Background/Purpose: While musculoskeletal (MSK) complaints are some of the most common reasons for primary care and specialty visits, little time is dedicated to this important topic in training curricula. To address this critical need, we developed an inter-disciplinary and inter-professional program involving primary care (PC), rheumatology (RHE), orthopaedic surgery (OrS), endocrinology (END), and physical medicine specialists (PM&R) to train physicians and associated health professionals in MSK care.
Methods: Through funding from the Office of Academic Affiliations (OAA) of the Department of Veterans Affairs (VA), we developed an intensive week of training that combines didactics, simulations, and clinical experiences to establish a Center of Excellence (COE) for patient centered MSK care. A significant component of this experience is an inter-disciplinary clinic for evaluation of patients with complex MSK disorders. During COE clinic visits, patients are seen by a team of specialists including trainees, attending physicians, and advanced practice clinicians in the specialties listed above. The trainees and practitioners of this inter-professional and inter-disciplinary team evaluate patients and implement a comprehensive management plan. Faculty assess trainee competence through direct observation in clinical experiences and an objective structured clinical exam (OSCE).
Results: To date, 40 physician trainees (30 PC, 3 RHE, 1 OrS, 1 END, 5 PM&R) and 8 associated health trainees (4 DNP, 2 PA, 1 Physical therapist, 1 Pharmacist) have been involved in COE training. A review of the first 140 patients seen in the COE MSK inter-disciplinary clinic documents a rich clinical training opportunity with an average of 2.4±1.5 complaints per visit, and patients being seen by 2.8±1.2 disciplines. The chief MSK complaint by patients was classified according to the following areas (OrS, RHE, END, PC); however, as noted, the vast majority of patients had multiple MSK diagnoses.
|
Chief Complaint |
Co-Morbid Conditions |
Most common diagnoses |
|
|
OrS |
73% |
91% |
Osteoarthritis, shoulder, knee & spine complaints |
|
RHE |
22% |
38% |
Rheumatoid arthritis, gout, other MSK diseases |
|
END |
4% |
49% |
Osteoporosis, vitamin D deficiency |
|
PC |
1% |
26% |
Fibromyalgia, chronic pain |
Trainees reported high satisfaction with the intensive training and COE MSK clinic. Self-assessment of knowledge and skills for several of the key elements evaluated for physician trainees is listed below.
|
Competency Assessment |
Pre-course |
Post-course |
Change |
|
Comprehensive shoulder and knee pain evaluation |
16.7% |
100% |
83.3% |
|
Manage shoulder and knee pain |
11.1% |
94.4% |
83.3% |
|
Manage gout |
22.2% |
94.4% |
72.2% |
|
Indication for joint injection |
5.6% |
94.4% |
88.9% |
|
Shoulder/Subacromial injection using simulation |
27.8% |
100.% |
72.2% |
|
Knee aspiration using simulation |
50.0% |
94.4% |
44.4% |
|
Perform joint aspirations and injections on patients |
23.5% |
100.% |
76.5% |
|
Diagnose and manage patients with osteoporosis |
35.3% |
100% |
64.7% |
There was marked improvement in MSK knowledge and skills in all areas of training with reported improvement in clinical competence confirmed on OSCE.
Conclusion: The COE in MSK disease provides a comprehensive training program in MSK disease. The employment of an inter-disciplinary and inter-professional training model gives trainees the unique opportunity to learn to manage patients with MSK disease in a rich collaborative setting.
Disclosure:
G. W. Cannon,
None;
A. Barker,
None;
J. P. Beck,
None;
J. Berdan,
None;
M. Grotzke,
None;
T. A. Huhtala,
None;
P. Kennedy,
None;
P. Lawrence,
None;
J. Rolando,
None;
M. J. Battistone,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/teaching-musculoskeletal-care-through-an-inter-disciplinary-and-inter-professional-clinical-training-program-successfully-provides-trainees-with-knowledge-and-skills-required-to-deliver-excellent-musc/