculoskeletal ultrasound (MSUS) curriculum. DESIGN Cohort study. SETTING A physical medicine and rehabilitation (PM&R) residency program at an academic institution. PARTICIPANTS Seventeen PM&R residents. INTERVENTIONS Residents underwent a knee-focused MSUS workshop. MAIN OUTCOME MEASURES Distance from needle placement to joint line confirmed with ultrasound. RESULTS All residents demonstrated improved accuracy in lateral knee joint line palpation after completing a knee-focused MSUS workshop, with statistically significant (P < .05) improvement in postgraduate year (PGY) 2 (P = .02), PGY-3 (P = .04), and across all residents (P = .001). CONCLUSIONS MSUS education significantly improved lateral knee joint line palpation accuracy in resident physicians.
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Affiliation(s)
- Robert Bowers
- Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, GA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - David Neuberger
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Lee Kneer
- Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, GA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Walter Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University School of Medicine, Boston, MA
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10
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Yu JC, Guo Q, Hodgson CS. Deconstructing the Joint Examination: A Novel Approach to Teaching Introductory Musculoskeletal Physical Examination Skills for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10945. [PMID: 32908950 PMCID: PMC7473186 DOI: 10.15766/mep_2374-8265.10945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/29/2020] [Indexed: 06/11/2023]
Abstract
Introduction Musculoskeletal (MSK) disorders are very common, but suboptimal teaching of MSK medicine occurs and expert clinicians agree that MSK physical examination (PE) skills can be confusing and complicated for medical students. An innovative approach in introductory teaching of MSK PE skills was developed using constructivist theory for second-year medical students. Methods We implemented the MSK PE curriculum innovation in the second year of a four-year MD program, utilizing a standard framework with spaced practice and clinician coaching. We evaluated this curriculum by comparing the innovation group (n = 123) to a historical control group (n = 134) using an anonymous survey and OSCE station scores. Data analysis included repeated measures analysis of variance comparing students' self-confidence in MSK PE to students' self-confidence in other systems-based PEs, as well as independent t-test comparisons of self-confidence scores and MSK-specific OSCE station scores between the historical and innovation groups. Results The mean self-assessed confidence of the historical group was significantly lower for the MSK PE than all other PEs (p < 0.001), except for the neurological PE. Significant improvement in MSK PE self-confidence was noted with the innovation group (t(259) = -4.05, p < 0.001). OSCE scores significantly improved in MSK-specific stations, with medium to large effect size across the different stations. Discussion We successfully used a framework of deconstruction, repetition, and spaced practice to develop fundamental MSK PE skills in preclerkship medical students. This curriculum structure provides an effective example for teaching introductory MSK PE skills to early medical learners.
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Affiliation(s)
- Jaime C. Yu
- Assistant Professor, Department of Medicine, Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta
| | - Qi Guo
- Postdoctoral Fellow, IDEAS (Innovation Discovery Education and Scholarship) Office, Faculty of Medicine and Dentistry, University of Alberta
| | - Carol S. Hodgson
- Associate Professor, Department of Pediatrics, and Director, IDEAS (Innovation Discovery Education and Scholarship) Office, Faculty of Medicine and Dentistry, University of Alberta
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11
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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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Fernández-Ávila DG, Rojas MX, Ramírez C, Rodelo L, Soriano E. Effectiveness of the use of an algorithm in the diagnostic approach of joint pain patients by primary care physicians. Rheumatol Int 2020; 40:1857-1864. [PMID: 32200425 DOI: 10.1007/s00296-020-04552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
There is a high percentage of error in the approach of patients with joint pain by primary care physicians. An algorithm can help improve this misdiagnosis problem. Our study seeks to determine the effectiveness of an algorithm when used by primary care physicians for the diagnosis of cases of joint pain patients. A randomized clinical experiment was carried out. Primary care physicians from five cities in Colombia developed a series of clinical cases, which were presented to them through a website on their personal cell phones. Half of the doctors developed the cases using the diagnostic algorithm, and the other half developed the cases without the use of the algorithm. Main measures were proportion of correct diagnosis, number, type of laboratory and diagnostic images requested for the diagnostic approach of clinical cases. Two hundred and twenty-four primary care physicians participated. The overall proportion of cases correctly diagnosed was 37.3% higher in the intervention group; we found a greater difference in cases of spondyloarthritis (60.8%), followed by systemic lupus erythematosus with joint involvement (32.2%), rheumatoid arthritis (30.3%) and osteoarthritis (25.9%). The average number of tests requested to develop clinical cases was lower in the intervention group than in the control group, both globally and for each of the four diseases, with statistically significant differences for each of the comparisons. The diagnostic algorithm proved to be an effective tool when used by primary care physicians; the proportion of correct diagnoses increased, and the number of tests requested in the development of the cases decreased.
