The Musculoskeletal Mini-Residency Collaborative Network: A National Department of Veterans Affairs Interdisciplinary and Interprofessional Educational Innovation for Primary Care Providers

Michael J. Battistone¹, Andrea M. Barker², Marissa P. Grotzke³, J. Peter Beck⁴, Anna Quan⁵, Michal Hose⁵, Victoria Seligman⁶, Roneka Ravenell⁷, Pushpa Pavuluri⁷, W. Neal Roberts⁷, Mathilde Pioro⁸, Nancy Fisher⁸, Vanessa Osting⁹, Betty Prihar⁹, Joanne Hackman¹⁰, Susan Kirsh¹⁰ and Grant W. Cannon¹, ¹Division of Rheumatology, Salt Lake City VA and University of Utah, Salt Lake City, UT, ²General Internal Medicine, Salt Lake City VA and University of Utah, Salt Lake City, UT, ³Division of Endocrinology, Salt Lake City VA and University of Utah, Salt Lake City, UT, ⁴Salt Lake City VA and University of Utah, Salt Lake City, UT, ⁵San Diego VA, San Diego, CA, ⁶Denver VA Medical Center, Denver, CO, ⁷Louisville VA, Louisville, KY, ⁸Cleveland VA, Cleveland, OH, ⁹Tampa VA, Tampa, FL, ¹⁰Office of Specialty Care Transformation, Patient Care Services, VHA Central Office, Washington, DC

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Education, educational innovation, interdisplinary and medical education, medical

Session Information

Title: Education (ACR)

Session Type: Abstract Submissions (ACR)

Background/Purpose

To address the problem of insufficient training in Musculoskeletal (MSK) diseases by practicing primary care providers (PCPs), the Veterans Affairs (VA) Office of Specialty Care Transformation provided pilot funding through a competitive, peer-reviewed process, to develop and support a “MSK Mini-Residency” to train PCPs in evaluation and management of common MSK diseases. Methods The 3 day MSK mini-residency curriculum intersperses didactic lectures with small group workshops, as well as case based interactive small-group practice sessions and technology-enhanced simulation (see full schedule, Table 1). Participants’ competency in performing and interpreting the physical examination of the shoulder and knee is evaluated by a 2-station Objective Structured Clinical Examination (OSCE), to ensure sufficient preparation for assessing patients in clinic. Course evaluation was conducted using the Kirkpatrick’s model of assessing educational effectiveness, and Phillip’s concept of Return on Investment. Table 1

-Day 1-
7:30-8:00	Sign In/Lunch Sign In
8:00-8:20	Course Introduction
8:20-9:10	Introduction to Shoulder Exam
	*Group I*	*Group II*
9:20-10:30	Small Group Shoulder Exam Practice	Bone Health
10:40-11:50	Bone Health	Small Group Shoulder Exam Practice
11:50-noon	Lunch Served
noon-1:15	Shoulder Pathology/Lunch
	*Group I*	*Group II*
1:30-3:00	Bone Health	Small Group Shoulder Cases
3:15-4:45	Small Group Shoulder Cases	Bone Health
4:45-5:00	Wrap Up
-Day 2-
7:30-8:00	Sign In/Lunch Sign In
8:00-8:40	Introduction to Knee Exam
	*Group I*	*Group II*
8:50-9:40	Bone Health Risk Factors	Small Group Knee Exam Practice
9:50-10:40	Small Group Knee Exam Practice	Bone Health Risk Factors
10:45-11:45	Practical Issues in Performing and Documenting Joint Injections
11:45-12:00	Lunch Served
12:00-1:00	Knee Pathology
	*Group I*	*Group II*
1:00-2:55	Bone Health Cases/Shoulder OSCE	Small Group Knee Cases/Injections
3:05-5:00	Small Group Knee Cases/Injections	Bone Health Cases/Shoulder OSCE
-Day 3-
7:30-8:00	Sign In/Lunch Sign In
	*Group I*	*Group II*
8:00-10:30	Rheumatology Cases	Bone Health Cases/Knee OSCE
10:30-1:00	Bone Health Cases/Knee OSCE	Rheumatology Cases
1:00-1:30	Lunch Served
1:30-2:30	Evaluation & Management of Back Pathology
2:30-3:00	Practical Issues in Performing and Documenting Joint Injections
3:00-4:00	Course Conclusion

Results

From 2012-2014, the 3-day MSK Mini-Residency course has been presented at 12 VA medical centers, serving catchment areas centered in Los Angeles, San Francisco, Denver, Omaha, Louisville, Cleveland, Philadelphia, Tampa, Orlando, and Boston. Table 2 shows the distribution of participants by professional credential, as well as their pre- and post-course self-assessments of their ability and preparation to evaluate and manage shoulder and knee pain in their clinics.

Table 2

MSK Mini-Residency Participants	Total	Physician		NP	PA	Unspecified
Number, %	241 (100)	148 (61)		75 (32)	15 (6)	3 (1)

			Pre Course		Post Course
Able to evaluate and manage shoulder complaints Able to evaluate and manage knee complaints Prepared to aspirate/inject knee or subacromial space			25%		99%
			31%		98%
			29%		66%

Post course competency in examining the shoulder and knee, and in reporting, interpreting, and managing the cases using a framework of high-value care, was confirmed with 2-station OSCE. Course evaluations were extremely positive across all sites: over 95% of participants anticipate that the training will impact their job performance and would recommend the course to others.

Conclusions

The MSK Mini-Residency is an effective model for training and evaluating primary care providers in the diagnosis and management of common musculoskeletal diseases.

Disclosure:

M. J. Battistone,
None;

A. M. Barker,
None;

M. P. Grotzke,
None;

J. P. Beck,
None;

A. Quan,
None;

M. Hose,
None;

V. Seligman,
None;

R. Ravenell,
None;

P. Pavuluri,
None;

W. N. Roberts,
None;

M. Pioro,
None;

N. Fisher,
None;

V. Osting,
None;

B. Prihar,
None;

J. Hackman,
None;

S. Kirsh,
None;

G. W. Cannon,
None.

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