Inaugural MSK Medicine Module: An innovative multidisciplinary medical education model

Background Given the increased need to enhance musculoskeletal education, an inaugural musculoskeletal (MSK) focused module was developed and evaluated as part of an orthopedic surgery training program at the University of Toronto. The educational offerings were based on a previously validated MSK Curriculum. Specifically, the aims are to evaluate the effectiveness of the module on 1) improving MSK knowledge and skills expected of graduating Orthopaedic residents and 2) the ability of residents to collaborate professionally with non-surgical MSK clinicians. Methods Nine residents initially selected to participate in the competency based curriculum for orthopaedic surgery completed this module as an essential component of their training. The module was experienced during the mid-point of training (PGY 3 equivalent). An evaluation template was developed using pre and post module multiple choice (MCQ) and short answer questions (SAQ) to assess knowledge; summary of in-training education reports (ITERs) of clinical educational experiences and; feedback obtained for scholarly presentations. Structured feedback was obtained from learners and educators to evaluate the effectiveness of the module and to inform changes to optimize future learning opportunities and environments. Results Nine residents completed the pilot study. The module was 8 weeks long. Learners rotated through clinical settings within five educational pillars. All residents demonstrated improvements in MSK medicine knowledge expected of graduating Orthopaedic residents with a 40% increase in mean MCQ scores (76% vs 60%; p<0.001) and 58% improvement in mean SAQ scores (78% vs 47%; p<0.001). Professionalism evaluations revealed performance above the expected level with a mean in-training education reports score of 4.19 out of 5 (SD: 0.44; range, 3.73 to 5). Conclusion Completing a MSK medicine module at the mid-point of postgraduate Orthopaedic training positively impacts acquisition of relevant MSK knowledge and skill, while facilitating interdisciplinary management of patients with MSK conditions using a new educational paradigm.

Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions

In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course. Confidence in diagnosing the conditions was gauged using a 6-point Likert-type scale. A two-sample t test was used to compare overall confidence score pre- and post-seminar. In addition, each subtopic was analyzed. The average pre-seminar confidence score was 3.92 versus 4.86 post-seminar. All categories demonstrated a statistically increased confidence score post-seminar ( P < .0001). Live MSK continuing education for pediatricians is effective in improving confidence in clinical practice.

Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques

Implication Statement We developed physiotherapist-led interprofessional (IP) workshops for medical students each dedicated to a specific anatomical region. The workshops alternated between theoretical presentations from a physiotherapist about basic musculoskeletal (MSK) assessment techniques and hands-on practice in small groups with feedback from Master’s-level physiotherapy students (MPT). The workshops created an optimal IP learning environment where medical students can learn MSK assessment techniques and MPTs can apply their knowledge and clinical skills. Academic institutions with physiotherapy and medical programs seeking to develop IP learning activities should foster opportunities for IP collaboration between physiotherapy and undergraduate medical education.

Advanced Primary Care Orthopedics: Bridging the Gap in Musculoskeletal Education

Background and Objectives: Musculoskeletal problems are common in primary care, yet many family physicians lack confidence and competence in this area. The Advanced Primary Care Orthopedics (APCO) course utilizes hands-on physical exam instruction, interactive cases, and intentional repetition to teach anatomy, a standardized exam, and important diagnoses. This study assesses the effectiveness of APCO in improving musculoskeletal exam knowledge and confidence. Methods: APCO is a 1.5-day course taught annually to family medicine residents. A 1-day course has also been conducted as a preconference workshop targeting faculty physicians. Participants completed pre- and postcourse assessments to evaluate their knowledge and confidence with the musculoskeletal exam. We compared results using mean differences with paired t-test statistics. Results: In the 2018 and 2019 resident courses, 23 of 30 participants (77%) completed the knowledge assessment and 25 of 30 participants (83%) completed the confidence assessment. Knowledge assessment scores improved by 9.5 points (P&lt;.05) after completion of the course. Confidence in the musculoskeletal exam, as assessed on a 5-point Likert scale (1–not confident at all; 5–very confident), improved from 2.2 to 3.8 after the course (P&lt;.05). In the 2018 preconference workshop, 23 of 36 participants (64%) completed the confidence assessment. Confidence increased from 2.17 to 3.61 (P&lt;.05) after course completion. Conclusions: Participation in the APCO course increased short-term musculoskeletal knowledge and confidence. APCO has many potential applications for residency curriculums, faculty development, and continuing medical education.

Integrating Osteopathic Evaluation and Treatment in a Case Report of Acute Chest Pain

Chest pain is an emergent presentation associated with a wide differential diagnosis including cardiac, pulmonary, gastrointestinal, and musculoskeletal origins. The evaluation of acute chest pain can be costly and can be a financial burden on the health care system. Integrating osteopathic diagnosis and treatment can assist with identifying and alleviating potential musculoskeletal sources of pain. This case illustrates how applying osteopathic manipulative medicine (OMM) benefited a 61-year-old woman presenting with anterior chest wall pain. Patient response to OMM can assist physicians with better managing acute chest wall pain syndromes. Improved musculoskeletal education can potentially improve medical management of chest pain of musculoskeletal origin.

An Evaluation of the Effectiveness of a Medical School Musculoskeletal Curriculum at an Academic Medical Center

Background: Musculoskeletal disorders are common medical problems encountered by physicians and affected 126.6 million Americans in 2012. Musculoskeletal education has inadequate in United States medical schools. Objective: To determine the musculoskeletal competency of third year medical students. Methods: A cross-sectional 25-question nationally validated musculoskeletal competency exam was given to the third year medical students. A survey was given to second and third year medical students to assess students’ level of interest in musculoskeletal medicine and their feedback regarding the curriculum. Results: The mean score of the competency exam was 69.0%. There was 48/107 (44.9%) students’ who reached the minimum passing score of 70%. Free-response feedback from both classes featured themes of more hands-on learning, a longer clinical block, and more small-group learning sessions. Conclusions: Third year medical students scored relatively well on the exam. Student feedback suggests the 2-week musculoskeletal block is useful and relevant to their future careers.

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

Persons with musculoskeletal disorders frequently seek care in family medicine clinics. However, musculoskeletal education provided in medical schools is often considered insufficient. The implementation of a collaborative model that integrates physiotherapists into teaching clinics may benefit the musculoskeletal training of medical residents. This paper describes a model developed in a family medicine teaching clinic by examining the interprofessional educational and collaborative activities implemented in this model. The model allowed to provide physiotherapy services, involve the physiotherapist in the training of family medicine residents and enhance interprofessional collaboration, particularly for the management of persons with musculoskeletal disorders._____Les personnes ayant des troubles musculosquelettiques consultent fréquemment en cliniques de médecine de famille. Cependant, l’enseignement musculosquelettique dispensé dans les programmes de médecine est souvent considéré comme insuffisant. L’implantation d’un modèle de collaboration qui intègre les physiothérapeutes aux cliniques d’enseignement pourrait améliorer la formation des médecins résidents. Cet article décrit un modèle développé dans une clinique d’enseignement en médecine familiale en examinant les activités interprofessionnelles d’éducation et de collaboration implantées dans ce modèle. Le modèle a permis d’offrir des services de physiothérapie, d’impliquer le physiothérapeute dans la formation des médecins résidents et d’améliorer la collaboration interprofessionnelle, particulièrement pour la prise en charge des personnes ayant des troubles musculosquelettiques.