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Affiliation(s)
- D G Fernández-Ávila
- PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - M X Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - C Ramírez
- Rheumatoid Arthritis Program, Sánitas EPS, Bogotá, Colombia
| | | | - E Soriano
- Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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13
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Barker AM, LaRochelle JS, Artino AR, Wiltz SA, Kim LM, Battistone MJ. SimLEARN Musculoskeletal Training for VHA Primary Care Providers and Health Professions Educators. Fed Pract 2020; 37:42-47. [PMID: 32047355 PMCID: PMC7010344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A simulation-based training curricula applied to the primary care evaluation and management of shoulder and knee pain resulted in improved access to care for veterans and cost savings for the health care system.
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Affiliation(s)
- Andrea M Barker
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Jeffrey S LaRochelle
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Anthony R Artino
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Scott A Wiltz
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Laura M Kim
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
| | - Michael J Battistone
- is Codirector; and is Director; both at the Center of Excellence in Musculoskeletal Care and Education at the George E. Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah. is an Associate Professor of Medicine; and is an Assistant Professor of Family Medicine; both at the University of Central Florida College of Medicine in Orlando. is Professor and Deputy Director, Division of Health Professions Education, Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences in Bethesda, Maryland. is a Health Professions Education Evaluation and Research Fellow; and Scott Wiltz is the Associate Medical Director of Training, both at the VHA Simulation Learning, Education and Research Network (SimLEARN) in Orlando. Andrea Barker is an Adjunct Instructor, Department of Family and Preventive Medicine; and Michael Battistone is Associate Professor in the Department of Internal Medicine, Division of Rheumatology, Health Sciences Center; both at the University of Utah in Salt Lake City
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14
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Battistone MJ, Barker AM, Durning SJ. Interprofessional Musculoskeletal Education: A Review of National Initiatives from the Department of Veterans Affairs. Rheum Dis Clin North Am 2019; 46:135-153. [PMID: 31757281 DOI: 10.1016/j.rdc.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article reviews several national programs in musculoskeletal education initiated by the Department of Veterans Affairs over the past decade. These programs have become sustained interprofessional opportunities for learners across disciplines and along the continuum of health professions education (HPE) and training pathways. This article also describes opportunities for leaders in rheumatology and other HPE programs to join these efforts and to collaborate in the scholarship that will be necessary in constructing educational programs fit for the purpose of ensuring a well-trained, competent workforce of health care providers.
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Affiliation(s)
- Michael J Battistone
- Division of Rheumatology, Department of Medicine, Center of Excellence in Musculoskeletal Care and Education, George E. Wahlen Veterans Affairs Salt City Health Care System, University of Utah Health Sciences Center, Salt Lake City VA Medical Center, 11/E, 500 Foothill Drive, Salt Lake City, UT 84148, USA.
| | - Andrea M Barker
- Department of Family and Preventive Medicine, Center of Excellence in Musculoskeletal Care and Education, George E. Wahlen Veterans Affairs Salt City Health Care System, University of Utah Health Sciences Center, Salt Lake City VA Medical Center, 11/E, 500 Foothill Drive, Salt Lake City, UT 84148, USA
| | - Steven J Durning
- Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4712, USA
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15
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Malone ER, Bingham G, Seo JH, Pine MD. Student perceived impact of a physical, kinetic and interactive model. J Vis Commun Med 2019; 42:182-194. [PMID: 31599181 DOI: 10.1080/17453054.2019.1662281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Current instructional tools for anatomy education are insufficient scaffolds for learning abstract visual concepts such as basic biomechanics. Diagrams, illustrations and even computer-generated models may be adequate for identification purposes, but are typically not effective when it comes to demonstrating dynamic functions. Evidence from educational concepts, such as the active learning principle in constructivism, indicate that current tools are ineffective due to a lack of opportunity for hands-on or interactive, learning. To address this, our interdisciplinary team designed an instructional model of the canine thoracic limb which is physical, kinetic and interactive. We hypothesised that the unique combination of these three crucial elements would enhance the student learning experience. In order to test this hypothesis, we asked 126 undergraduate students in a biomedical anatomy course to interact with the model. Students were then invited to complete a survey evaluating their experience using the thoracic limb model. Results from completed surveys showed that students perceived the model as easy to use and helpful with understanding basic biomechanical concepts. These results indicate that there is potential for the model to positively impact the students' learning. Future studies will include quantitative evaluation of student performance and cognitive impact in the biomedical anatomy course.
