Cummings Danielle L, Smith Matthew, Merrigan Brian, Leggit Jeffrey
Department of Orthopaedic Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
Department of Anesthesiology, San Antonio Military Medical Center, San Antonio, Texas, USA.
BMJ Open Sport Exerc Med. 2019 Mar 1;5(1):e000495. doi: 10.1136/bmjsem-2018-000495. eCollection 2019.
Musculoskeletal (MSK) complaints comprise a large proportion of outpatient visits. However, multiple studies show that medical school curriculum often fails to adequately prepare graduates to diagnose and manage common MSK problems. Current standardised exams inadequately assess trainees' MSK knowledge and other MSK-specific exams such as Freedman and Bernstein's (1998) exam have limitations in implementation. We propose a new 30-question multiple choice exam for graduating medical students and primary care residents. Results highlight individual deficiencies and identify areas for curriculum improvement.
METHODS/RESULTS: We developed a bank of multiple choice questions based on 10 critical topics in MSK medicine. The questions were validated with subject-matter experts (SMEs) using a modified Delphi method to obtain consensus on the importance of each question. Based on the SME input, we compiled 30 questions in the assessment. Results of the large-scale pilot test (167 post-clerkship medical students) were an average score of 74 % (range 53% - 90 %, SD 7.8%). In addition, the tool contains detailed explanations and references were created for each question to allow an individual or group to review and enhance learning.
The proposed MSK30 exam evaluates clinically important topics and offers an assessment tool for clinical MSK knowledge of medical students and residents. It fills a gap in current curriculum and improves on previous MSK-specific assessments through better clinical relevance and consistent grading. Educators can use the results of the exam to guide curriculum development and individual education.
肌肉骨骼（MSK）疾病在门诊就诊中占很大比例。然而，多项研究表明，医学院课程往往未能让毕业生充分做好诊断和处理常见MSK问题的准备。当前的标准化考试对实习生的MSK知识评估不足，而其他MSK专项考试，如弗里德曼和伯恩斯坦（1998年）的考试，在实施方面存在局限性。我们为即将毕业的医学生和初级保健住院医师提出了一项新的30道选择题考试。结果突出了个人的不足之处，并确定了课程改进的领域。
方法/结果：我们根据MSK医学的10个关键主题编制了一组选择题。通过改良的德尔菲法与主题专家（SME）对这些问题进行验证，以就每个问题的重要性达成共识。根据SME的意见，我们在评估中编制了30道问题。大规模试点测试（167名实习后医学生）的结果是平均成绩为74%（范围为53% - 90%，标准差7.8%）。此外，该工具包含详细解释，并为每个问题创建了参考文献，以便个人或小组进行复习和强化学习。
提议的MSK30考试评估临床重要主题，并为医学生和住院医师的临床MSK知识提供了一种评估工具。它填补了当前课程的空白，并通过更好的临床相关性和一致的评分改进了以前的MSK专项评估。教育工作者可以利用考试结果来指导课程开发和个人教育。
