Background/Purpose
While musculoskeletal (MSK) problems are common in primary care, the current formal education in the evaluation and management of these conditions is inadequate. Through funding from the Veterans Affairs (VA) Office of Academic Affiliations, we developed an interprofessional, interdisciplinary, mixed-method program to enhance the clinical education of medical students, residents, fellows, and trainees of other health professions.
Methods
The week-long course begins with didactics, is reinforced through technology-enhanced simulation and peer-teaching in small-group settings, and culminates in supervised ambulatory clinical experiences and reflective practice.
Table 1
|
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
|
Introduction |
Back Pain -Didactic- |
Gout -Didactic- |
Orthopaedic Injection Clinic
-or- PM&R Clinic |
Center of Excellence Multidisciplinary Musculoskeletal Clinic |
|
Introduction to the Evaluation of Rheumatic Disease -Didactic- |
Physical Exam of the Knee -Didactic- |
Rheumatology 101: Serologies and RA -Didactic- |
||
|
Physical Exam of the Shoulder -Didactic- |
Physical Exam of the Knee -Group Practice- |
Arthrocentesis -Didactic and Group Practice- |
||
|
Physical Exam of the Shoulder -Group Practice- |
Approach to Knee Pain -Didactic- |
|||
|
Approach to Shoulder Pain -Didactic- |
||||
|
Lunch |
Lunch |
Lunch |
Lunch |
Lunch |
|
Bone Health I: Osteoporosis Risk Factors and Evaluation -Didactic- |
Bone Health II: Osteoporosis Treatment and Hypogonadism -Didactic- |
Rheumatology Clinic |
Primary Care Musculoskeletal Clinic |
Rheumatoid Arthritis Clinic |
|
Shoulder Cases -Group Practice- |
OSCE |
Participants learn to perform, describe, and document a systematic physical exam of the shoulder and knee, interpret these findings, and develop patient-centered management options in a framework of high value care. Faculty represent Internal Medicine (IM) (Primary Care, Rheumatology, Endocrinology), Orthopaedics, and Physical Medicine and Rehabilitation (PM&R) disciplines. Course assessments include written surveys, 2-station Objective Structured Clinical Examination, and individual exit interviews.
Results
Student and trainee participants in the 2013-14 academic year are summarized below. Survey response rate was 89%. Post-course competency in examining the shoulder and knee, and in reporting, interpreting, and managing the case using a framework of high-value care, was confirmed with 2-station OSCE.
Table 2
|
|
Post-Graduate Trainees |
Students |
||||||||||
|
Discipline/Profession |
IM |
Rheum |
Geri |
Neuro |
Ortho |
PM&R |
Occ Med |
Med |
APRN |
PA |
||
|
Number of Trainees |
34 |
1 |
2 |
1 |
4 |
5 |
1 |
4 |
9 |
10 |
||
|
Percentage of Cohort |
48% |
1% |
3% |
1% |
6% |
7% |
1% |
6% |
13% |
14% |
||
|
|
||||||||||||
|
|
Pre-MSK COE Week |
Post-MSK COE Week |
||||||||||
|
Able to evaluate and manage shoulder complaints |
16% |
98% |
||||||||||
|
Able to evaluate and manage knee complaints |
35% |
94% |
||||||||||
|
Competent to aspirate/inject knee or subacromial space |
18% |
76% |
||||||||||
Conclusion
The MSK Intensive Education Week provides an interdisciplinary and interprofessional environment to teach trainees from multiple backgrounds in the evaluation and management of patients with complex MSK diseases through a cooperative practice model and evaluates their competency to practice in this system.
Disclosure:
M. J. Battistone,
None;
A. M. Barker,
None;
M. Grotzke,
None;
P. Beck,
None;
J. Berdan,
None;
C. Milne,
None;
J. Rolando,
None;
G. W. Cannon,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-center-of-excellence-in-musculoskeletal-care-and-education-a-sustainable-interprofessional-multidisciplinary-programmatic-innovation-developed-with-the-department-of-veterans-affairs/