Musculoskeletal Examination Skills Research Articles

Implementation and assessment of a structured curriculum for a 4-week pediatric rheumatology rotation for pediatric residents

BackgroundGeneral pediatricians often initially address children’s musculoskeletal (MSK) issues and play a crucial role in triaging and managing patients’ rheumatologic conditions. This study assessed the effectiveness of a structured curriculum in enhancing pediatric residents’ knowledge, MSK examination skills, and confidence during a 4-week pediatric rheumatology rotation.MethodsPediatric residents in their either second or third year who participated in the 4-week rheumatology rotation once across three academic years (July 2020–June 2023) were enrolled. Residents’ knowledge, MSK examination skills, and confidence were assessed at pre- and post-rotation by using 25 multiple-choice questions, the Thai pediatric Gait Arms Legs Spine examination, and a questionnaire, respectively. The curriculum comprised instruction on MSK examinations, interactive lectures, case-based discussion, topic reviews, MSK radiology conference, clinical experience in rheumatology clinic and consultations, with self-guided learning with educational resources.ResultsFifty-eight pediatric residents (48 females, 10 males) with a mean age of 28.9 ± 0.8 years participated. Significant improvements were noted postrotation. Knowledge scores rose from 63.0 ± 12.2 to 79.7 ± 9.1 (mean difference 16.7 ± 10.3, p < 0.001). Similarly, MSK examination scores increased from 67.5 ± 14.4 to 93.6 ± 8.7 (mean difference 26.1 ± 14.6, p < 0.001). Residents also reported a marked increase in confidence across all evaluated areas, including history taking, MSK examination, arthrocentesis, and diagnosing and treating rheumatologic conditions (p < 0.001).ConclusionsThe 4-week structured curriculum in the pediatric rheumatology rotation significantly enhanced pediatric residents’ knowledge, MSK examination skills, and confidence. These findings support the integration of pediatric rheumatology rotations into pediatric residency training programs.

Benefit of Outpatient Musculoskeletal Medicine Experience Early in Physical Medicine and Rehabilitation Residency.

Musculoskeletal care for persons with disabilities is an important competency in physical medicine and rehabilitation training. The optimal timing of musculoskeletal medicine rotations in the physical medicine and rehabilitation residency curriculum is unknown. The objective of this study is to determine whether outpatient experience in musculoskeletal medicine increases resident use of musculoskeletal examination skills in the inpatient setting. An eight-item multiple-choice questionnaire was administered monthly to 19 physical medicine and rehabilitation residents rotating on inpatient services inquiring about number and types of musculoskeletal examinations performed on each inpatient rotation. Seventy-one surveys were collected with a 90% response rate. Significant increases were noted in number of knee examinations and shoulder examinations performed on inpatient rotations after residents completed 2 mos of outpatient musculoskeletal medicine. Most postgraduate year 2 residents (76%) felt that they would perform more musculoskeletal examinations on their inpatient rotations if they had more outpatient musculoskeletal experience at that point in their training. The results suggest that outpatient musculoskeletal experience increases resident use of musculoskeletal examination skills in the inpatient setting. Earlier outpatient musculoskeletal experience in combination with a greater focus on teaching musculoskeletal examination skills in the inpatient setting can support residents in learning how to provide comprehensive musculoskeletal care to individuals with disabilities.

A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

ABSTRACT Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

Incorporating interactive workshops into bedside teaching: completion of a multi-modal rheumatology rotation significantly increases internal medicine residents’ competency and comfort with comprehensive knee examinations

BackgroundStudies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents’ competency and comfort with knee examinations when compared to the rotation alone.MethodsOver 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons.ResultsFifty-seven residents participated. For both groups, there were improvements between pre- and post-OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post-OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025).ConclusionAn elective in rheumatology augmented residents’ MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.

Undergraduate Medical Students' Perceptions of an Online Audio-Visual-Based Module for Teaching Musculoskeletal Physical Examination Skills.

