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Abstract Number: 2001

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

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Session Information

Session 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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