Background/Purpose

Musculoskeletal (MSK) complaints are commonly the reason for visits to Primary Care offices. Therefore, it is important to teach residents to recognize and manage them. Passive learning techniques such as reading may improve knowledge but do not necessarily teach residents to synthesize and apply that knowledge in a clinical encounter.  The purpose of this study is to determine if an enriched rheumatology curriculum, using active learning techniques, leads to better assessment and management of MSK complaints in a primary care setting among medical residents.

Methods

This pilot study is a blinded, retrospective, case-controlled trial comparing residents who participated in a rheumatology elective in comparison to residents who had passive learning about rheumatology.  Medical residents were assigned to rheumatology or another subspecialty elective.  All residents were assigned rheumatology reading in preparation for a post-test and objective structured clinical examination (OSCE). Rheumatology elective residents were taught using active learning techniques such as arthrocentesis simulation and small group teaching for MSK examination.  They attended rheumatology clinic for an average of 3 sessions weekly for 4 weeks.  The other residents viewed videos on arthrocentesis and MSK physical examination.

Fifty medical records from Primary Care continuity clinic were analyzed for evaluation of MSK complaints. The selected outpatient records had MSK-related chief complaints and were completed within 18 months from the writers’ rheumatology teaching in both groups.  The performance of the residents was assessed using a predetermined grading system by two blinded evaluators.  Evaluators reviewed specifics regarding history (10 points), physical examination (5 points), assessment (2 points) and management (2 points) for a possible total of 19 points. Evaluators also gave each record a summary score for documentation of history, physical examination, assessment or plan (possible total of 4 points) regarding the chief complaint.

Results

Results: Results are displayed in Table 1. A 2-tailed T-test was performed comparing the total scores by evaluator 1 and evaluator 2; p values were 0.14 and 0.28 respectively.

Table 1 Mean scores with +/- standard deviation for chart review by evaluator 1 and evaluator 2. 

	Evaluator 1		Evaluator 2
Resident assignment	Rheumatology	Non-Rheum	Rheumatology	Non-Rheum
History	4.2 (2.0)	4.7 (2.0)	4.3 (2.1)	4.4 (2.4)
Exam	1.2 (1.3)	1.8 (1.1)	1.2 (1.2)	1.9 (1.0)
Assessment	1.8 (0.9)	1.4 (0.9)	0.8 (0.6)	1.0 (0.7)
Management	1.8 (0.5)	1.6 (0.7)	1.7 (0.5)	1.6 (0.6)
Total	8.1 (3.2)	9.5 (3.3)	8.0 (3.1)	8.9 (3.3)
Summary score	3.2 (0.7)	3.6 (0.7)	3.2 (1.0)	3.5 (0.8)

Conclusion We found no significant difference in documentation of medical care for MSK complaints between medical residents who had a rheumatology elective with active learning and medical residents who had passive learning for rheumatology.  These results indicate that passive learning through reading and videos is as effective as small group teaching, at least for 4 week long elective experiences.    Improvement in outcomes may require reinforcement over a longer period of time and in different clinical settings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-a-rheumatology-ambulatory-rotation-for-medical-residents-on-documentation-of-musculoskeletal-complaints/