IntroductionVideo-based learning has gained prominence in medical education and, more recently, in musculoskeletal teaching. This study investigated medical students’ perceptions of the effectiveness of online video-based learning for musculoskeletal physical examination skills.MethodsFor one academic year, undergraduate medical students were instructed online through video-based learning before bedside teaching about the physical examination of knee and shoulder joints. At the end of the course, the students participated in a survey to assess their perceptions of the online video-based learning module using a pre-validated questionnaire. The questionnaire consisted of closed-ended and open-ended questions. The closed-ended question responses were assessed using a Likert scale; the open-ended responses were analyzed qualitatively.ResultsIn total, 242 out of 310 students who participated in the online video-based learning responded to the survey. Most students found the teaching approach to be satisfactory and preferable to traditional teaching methods. However, they also felt that these modules could not replace hands-on practice. The most helpful aspects of the training modules were a better understanding of the specific tests, technique, and sequence of administering the physical examination. Perceived limitations included the inadequately addressed theoretical basis of the physical examination and the special tests, the need for more time to explain clinical anatomy, and the practical implications of the positive special tests.ConclusionUndergraduate medical students perceive VBL as helpful for MPES learning. The positive aspects of the VBL approach in teaching MPES are that it is comprehensive, easily accessible, offers standardized teaching, save times, and it includes demonstrations of special tests, examination techniques, and the sequence and organization of the clinical examination. The main perceived limitations were lack of content regarding clinical reasoning and the anatomical basis of the clinical tests.

Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design

Phenomenon: The development of foundational clinical skills, such as physical examination, is essential to becoming a competent clinician. Musculoskeletal medicine is often considered a specialized area of practice despite the high prevalence of musculoskeletal conditions in the general population and presenting to general clinical practices. Prior work has shown that medical learners and practicing clinicians have low confidence in these skills but understanding of the student perspective on why these skills are more difficult to acquire is unclear. Approach: Our study was guided by social constructivist learning theory to explore the learner experience and present their perspectives. Qualitative analysis investigated the difference between learning musculoskeletal physical examination versus other body systems, using the voices from 11 semi-structured focus group interviews. Participants included third-year medical students across two academic cohorts at one institution. Our analysis was grounded in the principles of phenomenology and used triangulation and reflexivity to provide rigorous analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning musculoskeletal physical examination techniques. Four themes were developed from our data: a) the need for opportunities for both supervised and self-directed practice; b) assessment and competence as motivations for learning; c) the need for a different approach to the content and structure of musculoskeletal medicine and its associated examination techniques; and d) the need for distinct expertise and technical skill from musculoskeletal examination teachers. Insights: This study provides a valuable lens to critically reflect on existing curriculum and pedagogical approaches to musculoskeletal examination skills. Lessons from this study may be applicable to curriculum design in general, especially the teaching of physical examination skills, such as how it is taught and integrated with other content (including anatomy), how much practice is required, who teaches physical examination skills, and what faculty development is needed to standardize teaching. Promoting a learner-centered approach to the teaching and learning of these clinical skills will be beneficial to all stakeholders, especially to our future physicians and their patients. Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1954930 .

Evaluation of Resident Palpation Skills in Foot and Ankle Anatomic Structures Using Bedside Ultrasound.

The objective is to determine the accuracy of foot and ankle joint and soft tissue structure palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasonography (US) verification. PM&R residents were tested in an outpatient musculoskeletal (MSK) clinic on palpated foot and ankle anatomic structures in a human model. Once the presumed structures were localized, residents marked a 1 cm size circle on the overlying skin with a ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US. The overall palpation accuracy for 22 joint line and soft tissue structures was 38.0%. Accuracy by foot and ankle region, including the posterior, medial, lateral, plantar, and dorsal were 72.9%, 47.5%, 42.5%, 35% and 7.8% respectively. There was a positive trend with level of education without a statistically significant difference in palpation accuracy (30.4% in PGY-2, 38.3% in PGY-3, 44.2% in PGY-4, p = 0.11). Residents in this study demonstrated suboptimal accuracy of foot and ankle anatomic structure identification by palpation. US may be a useful adjunctive tool to advance current methods of teaching musculoskeletal examination skills to PM&R residents.