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Affiliation(s)
- Erica Reneé Malone
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Glenda Bingham
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Jinsil Hwaryoung Seo
- Department of Visualizations, College of Architecture, Texas A&M University, College Station, TX, USA
| | - Michelle D Pine
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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16
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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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17
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Webb AL, Green RA, Woodley SJ. The development of a core syllabus for teaching musculoskeletal anatomy of the vertebral column and limbs to medical students. Clin Anat 2019; 32:974-1007. [DOI: 10.1002/ca.23319] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Alexandra L. Webb
- Medical School, College of Health and MedicineAustralian National University Canberra Australia
| | - Rodney A. Green
- College of Science, Health & EngineeringLa Trobe University Bendigo Australia
| | - Stephanie J. Woodley
- Department of Anatomy, School of Biomedical SciencesUniversity of Otago Dunedin New Zealand
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18
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Malik KM, Beckerly R, Imani F. Musculoskeletal Disorders a Universal Source of Pain and Disability Misunderstood and Mismanaged: A Critical Analysis Based on the U.S. Model of Care. Anesth Pain Med 2018; 8:e85532. [PMID: 30775292 PMCID: PMC6348332 DOI: 10.5812/aapm.85532] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022] Open
Abstract
Musculoskeletal disorders are the leading source of pain and disability globally but are especially prevalent in the industrialized nations including the U.S. In addition to the substantial individual suffering caused the rising monetary costs of these disorders are noteworthy. In the U.S. alone the annual costs have been estimated to be $874 billion 5.7% of the annual U.S. G.D.P. Despite these expenditures the care provided to patients with musculoskeletal disorders is highly variable and has regularly been shown to have suboptimal outcomes. The many reasons for this ineffective care include the mutable nature of the prevailing syndromes and their limited and variable understanding. The care rendered by a broad and incongruent group of providers who practice disparate methodologies and employ variable treatments. Disorderedly triage comprised of arbitrary selection of providers, care methodologies, and treatments, which is prone to a range of extraneous influences. Treatments that are unable to apprehend the causative pathological processes, which are therefore progressive, cause irreversible damage to the respective musculoskeletal structures, and result in enduring pain and disability. The overall lack of preventative care and the consequent prevalence of these disorders especially in specific work environments and with certain high-risk life styles. This article makes recommendations for better understanding, prevention, early recognition, timely employment of disease altering therapies, streamlining the existing care, and policy initiatives for waste confinement and improvement. These discernments may improve the overall quality of care provided to these patients, diminish the staggering pain and disability caused, and can reduce the immense costs incurred.
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Affiliation(s)
- Khalid M Malik
- University of Illinois, Chicago, United States
- Corresponding Author: Professor of Anesthesiology and Pain Medicine, University of Illinois, 301 N Harvey Ave., Oak Park IL 60302, Chicago, United States. Tel: +1-3124852938,
| | | | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
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19
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Musculoskeletal Education in Medical Schools: A Survey of Allopathic and Osteopathic Medical Students. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e019. [PMID: 30211396 PMCID: PMC6132304 DOI: 10.5435/jaaosglobal-d-18-00019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Musculoskeletal (MSK) disorders are one of the most common causes of disability and emergency department and physician visits in the United States. However, there is very little consistency in how physicians in training are prepared to treat MSK disorders. On the basis of published reports, medical school graduates have a relative lack of cognitive mastery in MSK medicine, even with the recent increase in instruction. This study sought to compare MSK education at an allopathic medical school with that at an osteopathic medical school. Methods: An anonymous survey of students in medical school graduate years 2, 3, and 4 at Michigan State University College of Human Medicine (allopathic) and College of Osteopathic Medicine (osteopathic) was conducted. Questions were structured into three main categories: demographic information, content of the current MSK curriculum, and opinions regarding importance, instruction, and assessment of MSK education. Results: As of 2010, 83% of medical schools require MSK courses because of the United States Bone and Joint Initiative to incorporate such coursework into core curriculum. Yet only 54% of surveyed students thought that their MSK education was adequate. A greater portion of osteopathic students (57.1%) compared with allopathic students (26.8%) thought that their MSK curriculum is adequate, and as a consequence, 36.6% of allopathic students thought that they were inadequately prepared for the MSK content of US medical licensing examinations compared with 8.1% of osteopathic students. Further curriculum development and improvement is needed to advance physicians' abilities to address and treat MSK disorders. Medical students surveyed feel that this goal can be accomplished by emphasizing MSK education in third and fourth years of medical school. Conclusion: These findings highlight differences in MSK education between an allopathic and osteopathic medical school. Further standardization of the curriculum in medical schools may help improve the quality of teaching student comfort levels of new physicians. Level of Evidence: Level III
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20
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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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21
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Hose MK, Fontanesi J, Woytowitz M, Jarrin D, Quan A. Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions. J Gen Intern Med 2017; 32:1261-1265. [PMID: 28785987 PMCID: PMC5653557 DOI: 10.1007/s11606-017-4143-6] [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] [Received: 02/21/2017] [Revised: 06/12/2017] [Accepted: 07/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Deficiencies in musculoskeletal knowledge are reported at every stage of learning. Medical programs are looking for effective ways to incorporate competency-based training into musculoskeletal education. AIM To evaluate the impact of bedside feedback on learner's shoulder examination skills, confidence, and knowledge of common shoulder conditions. SETTING Four-week musculoskeletal clinic rotation. PARTICIPANTS UCSD third year medical students and internal medicine residents. PROGRAM DESCRIPTION Learners completed three baseline evaluations: videotaped shoulder examination, attitude survey, and knowledge test. During the 4-week intervention learners received bedside observation and feedback from musculoskeletal experts while evaluating patients with shoulder conditions. Post-intervention learners repeated the three assessments. PROGRAM EVALUATION Eighty-nine learners participated. In the primary outcome measure evaluating the pre/post videotaped shoulder examination, significant improvement was seen in 21 of 23 shoulder examination maneuvers. Secondary outcomes include changes in learner confidence and knowledge. Greatest gains in learner confidence were seen in performing the shoulder examination (61.5% improvement) and performing injections (97.1% improvement). Knowledge improved significantly in all categories including anatomy/examination interpretation, diagnosis, and procedures. DISCUSSION Direct observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.
