Evaluation of Knowledge of Common Hand Surgery Problems in Internal Medicine and Emergency Medicine Residents

Abstract

Musculoskeletal disorders are the principal reason for primary care outpatient visits and make up 14% of visits to emergency departments, with the upper extremity as the most common site affected. However, formal musculoskeletal education is inconsistent in medical school and primary care residencies, with many first-year residents reporting a lack of confidence in examination and diagnosis of musculoskeletal conditions. The authors evaluated the level of knowledge of common upper-extremity conditions with a validated examination taken by internal medicine and emergency medicine residents. A 38-question upper-extremity examination was created by a group of hand and upper-extremity surgeons from the Resident Education Committee of the American Society for Surgery of the Hand. The examination was reviewed by 30 hand fellowship directors, who rated each question on a Likert scale and determined a recommended passing percentage. The Web-based examination was taken by emergency and internal medicine residents from multiple institutions. The fellowship directors' recommended passing grade averaged 73%. The majority of respondents were in their first (33%) or second (33%) year of training. The average scores were 56% and 46% for the internal and emergency medicine residents, respectively. This evaluation of a cross-section of internal and emergency residents indicates a deficiency in knowledge of common upper-extremity conditions.