Does Ultrasound‐Enhanced Instruction of Musculoskeletal Anatomy Improve Physical Examination Skills of First‐Year Medical Students?

Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills. Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests. All students performed significantly better on the knee examination, irrespective of instructional group (F = 14.9; df = 1.25; P = .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t = -3.0; df = 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t = -2.8; df = 25; P = .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures. The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks.

Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery.

One in eight paediatric primary care presentations is for a musculoskeletal (MSK) disorder. These patients are frequently referred to paediatric orthopaedic surgeons; however, up to 50% of referrals are for normal variants. This results in excessive wait-times and impedes access for urgent surgical cases. Adult MSK medicine has successfully utilised advanced practice physiotherapists (APP) managing non-surgical candidates, with documented benefits both to patients and services. There is a gap in the literature with regard to APP in paediatric orthopaedics. In this review, we investigate demands on paediatric orthopaedic services, examine the literature regarding APP in paediatric orthopaedics and explore the value the role has to offer current outpatient services. Paediatric orthopaedic services are under-resourced with concurrent long wait times. Approximately 50% of referrals are for normal variants, which do not require specialist intervention. Poor musculoskeletal examination skills and low diagnostic confidence amongst primary care physicians have been identified as a cause of inappropriate referrals. APP clinics for normal variants have reported independent management rate and discharge rates of 95% and marked reduction in patient wait times. There is limited evidence to support the APP in paediatric orthopaedics. Further studies are needed investigating diagnostic agreement, patient/stakeholder satisfaction, patient outcomes and economic evaluation. Paediatric orthopaedics is in crisis as to how to effectively manage the overwhelming volume of referrals. Innovative multidisciplinary solutions are required so that the onus is not solely on physicians to provide all services. The APP in paediatric orthopaedics may be part of the solution.

Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

BackgroundMedical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning.MethodsA multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students’ ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson’s correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression.ResultsInter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a discriminatory finding correlated with the ability to perform the associated maneuver correctly, with the exception of the ability to perform maneuvers needed to diagnose a torn anterior cruciate ligament of the knee. Neither the ability to anticipate or perform was predictive of identifying correct diagnoses for the different cases.ConclusionsA novel musculoskeletal OSCE, based on principles of the hypothesis-driven physical examination, was able to identify significant deficiencies in examination skills needed to diagnose common disorders of the shoulder, back and knee amongst graduating medical students. In addition, the OSCE demonstrated that accurate anticipation of discriminatory examination findings correlates with ability to perform the associated maneuver; however, the ability to anticipate exceeds the ability to perform. Students do not appear to be using the physical exam to inform their diagnostic reasoning. The findings of this study have implications for both assessment and teaching of the musculoskeletal exam.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0780-4) contains supplementary material, which is available to authorized users.

Development of a Paediatric Musculoskeletal Skills Workshop for Canadian Medical Students

