Department of Orthopedics, Ohio State University, Columbus, OH 43221, USA.
J Surg Educ. 2012 Mar-Apr;69(2):180-9. doi: 10.1016/j.jsurg.2011.07.015. Epub 2011 Sep 25.
While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents.
Prospective, uncontrolled, observational.
A major Midwestern tertiary referral center and academic medical center.
The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE.
Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%.
We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.
肌肉骨骼（MSK）体检（PE）是患者就诊的重要组成部分，但我们认为它是骨科住院医师教育中被低估的部分，并且住院医师的 PE 技能可能存在不足。本研究的目的是：（1）评估当今骨科住院医师对 PE 教学的态度；（2）开发一种 MSK 客观结构化临床检查（OSCE），以评估我们骨科住院医师的 MSK PE 知识和技能。
前瞻性、非对照、观察性。
中西部的一家主要三级转诊中心和学术医疗中心。
我们计划中的骨科住院医师。24 名住院医师中有 22 名完成了 OSCE。
调查显示，住院医师们一致认为，尽管学习体检很重要，但在临床实践中，他们没有足够的时间观察和评估住院医师对患者的检查。对于参加 OSCE 的 22 名住院医师（住院医师 2-5 年），总体得分为 66%。在创伤场景中的得分（78%；p<0.05）明显高于肩部（67%）、脊柱（64%）和膝关节（59%）。OSCE 的每个组成部分的总分分别为：（1）病史 53%；（2）体检 60%；（3）5 个问题的后测 64%；（4）沟通技巧 90%。
我们已经发现我们住院医师的体检知识和技能存在不足。仅仅在临床实践中可能不足以教授和学习 MSK PE。MSK OSCE 的使用，虽然在骨科中是新颖的，但可以更直接地观察我们住院医师的 MSK PE 技能，并且还可以让我们通过他们的培训跟踪住院医师技能的发展。我们希望我们的努力将鼓励其他计划评估他们的 PE 课程，并可能促使其发生改变。