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Affiliation(s)
- Michal Kalli Hose
- VA San Diego Healthcare System, San Diego, CA, USA. .,University of California San Diego, La Jolla, CA, USA.
| | - John Fontanesi
- Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Manjulika Woytowitz
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | - Diego Jarrin
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
| | - Anna Quan
- VA San Diego Healthcare System, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
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22
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The effects of a brief educational intervention on medical students’ knowledge, attitudes and beliefs towards low back pain. Scand J Pain 2017; 16:101-104. [DOI: 10.1016/j.sjpain.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/30/2017] [Accepted: 04/01/2017] [Indexed: 11/21/2022]
Abstract
Abstract
Background and aims
Knowledge, attitudes and beliefs towards low back pain (LBP) can significantly impact a health care provider’s clinical decision making. Several studies have investigated interventions designed to change practitioner attitudes and beliefs towards LBP, however no such studies involving medical students have been identified.
Methods
This study explored medical students ‚ knowledge, attitudes and beliefs towards LBP before and after a brief educational intervention on LBP. Responses from medical students (n = 93) were evaluated before and after a 15-min educational video on back pain. The intervention was developed using Camtasia™ video editor and screen recorder. Knowledge, attitudes and beliefs were measured using the “Modified Back Beliefs Questionnaire”, with items from two previously reported questionnaires on back beliefs. The questionnaire asks participants to indicate their agreement with statements about LBP on a 5-point Likert scale. Preferred responses were based on guidelines for the evidence-based management of LBP. The primary analysis evaluated total score on the nine-inevitability items of the Back Beliefs Questionnaire (“inevitability score”).
Results
Following the brief intervention there was a significant improvement in the inevitability score (post-workshop mean [SD] 20.8 [4.9] vs pre-workshop mean [SD] 26.9 [4.2]; mean difference (MD) 6.1, p < 0.001; lower score more favourable 1) and large improvements in the proportion of students providing correct responses to items on activity (pre: 49% vs post: 79%), bed rest (41% vs 75%), imaging (44% vs 74%) and recovery (25% vs 66%).
Conclusions
After watching the educational video students’ knowledge, beliefs and attitudes towards LBP improved and thus aligned more closely with evidence-based guidelines.
Implications
Medical doctors are at the forefront of managing low back pain in the community, however there is a need to strengthen musculoskeletal education in medical training programmes. The results from this research suggest educational interventions on back pain do not need to be extensive in order to have favourable outcomes on medical students’ knowledge, attitudes and beliefs towards back pain. The translational effects of these changes into clinical practice are not known.
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23
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Battistone MJ, Barker AM, Beck JP, Tashjian RZ, Cannon GW. Validity evidence for two objective structured clinical examination stations to evaluate core skills of the shoulder and knee assessment. BMC MEDICAL EDUCATION 2017; 17:13. [PMID: 28086879 PMCID: PMC5237332 DOI: 10.1186/s12909-016-0850-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 12/20/2016] [Indexed: 05/24/2023]
Abstract
BACKGROUND We developed two objective structured clinical examinations (OSCEs) to educate and evaluate trainees in the evaluation and management of shoulder and knee pain. Our objective was to examine the evidence for validity of these OSCEs. METHODS A multidisciplinary team of content experts developed checklists of exam maneuvers and criteria to guide rater observations. Content was proposed by faculty, supplemented by literature review, and finalized using a Delphi process. One faculty simulated the patient, another rated examinee performance. Two faculty independently rated a portion of cases. Percent agreement was calculated and Cohen's kappa corrected for chance agreement on binary outcomes. Examinees' self-assessment was explored by written surveys. Responses were stratified into 3 categories and compared with similarly stratified OSCE scores using Pearson's coefficient. RESULTS A multi-disciplinary cohort of 69 examinees participated. Examinees correctly identified rotator cuff and meniscal disease 88% and 89% of the time, respectively. Inter-rater agreement was moderate for the knee (87%; k = 0.61) and near perfect for the shoulder (97%; k = 0.88). No correlation between stratified self-assessment and OSCE scores were found for either shoulder (0.02) or knee (-0.07). CONCLUSIONS Validity evidence supports the continuing use of these OSCEs in educational programs addressing the evaluation and management of shoulder and knee pain. Evidence for validity includes the systematic development of content, rigorous control of the response process, and demonstration of acceptable interrater agreement. Lack of correlation with self-assessment suggests that these OSCEs measure a construct different from learners' self-confidence.