Abstract BACKGROUND: Musculoskeletal (MSK) complaints in children account for up to 30% of visits to general practitioners. Doctors who see children with MSK complaints are often not confident in assessing them and MSK exams are poorly documented in medical records. There has been little published literature describing the logistics of teaching MSK skills in a group setting (which is how medical students are commonly taught). At our center, no MSK examination skills were previously taught during the undergraduate paediatrics clerkship. OBJECTIVES: 1) To develop a hands-on, paediatric MSK workshop for medical students with direct observation and feedback. 2) To evaluate student/faculty satisfaction with the workshop. 3) To develop an MSK workshop protocol as a resource for medical educators. DESIGN/METHODS: A 1-hour interactive workshop was designed for students to practice the paediatric Gait, Arms, Legs and Spine (pGALS) screening MSK exam. Students are given pre-reading, videos and pGALS checklists. Workshops include live demonstrations and videos/images of abnormal MSK findings for pGALS practice. Students practice pGALS with their peers with staff supervision(up to 5 physicians present)and receive feedback. All students complete a post-workshop evaluation. Teachers also complete a post-workshop evaluation discussing what went well and areas for improvement. RESULTS: Workshops are delivered every 2 months for 25 students (5 iterations completed). Feedback has been positive (median rating 4.5 on a 5-point Likert scale) for all areas evaluated: objectives, handouts, preparation time, discussion, resources, etc. Comments include: “Helpful and applicable to personal clinical practice,” and, “The hands-on practice was really appreciated, as was the chance to get feedback.” Workshops have been modified according to faculty/student evaluations, resulting in a workshop protocol (organizational template) for future workshop leaders including a teaching checklist, preparation timeline, and PowerPoint to be modified by instructors as they wish. CONCLUSION: The paediatric MSK workshop has been a welcome addition to our undergraduate paediatrics clerkship curriculum. We aim to further develop our workshop by explicitly including applied anatomy, e.g., land-marking for joints. We also aim to make our workshop protocol available on Paediatric Musculoskeletal Matters,www.pmmonline.org, as a resource for other medical educators. Further work will include evaluating its uptake, use and applicability by users in different contexts, and modifying it for different levels of learners, e.g., paediatricians.

The Physical Therapistʼs Expertise in the Emergency Medicine Residency Curriculum: An Academic Model for Integrated Health Care Education

BACKGROUND AND PURPOSEDespite higher costs compared with dedicated primary care practice settings, the emergency department (ED) is used as a primary care site and serves as a point of entry into the health care system.1 Patients with musculoskeletal complaints comprise 15%-20% of ED visits per year.2 The National Hospital Ambulatory Medical Care Survey (NHAMCS) data show that 7,400 individuals are diagnosed annually in the ED with acute musculoskeletal injuries.1 More specifically, the NHAMCS found that musculoskeletal injuries categorized as acute sprains and strains ranked as the fourth most-common diagnosis among patients treated and discharged from the ED.1 Thus, it is imperative that physicians practicing in the ED setting are competent in the assessment and initial management of musculoskeletal injuries.Data suggest that musculoskeletal training of graduating medical students is not sufficient to prepare them for practice in an emergency practice setting,3-5 so it could be questioned whether students entering emergency medicine (EM) residencies are prepared for this component of practice. Numerous studies support the need for enhanced musculoskeletal education and training in medical school curricula.3-5 Based on a 2007 study at Harvard Medical School, medical students typically leave medical school with a poor musculoskeletal skill set, as only 7% of students were able to pass a musculoskeletal competency examination.4 A subsequent elective in musculoskeletal medicine resulted in greater confidence and enhanced their performance on the competency examination.4 A review of medical school curricula in the United States showed that approximately 50% of medical schools did not require a musculoskeletal clinical rotation, and fewer than 50% had a formal didactic course dedicated to musculoskeletal medicine. Furthermore, 82% of recent medical school graduates did not pass a musculoskeletal competency examination.3 Similarly, in a study assessing 29,442 medical students' performance on the United States Medical Licensing Examination Step 2 CS (clinical skills test), the physical examination scores for the musculoskeletal and neurological systems were lower than other clinical examinations involving the gastrointestinal, cardiovascular/pulmonary, andintegumentary systems.6Other health care providers have identified deficiencies in students' performance on a clinical musculoskeletal examination. A survey of Doctor of Osteopathy students entering a residency program indicated they were adequately trained to assess patients with musculoskeletal conditions.7 When 1,920 osteopathic medical students were surveyed to assess their perception of formalized training in diagnosing and treating patients with musculoskeletal pain, 26% indicated they were poorly prepared to perform a musculoskeletal physical examination on a patient with low back pain, and 60% indicated they were poorly prepared to assess foot pain.7 Pediatric residency graduates have noted that musculoskeletal injuries and their management are areas where they felt the most uncomfortable.8-12 A subsequent paper in the pediatric literature corroborated the poor musculoskeletal baseline skills.8 At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. Nine months following a teaching intervention, their clinical examinations skills improved: residents performed 67% of the ankle and 47% of the knee physical examination techniques correctly.8 Based on these studies and the lack of EM literature on the topic, EM residents may face similar challenges with musculoskeletal examination.One approach to expanding musculoskeletal examination and procedural skills in the medical school curriculum is through the expanded role of the physiatrist. Newcomer et al13 discussed the development of the physiatrists' role in the implementation of musculoskeletal physical examination in medical schools through teaching inspection, palpation, range of motion, and application of special tests. …

