Background/Purpose: Musculoskeletal (MSK) complaints account for 15-30% of the ambulatory care visits in the United States. MSK training during Internal Medicine (IM) residency remains suboptimal, and residents report low self-confidence in managing MSK conditions. To address this gap, we developed an internet-based MSK module to improve IM residents’ knowledge and skills in evaluation and management of ambulatory MSK complaints. We examined the effectiveness of this educational intervention using data from the first 150 residents who completed this module.

Methods: The MSK module was disseminated on Physician Education and Assessment Center (PEAC), a web-based extramural ambulatory curriculum, currently used by 50% (194 out of 389) of the accredited IM Programs in the US and available to 11,000 IM residents as a key component to their ambulatory curricula. The module “Approach to a Patient with a Joint Complaint” was based on pretest-case based didactics-posttest format. The goal of this module was to give IM residents foundational knowledge and a systematic initial approach to a patient with a joint complaint, which leads to an appropriate initial diagnostic differential and work-up. Didactics and content was written to address the specific cognitive/knowledge objectives of the module, such as “to distinguish arthralgia from arthritis”. MSK knowledge was assessed using pre-tests and post-tests. We compared scores between first (PGY-1), second (PGY-2) and third year (PGY-3) residents to assess baseline knowledge, pretest and posttest scores among different years of training. Analyses were performed using SPSS v24.

Results: Of 151 residents completing the module, 32% were program year (PGY)-1, 32% were PGY-2, and 36% were PGY-3. The programs were 23.2% university training programs, 59.6% were community training programs, 7.3% were “other” training programs, and 9.9% were unknown training programs. Baseline mean (SD) pre-test scores were 59.4% (23.4). Pre-test scores were significantly higher when comparing PGY3 to PGY1 (p=0.02) only, but not between other years. The mean post-test score was 91.2% (11.2). Completion of the MSK module led to significant improvement from pre- to post-test scores (mean improvement =31.84% (SD=24.53). There was no difference in the post-test scores among the three years of trainees.

Conclusion: Web-based modules can be effective in augmenting and disseminating MSK knowledge to IM trainees. Additional modules and topics are being implemented. Further studies are required to evaluate whether knowledge gained from this intervention translates into improved care for patients with MSK complaints.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improving-internal-medicine-residents-knowledge-through-a-web-based-musculoskeletal-educational-module/