影响医学生骨骼肌肉系统知识和临床信心的因素。

Factors impacting musculoskeletal knowledge and clinical confidence in graduating medical students.

机构信息

Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for B.F. DiGiovanni:

Office of Curriculum and Assessment, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 601, Rochester, NY 14642.

出版信息

J Bone Joint Surg Am. 2014 Nov 5;96(21):e185. doi: 10.2106/JBJS.M.01283.

DOI:10.2106/JBJS.M.01283

PMID:25378518

Abstract

BACKGROUND

Despite the prevalence of musculoskeletal disorders, the degree to which medical schools are providing students with the knowledge and confidence to treat these problems is unclear. This study evaluated the factors that impact musculoskeletal knowledge and clinical confidence among fourth-year medical students.

METHODS

Over a three-year period, 253 fourth-year medical students participated in the study at a single institution. Musculoskeletal knowledge was evaluated using a National Board of Medical Examiners' musculoskeletal medicine subject examination. Factors analyzed included sex, class year, musculoskeletal elective experience, duration of musculoskeletal elective, career choice, and musculoskeletal curriculum satisfaction.

RESULTS

The participation rate was 95%. The mean National Board of Medical Examiners' musculoskeletal assessment score (and standard deviation) was 70.7 ± 9.5 points for all fourth-year medical students. Taking a musculoskeletal elective significantly increased knowledge (p < 0.001) but not clinical confidence. Increased satisfaction with how musculoskeletal medicine was taught was associated with increased clinical confidence (p < 0.001). No significant differences were seen if students were going into musculoskeletal medicine or primary care for either musculoskeletal knowledge or clinical confidence. Multivariate analysis of musculoskeletal knowledge found that taking a musculoskeletal elective for two weeks led to an increase of 6 points (from a possible 100 points) in the National Board of Medical Examiners' subject examination scores.

CONCLUSIONS

This study reveals that participation in a clinical elective is the only factor that led to a significant increase in musculoskeletal knowledge in fourth-year medical students. A two-week clinical elective can be sufficient time to have an impact on musculoskeletal knowledge, but it alone does not increase clinical confidence. Further studies are needed to determine how to improve musculoskeletal clinical confidence.

摘要

背景

尽管肌肉骨骼疾病较为普遍，但医学院向学生传授治疗这些疾病的知识和信心的程度尚不清楚。本研究评估了影响四年级医学生肌肉骨骼知识和临床信心的因素。

方法

在三年的时间里，253 名四年级医学生在一所机构参与了这项研究。肌肉骨骼知识通过美国医师执照考试委员会的肌肉骨骼医学科目考试进行评估。分析的因素包括性别、年级、肌肉骨骼选修经历、肌肉骨骼选修持续时间、职业选择和肌肉骨骼课程满意度。

结果

参与率为 95%。所有四年级医学生的美国医师执照考试委员会肌肉骨骼评估平均分数（和标准差）为 70.7 ± 9.5 分。选修肌肉骨骼课程可显著提高知识（p < 0.001），但不会提高临床信心。对肌肉骨骼医学教学满意度的增加与临床信心的增加相关（p < 0.001）。如果学生选择肌肉骨骼医学或初级保健作为职业，无论是在肌肉骨骼知识还是临床信心方面，都没有显著差异。肌肉骨骼知识的多变量分析发现，选修两周的肌肉骨骼课程可使美国医师执照考试委员会科目考试成绩增加 6 分（满分 100 分）。