ASSESSMENT TOOLS FOR PHYSICIAN KNOWLEDGE AND CLINICAL SKILL IN DIAGNOSIS OF ANKLE AND KNEE INJURIES

Abstract

48 OBJECTIVES: The purpose of this project was to develop a valid, reliable measure of both the knowledge and clinical skills necessary to diagnose ankle and knee injuries, which are among the most common musculoskeletal problems seen by primary care physicians. METHODS: The investigators developed a two-part assessment of knowledge and skills in diagnosis of musculoskeletal injuries of the ankle and knee. Knowledge is measured using 20-item multiple choice examination (MCE) that was pilot tested and revised to improve test-retest reliability. Clinical skills are measured using a 60-item clinical skills assessment (CSA) on which both proper and improper techniques are recorded. The two-part assessment tool is currently being used with pediatric residents and medical students on a one-month rotation in clinical adolescent medicine. At the beginning of the rotation, subjects take the MCE, watch a videotaped and then a live demonstration of proper ankle and knee examination, and finally complete the CSA. For the CSA, there are three raters, including two sports medicine physicians and a certified athletic trainer, who serves as the standardized patient. After a month, the MCE and CSA are repeated to assess retention. RESULTS: For the first 14 MCE's, test-retest reliability was .748. Interrater reliability for the first 9 CSA's was .895. MCE pretest and posttest mean scores were 9.64 (SD=4.05) and 14.93 (SD=4.18) (p<.001). CONCLUSIONS: The present study describes development of a valid, reliable assessment tool to measure both clinical diagnosis knowledge and skills. In addition to the 50 residents and medical students in this year's rotation schedule, the investigators are monitoring the MCE and CSA for validity and reliability among a group of 100 community pediatricians. The end result will be a clinical skills education package that can be used to monitor learning in a variety of settings.