From the Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (JB, SK, NE, DP); Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (HLL); University of Hawaii School of Medicine, Honolulu, Hawaii (HLL); Kessler Institution for Rehabilitation and Kessler Foundation, West Orange, New Jersey (SK); and Department of Physical Medicine & Rehabilitation, VA New Jersey Health Care System, East Orange, New Jersey (RTM).
Am J Phys Med Rehabil. 2020 Dec;99(12):1177-1183. doi: 10.1097/PHM.0000000000001487.
Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents' palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course's upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.
研究表明，物理医学与康复住院医师体表解剖触诊准确性较差，这表明需要找到新的肌肉骨骼（MSK）检查教学方法。本研究描述了一种新的 MSK 超声课程的设计，该课程将超声技能与触诊技能相结合。超声用于教授、验证和完善物理医学与康复住院医师对 MSK 结构的触诊。体表解剖触诊与超声密切相关，因为临床医生应该使用触诊来指导他们的超声检查，而不是纯粹遵循算法。本研究评估了超声课程是否能提高物理医学与康复住院医师在 12 个上肢结构上的触诊准确性。在住院医师培训开始时和完成上肢部分的超声课程后几周进行触诊准确性测试，以评估技能的保留情况。从预测试到后测试，12 个部位中有 9 个部位的准确性显著提高（P < 0.05）。8 个结构中有 8 个结构的课程后触诊准确性在 1cm 以内。本研究表明，MSK 超声和触诊综合课程可提高多个 MSK 结构的触诊准确性，并且这种提高是可以保持的。物理医学与康复住院医师应考虑将触诊技能纳入其超声课程，以提高学员的素质。
