Background/Purpose: Musculoskeletal (MSK) problems present frequently during outpatient visits to primary care providers.   Training in the diagnosis and care of MSK disease varies based on the specific discipline and on the degree of emphasis placed on these problems by training programs.  Providers may also have different learning styles and post-training experiences that influence their comfort and competence with MSK problems.   We examined the impact of prior training and experience on providers’ perceived level of competence before and after participation in a novel intensive 3 day MSK “mini-residency” training program including physicians (MD), physician assistants (PA) and nurse practitioners (NP) from six VA health systems across the country.

Methods: Providers engaged in a three-day intensive, multi-method training program that included specific training in the approach to common shoulder and knee problems.  Participants were surveyed regarding training and clinical experience with MSK problems. We compared experience with self-reported competency and performance in observed structured clinical examinations (OSCE) of the shoulder and knee.

Results:  Participants had significant heterogeneity in their educational and training experience with MSK disease.

95.4% of 109 participants reported that they frequently see common MSK conditions in practice.  However, there were no significant differences in their confidence level in the evaluation and management of common MSK conditions prior to taking the course, or in specific self-reported baseline competencies based on these differences in training or experience.  Providers exhibited significant improvements in post-course evaluations, with no significant differences in improvement in self-rated competencies or in objective skill assessments across education, experience, or practice specialty.  Surprisingly, providers with less than 5 years post-training experience performed better on the post-course OSCE than those with 10 or more years (p = 0.022 and 0.017 for shoulder and knee, respectively).

Conclusion: Providers have widely varying education and training in MSK problems.  Higher performance in OSCE among providers recently completing training may reflect easier acceptance of a systematic physical examination approach or greater comfort with the OSCE format. Despite differences in prior training and experience, participation in a focused, structured, multi-method training experience can lead to improved MSK competency, even among experienced clinicians from varied backgrounds.