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Affiliation(s)
- Michael J. Battistone
- Salt Lake City Veterans Affairs Medical Center (SLC VAMC), 500 Foothill Drive, Salt Lake City, UT 84148 USA
- Department of Medicine, Division of Rheumatology, University of Utah, Salt Lake City, USA
| | - Andrea M. Barker
- Salt Lake City Veterans Affairs Medical Center (SLC VAMC), 500 Foothill Drive, Salt Lake City, UT 84148 USA
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, USA
| | - J. Peter Beck
- Salt Lake City Veterans Affairs Medical Center (SLC VAMC), 500 Foothill Drive, Salt Lake City, UT 84148 USA
- Department of Orthopaedics, University of Utah, Salt Lake City, USA
| | - Robert Z. Tashjian
- Salt Lake City Veterans Affairs Medical Center (SLC VAMC), 500 Foothill Drive, Salt Lake City, UT 84148 USA
- Department of Orthopaedics, University of Utah, Salt Lake City, USA
| | - Grant W. Cannon
- Salt Lake City Veterans Affairs Medical Center (SLC VAMC), 500 Foothill Drive, Salt Lake City, UT 84148 USA
- Department of Medicine, Division of Rheumatology, University of Utah, Salt Lake City, USA
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24
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Battistone MJ, Barker AM, Grotzke MP, Beck JP, Lawrence P, Cannon GW. "Mini-Residency" in Musculoskeletal Care: a National Continuing Professional Development Program for Primary Care Providers. J Gen Intern Med 2016; 31:1301-1307. [PMID: 27350280 PMCID: PMC5071283 DOI: 10.1007/s11606-016-3773-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/16/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A cost-effective professional development program enhancing musculoskeletal (MSK) skills of physicians and allied health providers working in primary care settings has been reported at a single site. This article describes the first 2 years of the national expansion and implementation of a 3-day "MSK Mini-residency." METHODS Faculty from Veterans Affairs (VA) medical centers worked in partnership with national program faculty from the Salt Lake City VA to present an intensive, integrated, multidisciplinary program to strengthen the skills of primary care providers in evaluating and managing MSK conditions common in primary care. Course assessments included written surveys and a two-station observed structured clinical examination (OSCE) evaluating the physical examination of the shoulder and knee. RESULTS In the first 2 years of the program, 13 VA facilities participated. Two hundred twenty-seven health care providers, including 135 physicians, were trained. Two hundred seven participants (91 %) completed all pre- and post-course written assessments and the two-station OSCE. DISCUSSION The MSK Mini-residency program is an effective and well-received mixed-method educational initiative to strengthen the skills of primary care physicians and other health care providers in evaluating and managing patients with MSK complaints and to document their competence in performing physical examinations of the shoulder and knee. The 2-year experience in implementation suggests that this model of educational partnerships is a feasible approach to disseminating innovative educational programs in a way that preserves curricular consistency yet is adaptable to local needs.
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Affiliation(s)
- Michael J Battistone
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA. .,Department of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Andrea M Barker
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marissa P Grotzke
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Medicine, Division of Endocrinology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - J Peter Beck
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Phillip Lawrence
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Roseman University of Health Sciences, South Jordan, UT, USA
| | - Grant W Cannon
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.,Department of Medicine, Division of Rheumatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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25
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Stansfield RB, Diponio L, Craig C, Zeller J, Chadd E, Miller J, Monrad S. Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam. BMC MEDICAL EDUCATION 2016; 16:268. [PMID: 27741946 PMCID: PMC5065081 DOI: 10.1186/s12909-016-0780-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/27/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. METHODS A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students' ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson's correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. RESULTS Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a discriminatory finding correlated with the ability to perform the associated maneuver correctly, with the exception of the ability to perform maneuvers needed to diagnose a torn anterior cruciate ligament of the knee. Neither the ability to anticipate or perform was predictive of identifying correct diagnoses for the different cases. CONCLUSIONS A novel musculoskeletal OSCE, based on principles of the hypothesis-driven physical examination, was able to identify significant deficiencies in examination skills needed to diagnose common disorders of the shoulder, back and knee amongst graduating medical students. In addition, the OSCE demonstrated that accurate anticipation of discriminatory examination findings correlates with ability to perform the associated maneuver; however, the ability to anticipate exceeds the ability to perform. Students do not appear to be using the physical exam to inform their diagnostic reasoning. The findings of this study have implications for both assessment and teaching of the musculoskeletal exam.
