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Abstract Number: 2885

Clinical Training Opportunities in Two Innovative Ambulatory Resources: The Primary Care Musculoskeletal Clinic and Center of Excellence Multidisciplinary Clinic

Michael J. Battistone1, Andrea M. Barker2, Marissa Grotzke3, Peter Beck4, Jeffery Berdan5, Phillip Lawrence6 and Grant W. Cannon1, 1Division of Rheumatology, Salt Lake City VA and University of Utah, Salt Lake City, UT, 2General Internal Medicine, Salt Lake City VA and University of Utah, Salt Lake City, UT, 3Division of Endocrinology, Salt Lake City VA and University of Utah, Salt Lake City, UT, 4Orthopaedics, Salt Lake City VA and University of Utah, Salt Lake City, UT, 5Physical Medicine and Rehabilitation, Salt Lake City VA and University of Utah, Salt Lake City, UT, 6Salt Lake City VA and University of Utah, Salt Lake City, UT

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Education, educational innovation, educational research, interdisplinary and medical education, medical

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Session Information

Session Title: Education

Session Type: Abstract Submissions (ACR)

Background/Purpose

While musculoskeletal (MSK) problems are common in primary care, current training models do not adequately prepare primary care providers (PCP) to deal with these issues.  With funding from the Veterans Affairs (VA) Office of Academic Affiliations (OAA), we developed a Center of Excellence (COE) for MSK Care and Education to meet this training need for health care professional trainees.

Methods

Two new weekly outpatient clinics, the Primary Care MSK (PC-MSK) and the Multidisciplinary (COE-MSK) Clinics were developed as key components of the COE.  The PC-MSK is staffed by a rheumatologist and a physician assistant (PA) with orthopaedic experience.  The COE-MSK is attended by a rheumatologist, endocrinologist, orthopaedic surgeon, physiatrist, and a PCP.  All categorical internal medicine (IM) interns, orthopaedic interns, PM&R residents, and rheumatology fellows participate in this clinic over the course of the academic year.   Additional IM residents, medical students, nurse practitioner students and physician assistant students are also included as space allows.

Results

In 2013-14, 80 trainees participated in the PC-MSK and COE-MSK clinics. The distribution of disciplines and professions represented in this multi-level cohort are shown in Table 1.

Table 1

 

Post-Graduate Trainees

Students

Discipline/Profession

IM

Rheum

Geri

Neuro

Ortho

PM&R

Occ Med

Med

APRN

PA

Number of Trainees

39

4

2

1

4

6

1

4

9

10

Percentage of Cohort

49%

5%

3%

1%

5%

8%

1%

5%

11%

12%

Since June 2013, 330 patients have been seen in these clinics. As shown in Table 2, most are referred from primary care, mainly by providers in non-resident clinics. Most non-resident referrals were to the PC-MSK clinic, all others tended to request the multidisciplinary COE-MSK clinic.

Table 2

 

Referral Destinations

Referral Sources

Total

COE

MSK

All Patients (n, %)

330 (100)

191 (58)

139 (42)

Primary Care

217

110

107

Resident Continuity Clinics

73

47

26

Faculty and Staff Clinics

138

60

78

Women’s Clinics

6

3

3

Specialty Care

36

28

8

Medicine Subspecialties

25

18

7

Surgery

11

10

1

PC-MSK + COE-MSK (self-referrals)

23

19

4

Other

54

34

20

Procedures Performed (n, % of patients referred)

115 (35%)

43 (23%)

72 (52%)

Days to Consult Completion (mean, st.dev.)

47 (31.7)

55 (36.3)

36 (19.8)

 

Conclusion

These clinics provide unique and innovative opportunities for a broad range of trainees in a rich interdisciplinary and interprofessional educational environment.   Additionally, these clinics are a valuable resource to primary care providers, specialty physicians, and patients for prompt and comprehensive care for veterans with either limited or complex MSK problems.


Disclosure:

M. J. Battistone,
None;

A. M. Barker,
None;

M. Grotzke,
None;

P. Beck,
None;

J. Berdan,
None;

P. Lawrence,
None;

G. W. Cannon,
None.

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