Teaching musculoskeletal examination skills to UK medical students: A comparative survey of Rheumatology and Orthopaedic education practice

BMC Medical Education

Tim Blake¹ 

[1] Undergraduate Education Department, South Warwickshire NHS Foundation Trust, Lakin Road, South Warwickshire CV34 5BW, UK

关键词: Curriculum;    Medical;    Education;    Undergraduate;    Musculoskeletal;   

Others  :  1118133
DOI  :  10.1186/1472-6920-14-62

 received in 2013-11-10, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

Background

Specialists in Rheumatology and Orthopaedics are frequently involved in undergraduate teaching of musculoskeletal (MSK) examination skills. Students often report that specialty-led teaching is inconsistent, confusing and bears little resemblance to the curricula. The Gait, Arms, Legs and Spine (GALS) is a MSK screening tool that provides a standardised approach to examination despite it being fraught with disapproval and low uptake. Recent studies would appear to support innovative instructional methods of engaging learners such as patient educators and interactive small group teaching.

Methods

This comparative cross-sectional survey evaluates the current state of undergraduate teaching in Rheumatology and Orthopaedics, including preferred teaching methods, attitudes towards GALS, and barriers to effective teaching. An electronic questionnaire was sent to specialist trainees and Consultants in the East and West Midlands region, representing 5 UK medical schools. Descriptive statistical data analysis was performed.

Results

There were 76 respondents representing 5 medical schools. There was a request for newer teaching methodologies to be used: multi-media computer-assisted learning (35.5%), audio-visual aids (31.6%), role-playing (19.7%), and social media (3.9%). It is evident that GALS is under-utilised with 50% of clinicians not using GALS in their teaching.

Conclusions

There is a genuine desire for clinical educators to improve their teaching ability, collaborate more with curriculum planners, and feel valued by institutions. There remains a call for implementing a standardised approach to MSK clinical teaching to supersede GALS.

【 授权许可】

   
2014 Blake; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Yelin E, Herrndorf A, Trupin L, Sonneborn D: A national study of medical care expenditures for musculoskeletal conditions - The impact of health insurance and managed care. Arthritis Rheum 2001, 44:1160-1169.
• [2]Woolf AD, Akesson K: Primer: history and examination in the assessment of musculoskeletal problems. Nat Clin Pract Rheumatol 2008, 4:26-33.
• [3]Hood C, Johnson J, Kelly C: What is the prevalence of rheumatic disorders in general medical inpatients? Postgrad Med J 2001, 77:774-777.
• [4]Dequeker J, Rasker JJ, Woolf AD: Educational issues in rheumatology. Best Pract Res Clin Rheumatol 2000, 14:715-729.
• [5]Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, et al.: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380:2197-2223.
• [6]Badley EM, Crotty M: An international comparison of the estimated effect of the aging of the population on the major cause of disablement, Musculoskeletal disorders. J Rheumatol 1995, 22:1934-1940.
• [7]Doherty M, Abawi J, Pattrick M: Audit of medical inpatient examination - a cry from the joint. J R Coll Physicians Lond 1990, 24:115-118.
• [8]Walker DJ, Kay LJ: Musculoskeletal examination for medical students: the need to agree what we teach. Rheumatology 2002, 41:1221-1223.
• [9]Marshall RW, Hull RG: For crying out loud: musculoskeletal assessment of inpatients referred to rheumatology. Rheumatology 2004, 43:1447-1447.
• [10]Rigby JC, Oswald AG: An evaluation of the performing and recording of physical examinations by psychiatric trainees. Br J Psychiatry 1987, 150:533-535.
• [11]O’Dunn-Orto A, Hartling L, Campbell S, Oswald AE: Teaching musculoskeletal clinical skills to medical trainees and physicians: A Best Evidence in Medical Education systematic review of strategies and their effectiveness: BEME Guide No. 18. Med Teach 2012, 34:93-102.
• [12]Lanyon P, Pope D, Croft P: Rheumatology education and management skills in General Practice - a national study of trainees. Ann Rheum Dis 1995, 54:735-739.
• [13]Dequeker J, Esselens G, Westhovens R: Educational issues in rheumatology. The musculoskeletal examination: a neglected skill. Clin Rheumatol 2007, 26:5-7.
• [14]Coady D, Walker D, Kay L: The attitudes and beliefs of clinicians involved in teaching undergraduate musculoskeletal clinical examination skills. Med Teach 2003, 25:617-620.
• [15]Doherty M, Dacre J, Dieppe P, Snaith M: The GALS locomotor screen. Ann Rheum Dis 1992, 51:1165-1169.
• [16]Plant MJ, Linton S, Dodd E, Jones PW, Dawes PT: The GALS locomotor screen and disability. Ann Rheum Dis 1993, 52:886-890.
• [17]Fox RA, Dacre JE, Clark CLI, Scotland AD: Impact on medical students of incorporating GALS screen teaching into the medical school curriculum. Ann Rheum Dis 2000, 59:668-671.
• [18]Lillicrap MS, Byrne E, Speed CA: Musculoskeletal assessment of general medical in-patients - joints still crying out for attention. Rheumatology 2003, 42:951-954.
• [19]SurveyMonkey http://surveymonkey.com/ webcite
• [20]Saleh K, Messner R, Axtell S, Harris I, Mahowald ML: Development and evaluation of an integrated musculoskeletal disease course for medical students. J Bone Joint Surg Am 2004, 86-A:1653-1658.
• [21]Woolf AD, Walsh NE, Akesson K: Global core recommendations for a musculoskeletal undergraduate curriculum. Ann Rheum Dis 2004, 63:517-524.
• [22]Hays RB: Practice-Based Teaching: A Guide for General Practitioners. Melbourne: Eruditions Publishing; 1999.
• [23]Fulford KWMB, Peile E, Carroll H: Essential values-based practice: clinical stories linking science with people. Cambridge: CUP; 2012.
• [24]Thistlethwaite JE: Values-based interprofessional collaborative practice: working together in healthcare. Cambridge: CUP; 2012.
• [25]Cooperrider DL, Srivastva S: Appreciative inquiry in organizational life. Stamford, CT: JAI Press; 1987.