Teaching musculoskeletal examination skills to UK medical students: A comparative survey of Rheumatology and Orthopaedic education practice

BackgroundSpecialists in Rheumatology and Orthopaedics are frequently involved in undergraduate teaching of musculoskeletal (MSK) examination skills. Students often report that specialty-led teaching is inconsistent, confusing and bears little resemblance to the curricula. The Gait, Arms, Legs and Spine (GALS) is a MSK screening tool that provides a standardised approach to examination despite it being fraught with disapproval and low uptake. Recent studies would appear to support innovative instructional methods of engaging learners such as patient educators and interactive small group teaching.MethodsThis comparative cross-sectional survey evaluates the current state of undergraduate teaching in Rheumatology and Orthopaedics, including preferred teaching methods, attitudes towards GALS, and barriers to effective teaching. An electronic questionnaire was sent to specialist trainees and Consultants in the East and West Midlands region, representing 5 UK medical schools. Descriptive statistical data analysis was performed.ResultsThere were 76 respondents representing 5 medical schools. There was a request for newer teaching methodologies to be used: multi-media computer-assisted learning (35.5%), audio-visual aids (31.6%), role-playing (19.7%), and social media (3.9%). It is evident that GALS is under-utilised with 50% of clinicians not using GALS in their teaching.ConclusionsThere is a genuine desire for clinical educators to improve their teaching ability, collaborate more with curriculum planners, and feel valued by institutions. There remains a call for implementing a standardised approach to MSK clinical teaching to supersede GALS.

Efficacy of a Checklist as Part of a Physical Medicine and Rehabilitation Clerkship to Teach Medical Students Musculoskeletal Physical Examination Skills

The aim of this study was to evaluate the efficacy of a checklist as part of a physical medicine clerkship to teach medical students physical examination maneuvers. This is a prospective study performed on fourth year medical students enrolled in a 2-wk mandatory clerkship of the Department of Physical Medicine and Rehabilitation. At the start and end of the rotation, the participating students were tested by performing 20 physical examination maneuvers on an investigator who was both the standardized patient and the evaluator. At the end of the rotation, the students also completed a survey. Data were analyzed using the Bernoulli trial model, with the percentage of students who performed the maneuver correctly on the pretest as the a priori probability. A full Bonferroni correction was applied. The authors enrolled 141 of the 176 fourth year medical students; 121 completed testing. At prerotation, approximately 35% of the physical examination maneuvers were performed correctly; at postrotation, 82%. For 19 of 20 maneuvers, the improvement was statistically significant at P < 0.01. The survey results indicated that the students felt that they had limited exposure to musculoskeletal examination skills at prerotation, that this rotation helped them achieve competency in performing the maneuvers, and that this would improve their future patient care irrespective of field of choice. Considering the high prevalence of musculoskeletal disorders and the anticipated rise in the future, the authors strongly recommend teaching musculoskeletal physical examination maneuvers in medical school, which can be accomplished via a mandatory physical medicine and rehabilitation rotation. The authors conclude that checklists as part of this rotation can effectively help in teaching physical examination skills to medical students.

AB1265 Accuracy of standardized muscuoloskeletal examination of the hand and wrist joints in detecting arthritis in comparison to ultrasound findings in patients attending rheumatology clinics

BackgroundMusculoskeletal (MSK) examination lacks standardization and appropriate validation1,2. Ultrasound (US) has the potential to facilitate early diagnosis of arthritis 3,4. There is a current trend incorporating the use of US...

AB1407 Musculoskeletal teaching and training in saudi arabia: A national survey

BackgroundMusculoskeletal (MSK) symptoms are the most common reason for patients to seek medical attention, accounting approximately 20% of both Primary care and emergency-room visits. Despite the high prevalence of musculoskeletal...