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Affiliation(s)
| | - Lisa Diponio
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Cliff Craig
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - John Zeller
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Edmund Chadd
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Joshua Miller
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Seetha Monrad
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI 48109 USA
- 1560 E. Maple Rd, Troy, MI 48083 USA
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Storheil B, Klouman E, Holmvik S, Emaus N, Fleten N. Intertester reliability of shoulder complaints diagnoses in primary health care. Scand J Prim Health Care 2016; 34:224-31. [PMID: 27404451 PMCID: PMC5036011 DOI: 10.1080/02813432.2016.1207139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting. DESIGN Cross-sectional study. SETTING Four primary health care clinicians used patients' history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints. SUBJECTS 62 patients, aged 18-75 years. MAIN OUTCOME MEASURE Reliability of diagnoses was assessed by observed intertester agreement and Cohen's kappa. A total of 372 diagnostic pairs were available for intertester comparisons. RESULTS Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73). CONCLUSIONS Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key points Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients. • Agreements on diagnoses were generally better than the agreement on individual tests. • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion. • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.
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Affiliation(s)
- Benny Storheil
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elise Klouman
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Stian Holmvik
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Nils Fleten
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- CONTACT Nils Fleten Department of Community Medicine, UiT the Arctic University of Norway, N-9037 Tromsø, Norway
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Battistone MJ, Barker AM, Grotzke MP, Beck JP, Berdan JT, Butler JM, Milne CK, Huhtala T, Cannon GW. Effectiveness of an Interprofessional and Multidisciplinary Musculoskeletal Training Program. J Grad Med Educ 2016; 8:398-404. [PMID: 27413444 PMCID: PMC4936859 DOI: 10.4300/jgme-d-15-00391.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Musculoskeletal (MSK) problems are common, and a recent US Bone and Joint Initiative calls for new models of education and professional collaboration. Evidence of feasibility and acceptability of innovative methods are needed. OBJECTIVE We assessed if an experimental immersion interdisciplinary MSK curriculum would be acceptable to residents from different specialties, be feasible within existing rotations, and be effective in strengthening clinical skills. METHODS Through funding from the Veterans Affairs Office of Academic Affiliations and the Office of Specialty Care, we developed a Center of Excellence in MSK Care and Education. A core element is the monthly MSK Education Week, which teaches skills and provides opportunities to apply these in clinical settings. Participants include internal medicine, physical medicine and rehabilitation, and orthopaedic surgery residents, as well as students and residents from other health professions programs. All were assigned to the MSK week in lieu of other clinical experiences. Faculty encompassed primary care, rheumatology, endocrinology, orthopaedics, and physical medicine and rehabilitation. Assessments include surveys and a 2-station objective structured clinical examination (OSCE). RESULTS Since 2012, a total of 176 trainees have participated. Percentage of trainees reporting ability to evaluate and manage MSK complaints increased (9% to 87% for shoulder; 18% to 86% for knee), and confidence performing MSK injections increased from 10% to 70%. Competency in evaluation of shoulder and knee pain was confirmed by OSCEs. CONCLUSIONS The MSK week program was accepted by residents from the 3 specialties, with learners reporting improved ability to perform shoulder and knee examinations, as demonstrated by OSCEs.
