Session Title: Medical Education
Session Type: Abstract Submissions (ACR)
Background/Purpose: Few studies have addressed use of simulation-based education (SBE) to teach musculoskeletal (MSK) medicine to Internal Medicine (IM) residents. Our purpose was to obtain IM resident confidence levels in ability to diagnose MSK disorders and observe MSK performance skills with use of SBE at a single, large academic center.
Methods: Participants were 68 first and third-year IM residents. Surveys were completed before and after SBE using a 9-point Likert scale, ranging from 1 = poor, 5 = average, and 9 = very good, to assess ability to confidently perform MSK exams and diagnose shoulder, hand/wrist, hip, and knee disorders. Baseline exams were performed on two standardized patients (SPs) and videotaped. These were scored using a three-point scale (0 = not done; 1 = done, but not correctly; 2 = done correctly). An interactive lecture, self-demonstration of MSK exam, and participation with SPs in one or more scripted scenarios was provided. A debriefing session critiqued MSK exam skills. Post-SBE exams were performed with SPs and scored. Six month follow-up surveys assessed retention of confidence in MSK exam skills.
Results: Before intervention, mean (SD) rating of ability ranged from 4.4 (1.8) for pes anserine bursitis to 5.9 (1.6) for trochanteric bursitis, while confidence to perform MSK exams ranged from 4.3 (1.4) on the hand/wrist to 5.0 (1.5) on the knee. Following SBE, ratings of ability significantly improved, ranging from +1.7 (1.4) for trochanteric bursitis to +2.6 (1.5) for pes anserine bursitis and +2.0 (1.4) to +2.3 (1.5) for knee and hand/wrist exam, respectively (all p<.0001). Hip exams improved on inspection, gait, palpation, passive and active range of motion (ROM), strength testing, and provocative maneuvers (PM) (all p<.001). Hand/wrist exams improved on inspection, palpation, active ROM, strength testing, and PM (all p<.004), while passive ROM was unchanged (p=.31). Shoulder exams improved on palpation, passive and active ROM, strength testing, and PM (all p<.005), while inspection was unchanged (p=.02). Knee exams improved on inspection, gait assessment, palpation, active ROM, and strength testing (all p<.001), while passive ROM (p=.60) and PM (p=.07) were unchanged. Follow-up surveys completed 6 months post intervention by 32 eligible residents indicate durable ratings of ability, ranging from +1.5 (1.7) for patellofemoral pain syndrome to +2.5 (2.2) for de Quervain’s tenosynovitis and +2.0 (1.4) to 2.3 (1.5) for knee and hand/wrist examination, respectively (all p<.0001).
Conclusion: Use of SBE significantly improved IM resident confidence in ability to perform MSK exams and diagnose common MSK disorders. Resident performance of MSK exams as judged by a trained evaluator also improved. Improved confidence in ability to diagnose common disorders and perform MSK exams were durable 6 months after intervention. Therefore, use of SBE is an effective way to teach MSK medicine to IM residents.
F. C. Ernste,
F. S. McDonald,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/standardized-patient-simulation-improves-internal-medicine-resident-musculoskeletal-examination-skills/