Musculoskeletal Examination Skills: Are We Still Interested?

This article explores problems and solutions of Musculoskeletal (MSK) examinations skills and points out that it is very important to keep medical educators interested to improve the situation of MSK teaching. MSK conditions are usually overlooked though they represent 20% of both primary care and emergency-room visits of the most common health complications that require medical attention across the world. MSK disorders can lead to serious disabilities and significant burden and though its problems are expected to increase, there is a continuous neglect in musculoskeletal examination skills in clinical practice. To participate in solving this problem, the article accentuates the necessity of defining MSK competencies and of agreeing on standards of MSK exams and calls for an integrated teaching of MSK examination skills that uses interactive methodologies like patients’ educators and peer-assisted learning. This article comprises four parts, an introduction, a description of the deficiencies in musculoskeletal examination skills, the causes of these deficiencies and finally some solutions of musculoskeletal examination skills deficiencies. We venture to bring attention to an overlooked but major analyses constituent that impacts patients’ overall health.

Musculoskeletal examination skills of pediatric residents

The aim of our work is to assess musculoskeletal examination skills of pediatric residents. A self-assessment questionnaire with five-point Likert scale (1=strongly disagree, 5=strongly agree) was used. After completion of questionnaires, the residents were taught proper joint examination techniques. Thereafter, the residents were asked to judge whether they had rated their skills accurately. The session was attended by 25/41 residents (61%). Overall, their reported examination skills were poor with a mean score of 3.0 for PGY1, 2.1 for PGY2, 2.2 for PGY3 and 3.0 for PGY4. After being taught the proper joint examinations techniques, 22% of residents reported they initially overestimated their skills and 5% underestimated their skills. The residents felt most comfortable with the knee exam, least comfortable with the finger and wrist joint exam. Most pediatric residents did not feel they can perform a focused musculoskeletal exam.

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics.

For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier.Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care.A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills.Changing demographics and persistent reimbursement disparities will require workplace innovation and legislative reform. Reimbursement reform is utterly essential to extending patient access to subspecialty care. In practice settings characterized by a proportion of Medicaid-subsidized patients in excess of the national average (> 41%), institutional support is vital. Accelerating access to care will require the most efficient deployment of existing, limited resources. Practice redesign of such resources can also improve access, e.g., group appointments and an escalating role for physician extenders. Multidisciplinary, team-oriented care and telemedicine have growing evidence basis as solutions to limited access to pediatric rheumatology services.

Avaliação do sistema musculoesquelético na unidade de emergência

Musculoskeletal conditions have an enormous and growing impact worldwide. In spite of that, some clinicians are not confident in their own musculoskeletal examination skills. This study aimed to evaluate the prevalence of musculoskeletal symptoms in an emergency room, and the frequency of musculoskeletal physical examination description on those cases. This was a cross-sectional study. We performed a systematic analysis of medical files at the emergency room of the University Hospital of the Federal University of Santa Catarina, Brazil, from April 24th to 30th, 2009. We analyzed 392 files, where 41.5% of patients were male and mean age was 38.7 ± 17.2 years-old. Sixty nine out of 392 patients (17.6%) presented with a musculoskeletal complaint. The most common musculoskeletal complaint was low back pain (33/69). Only 49.2% of patients with a musculoskeletal chief complaint had a specific physical examination registered on the files. Patients with musculoskeletal complaints had lower registrations of abdominal examination (46% versus 62%, P = 0.01) and vital signs (46% versus 66%, P = 0.002), but a higher frequency of musculoskeletal examination registration (49% versus 0.6%, P = 0.00). Our study confirms other observations worldwide. Musculoskeletal complaints are frequent in a emergency room setting and in spite of that it is suggested that musculoskeletal symptoms are poorly evaluated, which is probably related to an insufficient musculoskeletal education. It is essential that medical schools place more emphasis on these conditions so that young physicians will be more prepared to deal with these common diseases.