Abstract
BackgroundThe traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX).MethodsParticipants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants’ performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis.ResultsThe mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters.ConclusionsThrough a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.
Highlights
The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis
We developed our study to answer the following question: Do students who experienced peer role-playing as lowfidelity simulation for MSK cases improve their competency in performing a physical examination, exercising clinical reasoning and diagnosing in a clinical setting compared with the control group? Low-fidelity simulation in our study was defined as peer role-plays, and the high-fidelity simulation was defined as other role-plays, for example, with the simulated patient
The mini-CEX scores of physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group
Summary
The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. It is estimated that MSK and connective tissue diseases rank behind digestive and cardiovascular diseases in terms of outpatient visits, accounting for 12 % of all outpatient hospital consultations in Japan (Overview of the citizen life basic survey in 2016, Overview of Patient Survey in 2017) Considering this pattern, sound physical examination and clinical reasoning skills are essential for physicians to rapidly and accurately diagnose MSK conditions of the limbs and spine to practice in primary care. In the UK, the gait-arms-legs-spine (GALS) programme has been strategically included in undergraduate medical education to improve learners’ competence with MSK examination and diagnosis [1]. Even this wellthought-out initiative was reported to be insufficient for learners to acquire confidence with physical examinations [2] or to effectively link findings to diagnosis through clinical reasoning [3]
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