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Affiliation(s)
- Michael J. Battistone
- Corresponding author: Michael J. Battistone, MD, Salt Lake City VAMC, 500 Foothill Drive, Salt Lake City, UT 84148, 801.582.1565, ext. 4261,
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Rosenberg CJ, Nanos KN, Newcomer KL. The "Near-Peer" Approach to Teaching Musculoskeletal Physical Examination Skills Benefits Residents and Medical Students. PM R 2016; 9:251-257. [PMID: 27292435 DOI: 10.1016/j.pmrj.2016.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 06/01/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The musculoskeletal physical examination (MSK PE) is an essential part of medical student training, and it is best taught in a hands-on, longitudinal fashion. A barrier to this approach is faculty instructor availability. "Near-peer" teaching refers to physicians-in-training teaching their junior colleagues. It is unknown whether near-peer teaching is effective in teaching this important physical examination skill. OBJECTIVE To investigate attitudes of medical students and physical medicine and rehabilitation (PM&R) residents regarding near-peer teaching in an MSK PE curriculum. DESIGN Qualitative, anonymous paper and online surveys. SETTING Tertiary academic center with a medical school and PM&R training program. PARTICIPANTS Ninety-nine second- and third-year medical students and 13 PM&R residents in their third or fourth postgraduate year. METHODS Attitudes of second- and third-year medical students were measured immediately after their MSK PE course. Resident attitudes were measured in a single cross-sectional sample. MAIN OUTCOME MEASUREMENTS Student attitudes were assessed via a questionnaire with 5-point Likert scales and a free-text comment section. The resident questionnaire included a combination of multiple-choice questions, rankings, free-text responses, and Likert scales. RESULTS All 99 students completed the questionnaire. The majority of students (n = 79 [80%]) reported that resident involvement as hands-on instructors of examination skills was "very useful," and 87 (88%) indicated that resident-led small discussion groups were "very helpful" or "somewhat helpful." Fifty-seven of 99 students (58%) reported that the resident-facilitated course was "much better" than courses without resident involvement. Twelve of 13 eligible residents completed the survey, and of those, 8 found teaching "very helpful" to their MSK knowledge, and 11 became "somewhat" or "much more confident" in clinical examination skills. CONCLUSIONS Our study supports educational benefits to medical students and resident instructors in our MSK PE program. We recommend including near-peer teaching in medical student education, particularly for hands-on skills; we also recommend providing opportunities for PM&R residents to participate in formal near-peer education. LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Casandra J Rosenberg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN(∗)
| | - Katherine N Nanos
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN(†)
| | - Karen L Newcomer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905(‡).
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Battistone MJ, Barker AM, Lawrence P, Grotzke MP, Cannon GW. Mini-Residency in Musculoskeletal Care: An Interprofessional, Mixed-Methods Educational Initiative for Primary Care Providers. Arthritis Care Res (Hoboken) 2016; 68:275-9. [PMID: 26097001 DOI: 10.1002/acr.22644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/28/2015] [Accepted: 06/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A structured educational effort to train primary care providers (PCPs) to perform joint injections has been projected to be cost effective. The US Department of Veterans Affairs (VA) is developing a national continuing professional development program to train PCPs in the evaluation and management of patients with common musculoskeletal conditions. The objective of this pilot project was to confirm initial projections of cost effectiveness and to inform further efforts to develop this program on a national scale. METHODS The Salt Lake City VA served as the national hub for this pilot project. The initial phase included 19 providers, who participated in a weeklong mixed-methods course. Evaluation was conducted by the VA Employee Education System. Assessments included anonymous surveys, structured telephone interviews, and a review of de-identified procedure codes. RESULTS The survey response rate was 100%, with uniformly positive results. All participants recommended the expansion of this program. The mean number of joint injections performed each month increased from 0.3 (precourse) to 3.5 (postcourse), congruent with prior analyses projecting program cost effectiveness. CONCLUSION The musculoskeletal mini-residency is a well-received program, with early evidence of cost effectiveness and impact aligned with course objectives. This pilot program is a foundation for efforts in the national dissemination of this initiative.
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Affiliation(s)
- Michael J Battistone
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Andrea M Barker
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | | | - Marissa P Grotzke
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
| | - Grant W Cannon
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City
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Sayma M, Williams HR. A new method for teaching physical examination to junior medical students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2016; 7:91-97. [PMID: 26937208 PMCID: PMC4762462 DOI: 10.2147/amep.s100509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Teaching effective physical examination is a key component in the education of medical students. Preclinical medical students often have insufficient clinical knowledge to apply to physical examination recall, which may hinder their learning when taught through certain understanding-based models. This pilot project aimed to develop a method to teach physical examination to preclinical medical students using "core clinical cases", overcoming the need for "rote" learning. METHODS This project was developed utilizing three cycles of planning, action, and reflection. Thematic analysis of feedback was used to improve this model, and ensure it met student expectations. RESULTS AND DISCUSSION A model core clinical case developed in this project is described, with gout as the basis for a "foot and ankle" examination. Key limitations and difficulties encountered on implementation of this pilot are discussed for future users, including the difficulty encountered in "content overload". CONCLUSION This approach aims to teach junior medical students physical examination through understanding, using a simulated patient environment. Robust research is now required to demonstrate efficacy and repeatability in the physical examination of other systems.
