Bilderback Karl, Eggerstedt Jane, Sadasivan Kalia K, Seelig Leonard, Wolf Robert, Barton Shane, McCall Richard, Chesson Andrew L, Marino Andrew A
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center-Shreveport, PO Box 33932, Shreveport, LA 71130-3932, USA.
J Bone Joint Surg Am. 2008 Oct;90(10):2292-300. doi: 10.2106/JBJS.G.01676.
The amount of time devoted to musculoskeletal medicine in the typical undergraduate curriculum is disproportionately low compared with the frequency of musculoskeletal complaints that occur in a general practice. Consequently, whether because of the quantity or quality of the education, the competence level of graduating physicians regarding musculoskeletal problems is inadequate. Our purposes were to design a self-contained, system-based course in musculoskeletal medicine for medical students in the preclinical years and to measure the level of competence achieved by a class of first-year medical students who took the course.
The course was formulated by faculty from the departments of orthopaedic surgery, anatomy, and rheumatology and included elements of both objectives-based and problem-centered curricular models. The clinical lectures were preceded by pertinent anatomy lectures and dissections to provide a context for the clinical information. The lectures on basic science were designed to rationalize and explicate clinical practices. Small-group activities were incorporated to permit engagement of the students in critical thinking and problem-solving. A general musculoskeletal physical examination was taught in two two-hour-long small-group sessions with the orthopaedic residents serving as instructors. Cognitive competency was evaluated with use of comprehensive anatomy laboratory and written examinations, the latter of which included a validated basic competency examination in musculoskeletal medicine. Process-based skills were evaluated in the small-group meetings and in a timed, mock patient encounter in which each student's ability to perform the general musculoskeletal physical examination was assessed.
The course lasted six weeks and consisted of forty-four lecture hours, seventeen hours of small-group meetings, and twenty-eight hours of anatomy laboratory. The average student score on the basic competency examination was 77.8%, compared with 59.6% for a historical comparison group (p < 0.05). Each student demonstrated the ability to adequately perform a general musculoskeletal physical examination in twenty minutes. The survey of student opinion after the course indicated a high level of student satisfaction.
The main features of the course were: (1) an emphasis on both cognitive and process-based knowledge; (2) more contact hours and broader content than in previously described courses in musculoskeletal medicine; (3) the use of small groups to focus on problem-solving and physical examination competencies; (4) basic-science content directly related to clinical goals. These features might be used at other institutions that employ a system-based curriculum for the preclinical years to help improve competence in musculoskeletal medicine.
与普通门诊中肌肉骨骼疾病的发生频率相比，典型本科课程中分配给肌肉骨骼医学的时间少得不成比例。因此，无论由于教育的数量还是质量，毕业医生在肌肉骨骼问题方面的能力水平都不足。我们的目的是为临床前阶段的医学生设计一门独立的、基于系统的肌肉骨骼医学课程，并评估参加该课程的一年级医学生所达到的能力水平。
该课程由骨科、解剖学和风湿病学系的教师制定，包括基于目标和以问题为中心的课程模式的要素。临床讲座之前先进行相关的解剖学讲座和解剖，为临床信息提供背景。基础科学讲座旨在使临床实践合理化并加以阐释。纳入小组活动，以使学生参与批判性思维和问题解决。在两个两小时的小组课程中教授一般肌肉骨骼体格检查，由骨科住院医师担任教员。通过综合解剖实验室和笔试评估认知能力，后者包括经过验证的肌肉骨骼医学基本能力考试。在小组会议和定时模拟患者问诊中评估基于过程的技能，在模拟问诊中评估每个学生进行一般肌肉骨骼体格检查的能力。
该课程为期六周，包括44个讲座小时、17个小时的小组会议和28个小时的解剖实验室。基础能力考试的平均学生成绩为77.8%，历史对照组为59.6%（p < 0.05）。每个学生都展示了在20分钟内充分进行一般肌肉骨骼体格检查的能力。课程结束后对学生意见的调查表明学生满意度很高。
该课程的主要特点是：（1）强调认知和基于过程的知识；（2）与先前描述的肌肉骨骼医学课程相比，有更多的接触时间和更广泛的内容；（3）使用小组专注于问题解决和体格检查能力；（4）基础科学内容与临床目标直接相关。这些特点可被其他在临床前阶段采用基于系统课程的机构使用，以帮助提高肌肉骨骼医学方面的能力。
