Abstract
ABSTRACT Background: Musculoskeletal (MSK) problems are common, yet many primary care (PC) providers feel inadequately trained to manage these conditions. Previous studies describe successful MSK educational innovations at single sites, but none have reported on subsequent attempts to replicate or adapt these innovations to new contexts. This article presents a study of a national Veterans Affairs MSK training program modified to fit an existing PC educational program. Objectives: (1) To evaluate the effectiveness and feasibility of an adapted MSK curriculum in a new context. (2) To provide a model for adaptation studies in health professions education. Design: A national MSK shoulder and knee curriculum was adapted for San Francisco VA PC trainees, which included a small-group workshop and workplace learning within a newly-created MSK clinic. Effectiveness was evaluated by assessments of trainee confidence in exam and injection skills (via 5-point Likert scale) and faculty-observed performance of knee and shoulder exams (reported as percent of maximum possible score). Feasibility was evaluated by determining acceptability of the program to PC trainees (via 5-point Likert scale) and ability to implement the curriculum using local resources. Results: 52 trainees completed the training during a 2-year period. Trainees’ confidence in MSK exam skills improved from 3.3 to 4.5 for shoulder, and from 3.5 to 4.6 for knee. Confidence performing joint injections improved from 2.6 to 4.2 (shoulder) and 2.5 to 4.5 (knee) (p < 0.001 for all). Observed performance improved markedly – from 50% to 92% for shoulder, and 57% to 90% for knee. Feasibility was evident in high acceptability (5.0 for MSK clinic, and 4.9 for workshops), and successful and sustained implementation. Conclusions: Adapting an established MSK curriculum to a new context was effective and feasible. This may serve as a more efficient model for improving trainee education than de novo curriculum design at individual sites.
Highlights
IntroductionMusculoskeletal (MSK) disorders affect more than 50% of the US population age 18 and over, nearly 75% age 65 and over, and are one of the leading reasons for visits to health-care providers [1,2]
The decision to prioritize shoulder and knee conditions was based on several factors including 1) shoulder and knee steroid injections are commonly performed by primary care providers (PCPs) and are important skills for our primary care trainees to acquire; 2) shoulder and knee pain are prevalent in our veteran population; and 3) there was a clinical need at our institution to improve patient access to care for shoulder and knee pain
Our study suggests that our adapted primary care MSK curriculum was effective in improving trainee confidence and clinical skills, and that the process of implementing existing curricula in a new context was feasible and sustainable
Summary
Musculoskeletal (MSK) disorders affect more than 50% of the US population age 18 and over, nearly 75% age 65 and over, and are one of the leading reasons for visits to health-care providers [1,2]. In 2012, a multi-method curriculum for evaluation and management of MSK problems commonly encountered in primary care settings was developed for PCPs and trainees at the Salt Lake City Veterans Affairs (SLCVA) Medical Center and University of Utah [8–10]. The following year, faculty from the San Francisco VA (SFVA) worked in partnership with SLC faculty to present this program for PCPs at SFVA[10]. The success of this program formalized a collaborative educational partnership between the two sites and galvanized the SFVA team to develop a similar MSK curriculum tailored to the needs of the local primary care training program. Musculoskeletal (MSK) problems are common, yet many primary care (PC) providers feel inadequately trained to manage these conditions. Objectives: (1) To evaluate the effectiveness and feasibility of an adapted MSK curriculum in a new context. (2) To provide a model for adaptation studies in health professions education
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