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Affiliation(s)
- Meelad Sayma
- Peninsula College of Medicine and Dentistry, Plymouth, UK
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Pujari-Palmer M, Pujari-Palmer S, Engqvist H, Karlsson Ott M. Rebamipide delivered by brushite cement enhances osteoblast and macrophage proliferation. PLoS One 2015; 10:e0128324. [PMID: 26023912 PMCID: PMC4449171 DOI: 10.1371/journal.pone.0128324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 04/26/2015] [Indexed: 01/04/2023] Open
Abstract
Many of the bioactive agents capable of stimulating osseous regeneration, such as bone morphogenetic protein-2 (BMP-2) or prostaglandin E2 (PGE2), are limited by rapid degradation, a short bioactive half-life at the target site in vivo, or are prohibitively expensive to obtain in large quantities. Rebamipide, an amino acid modified hydroxylquinoline, can alter the expression of key mediators of bone anabolism, cyclo-oxygenase 2 (COX-2), BMP-2 and vascular endothelial growth factor (VEGF), in diverse cell types such as mucosal and endothelial cells or chondrocytes. The present study investigates whether Rebamipide enhances proliferation and differentiation of osteoblasts when delivered from brushite cement. The reactive oxygen species (ROS) quenching ability of Rebampide was tested in macrophages as a measure of bioactivity following drug release incubation times, up to 14 days. Rebamipide release from brushite occurs via non-fickian diffusion, with a rapid linear release of 9.70% ± 0.37% of drug per day for the first 5 days, and an average of 0.5%-1% per day thereafter for 30 days. Rebamipide slows the initial and final cement setting time by up to 3 and 1 minute, respectively, but does not significantly reduce the mechanical strength below 4% (weight percentage). Pre-osteoblast proliferation increases by 24% upon exposure to 0.4 uM Rebamipide, and by up to 73% when Rebamipide is delivered via brushite cement. Low doses of Rebamipide do not adversely affect peak alkaline phosphatase activity in differentiating pre-osteoblasts. Rebamipide weakly stimulates proliferation in macrophages at low concentrations (118 ± 7.4% at 1 uM), and quenches ROS by 40-60%. This is the first investigation of Rebamipide in osteoblasts.
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Affiliation(s)
- Michael Pujari-Palmer
- Division of Applied Material Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | - Shiuli Pujari-Palmer
- Division of Applied Material Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Engqvist
- Division of Applied Material Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
| | - Marjam Karlsson Ott
- Division of Applied Material Science, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
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Hecimovich M, Volet S. Simulated learning in musculoskeletal assessment and rehabilitation education: comparing the effect of a simulation-based learning activity with a peer-based learning activity. BMC MEDICAL EDUCATION 2014; 14:253. [PMID: 25471306 PMCID: PMC4258291 DOI: 10.1186/s12909-014-0253-6] [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: 07/19/2014] [Accepted: 11/17/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Musculoskeletal disorders and diseases are leading causes of pain, physical disability, and doctor visits throughout the world. Health professionals must be trained to assess, treat through rehabilitation and monitor patients with these disorders. Yet, due to overcrowded curricula, some health education programs struggle to accommodate more than minimal training in musculoskeletal conditions. Consequently, educators in these professions must consider how traditional instruction could be complemented effectively to enhance students' preparation for the diverse musculoskeletal disorders and pathologies they may encounter. The purpose of this study was to explore the benefits that can be obtained from laboratory practice in musculoskeletal conditions with a standardised patient, rather than a peer patient, in a condensed time frame. METHODS Two groups of students were assigned to either a standardised or a peer patient condition for 2 × 2 hours musculoskeletal assessment and rehabilitation lab sessions. All students completed a pre-post matched questionnaire measuring their clinical knowledge, confidence in clinical skills and motivation for further learning. Their clinical skills were tested at the end. Students and standardised patients' perceptions of the simulated learning environment to practise musculoskeletal assessment and rehabilitation were also elicited. RESULTS A t-test for independent samples revealed that students working with standardised patients displayed significantly higher standards of practical clinical skills than those working with peer patients (p=0.018). Using MANOVAs with repeated measures, no interaction effect for clinical knowledge, confidence in clinical skills, and motivation for future learning were found, both groups displaying significantly enhanced cognition and motivation. Three positive and two negative themes emerged from the analysis of students' perceptions of the simulated learning environments. These were consistent with the simulated patients' perceptions. CONCLUSIONS The findings of this study provide support for the value of using standardised patients to enhance clinical skills in musculoskeletal assessment and rehabilitation when the timeframe for laboratory practice is limited. Students' perceptions of their experience contributed to explain why confidence in clinical skills might not necessarily improve when practising with standardised patients. Suggestions are made for optimising learning with standardised patients and for addressing the economic challenge on health education programs of hiring standardised patients.
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Affiliation(s)
- Mark Hecimovich
- />School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia
| | - Simone Volet
- />School of Education, Murdoch University, Murdoch, Western Australia
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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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Das B. Rheumatology in undergraduate curriculum. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Modica RF, Sukumaran S, Milojevic D. Pediatric musculoskeletal examination for juvenile arthritis. Pediatr Ann 2012; 41. [PMID: 23152981 DOI: 10.3928/00904481-20121022-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Renee F Modica
- Pediatric Rheumatology, University of Florida, 1600 SW Archer Road, R118-G, Box 100296, Gainesville, FL 32610-0296, USA.
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