Background/Purpose:

Prior studies have elucidated the lack of competency and confidence in musculoskeletal (MSK) examination skills amongst medical trainees. A variety of teaching modalities have been studied, including lecture or workshop-based and peer-to-peer training, however, there remains a dearth of literature regarding the effectiveness of traditional bedside teaching versus dedicated workshops. The aim of this study was to determine if incorporating a MSK workshop into a 2 week clinical rotation in rheumatology would be an effective means to increase internal medicine residents’ competency and comfort with knee examinations when compared to the rotation alone.

Methods:

Informed consent was obtained from all participants. Each block of resident rotations during a 6 month period was randomized to workshop plus rotation versus rotation alone; the number of residents assigned to rheumatology varied biweekly, yielding unequal group sizes. Participants were tested on their knee examination skills at the start of their rotation using an objective structured clinical examination (OSCE) administered by trained rheumatology faculty. Those randomized to the intervention group were provided a 1-hour workshop consisting of a didactic presentation, video and hands on application of skills. Immediately following the rotation, all residents were retested using the OSCE. Residents were administered a pre and post rotation survey assessing to what degree the rotation was beneficial in enhancing their comfort with knee examination skills. Comfort and helpfulness were measured using a 5-point Likert scale (1: not comfortable and 5: very comfortable). Paired and independent samples t-tests were used for pre and post as well as between group comparisons.

Results:

Twenty residents participated in the study (12 received the workshop). For the group as a whole, there were significant improvements in pre and post-test OSCE scores (pre-test mean = 6.3±2.2, post-test mean = 11.3±1.4, p<0.001), showing improvements of close to 80%. Comfort with examination also significantly improved post rotation (pre-level mean = 2.6±0.8, post-level mean = 4.1±0.7, p<0.001), moving overall from “somewhat uncomfortable” to “comfortable” ranges. Interestingly, there was no significant difference in the change in OSCE scores (p = 0.140) or levels of comfort (p = 0.560) between the group that received the workshop and the group that completed rotation alone. Ninety-five percent of residents found completion of the rotation to be helpful in improving examination skills (mean helpfulness = 4.5±0.7). This did not differ between groups (p = 0.560).

Conclusion:

This study provides evidence that completion of a rheumatology rotation results in substantial improvement in resident competency and comfort with comprehensive knee examinations. In an educational era emphasizing organized interactive learning, it is of interest that we were unable to demonstrate that provision of a focused workshop improved outcomes beyond the rotation itself. These findings highlight the continued value of bedside teaching and the effectiveness of the rheumatology elective in helping to bridge known gaps in MSK education.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/back-to-bedside-teaching-completion-of-a-rheumatology-rotation-significantly-increases-internal-medicine-residents-competency-and-comfort-with-comprehensive-knee-examinations/