Background/Purpose:
Musculoskeletal (MSK) complaints in primary care are common but often underemphasized in residency training. There are few reports of methods residency programs have reported to address this need. Wilcox et. al reported an intervention for residents consisting of a monthly experience, and Houston et. al reported the experience of residents in a community clinic precepted by general internists. Both these interventions were scheduled as multi-week curricula. With limitation of work hours, residents spend less time on sub-specialty rotations such as Rheumatology, and so it becomes challenging to incorporate adequate exposure to the MSK examination. To address this need for more dedicated MSK teaching while remaining sensitive to the constraints of limited contact hours, a pilot MSK workshop consisting of a single 90 minute session was initiated.
Methods:
As part of the ambulatory medicine curriculum for medicine residents at Rush University a MSK workshop was initiated. The workshop consisted of a lecture followed by assessment of preselected patients with MSK complaints. The residents assessed each patient through a focused history and dedicated musculoskeletal exam. Prior to the workshop a multiple choice pretest was administered. Subsequently, a post-test with different questions and an anonymous survey was completed. Informed consent was obtained from the patients. Paired t-test was used to compare pre-test and post-test scores. One-way ANOVA with Bonferroni correction was used to compare mean pre-test and post-test scores across PGYs.
Results:
45 medicine residents participated in the workshop. The mean±SD pretest score was 68.44 % ± 20.21. Post test scores are available for 26 residents. There was significant improvement in post test scores overall for PGY2 and PGY3, but none for PGY1s (table). One-way ANOVA with Bonferroni correction revealed no baseline differences at any PGY, but significant improvement among PGY2 and PGY3 compared to PGY1. Post workshop survey results are available for 19 residents. 92.9% of residents strongly agreed or agreed that the workshop was helpful and clinically useful. 89.3% strongly agreed or agreed that they were applying what they learned in their evaluation of patients in their continuity clinics and they felt more confident with their skills. Notwithstanding the PGY1 test results, there was no difference in their overall acceptance of the workshop compared to PGY2 or PGY3s.
|
|
Pre-test Percentage (±SD) |
Post-test Percentage (±SD) |
P-Value |
|
All PGY (n=26) |
69.2(21.3) |
87.7 (12.7) |
0.001 |
|
PGY1 (n=9) |
64.4 (26.0) |
77.8 (12.0) |
0.111 |
|
PGY2 (n=8) |
70.0 (18.5) |
92.5 (10.3) |
0.0002 |
|
PGY3 (n=9) |
73.3(20.0) |
93.3 (10.0) |
0.003 |
|
PGY1 vs. PGY2 |
66.7 vs. 66.7 (p-value =1.000) |
77.8 vs.92.5 (p-value=0.031) |
|
|
PGY1 vs. PGY3 |
66.7 vs.72.0 (p-value=1.000) |
77.8 vs.93.3 (p-value=0.017) |
|
|
PGY2 vs. PGY3 |
66.7 vs. 72 (p-value=1.000) |
92.5 vs. 93.3 (p-value=1.000) |
|
Conclusion:
These data suggest that an intervention requiring a single session may result in substantial and durable improvement in testable knowledge among PGY2 and PGY3 residents. The lack of improvement in post-test scores among PGY1 residents may indicate that this group needs more dedicated sessions. This is the first report to indicate that residents apply what is learned longitudinally in their long-term continuity experiences and a single session led them to feel more confident with their skills.
Disclosure:
S. Khandelwal,
None;
N. Annapureddy,
None;
J. A. Block,
None;
A. Ekpenyong,
None;
R. I. Abrams,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pilot-musculoskeletal-workshop-for-internal-medicine-residents/