Session Title: Medical Education
Session Type: Abstract Submissions (ACR)
Musculoskeletal problems are among the most common patient complaints in the United States. Despite this, studies show that medical students and interns are not adequately prepared in these topics. The University of Central Florida College of Medicine (UCF) is a new medical school with an integrated curriculum that graduated its charter class of in May 2013. At UCF a four week module that includes topics in rheumatology and orthopedics is taught in the second year. The purpose of this study was to test the UCF charter class on basic topics in musculoskeletal medicine to assess their competence in this area and compare it to the national average and to their juniors who have had an improved curriculum.
Methods: A basic-competency examination in musculoskeletal medicine has been previously validated and used since 1999 by various medical schools. It has 25 short-answer questions covering topics seen in primary care settings. This exam was taken by UCF second year medical students (M2) during their musculoskeletal module and by UCF fourth year medical students (M4) just before their graduation. A Likert-Scale questionnaire was administered to M4 class to rate their self-confidence in musculoskeletal physical examination skills. M4 students were asked if they had taken an elective in orthopedics or rheumatology (MSK). The exam was scored anonymously according to a standardized answer key.
A total of 79 second-year (M2) and 35 fourth-year (M4) medical students took the quiz. The mean score for the M2 class was 80% (sd=10.9), M4 class was 58% (sd=13.1). The pass rate using 60% cut off was 96.2% for M2 and 54.3% for M4 (p<0.001). The pass rate using 73% cut off was 82.3% for M2 and 8.6% for M4 (p<0.001). The pass rate for UCF M2 and M4 classes was higher than the national average pass rate of 18% for medical school graduates using the same exam in 1998. Using the 60% cut off for the M4 class, those who had taken an MSK elective had a pass rate of 76.5% compared to 33.3% in those who did not take such an elective (p=0.01). For the M4 class, confidence level in physical exam skills was as follows: back exam: poor=5.7%, fair to good=94%; shoulder exam: poor=25.7%, fair to good= 74.3%; knee exam: poor=17.1%, fair to good=82.8%. M4 students who had an MSK elective were more confident in back exam (p=0.014) compared to those who did not take an elective, but there was no significant difference between shoulder (p=0.85) and knee (p=0.39) exam confidence levels between the two groups, although the trend was towards more confidence in the group that had taken an MSK elective.
Pass rate using a validated musculoskeletal exam for the UCF graduating class was better than the national average but was still poor overall. Pass rate was significantly better in the second year class who had the improved curriculum. M4 students who had taken a MSK elective had significantly higher pass rates and trended towards having higher confidence in physical exam skills compared to those who had not taken such an elective. Musculoskeletal medicine education needs to be improved in all four years of undergraduate medical education to increase confidence and performance in the real world where there is a high demand for these skills.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/competency-and-confidence-in-musculoskeletal-medicine-for-the-first-graduating-class-of-a-new-medical-school/