Assistant Professor, Department of Medicine, Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta.
Postdoctoral Fellow, IDEAS (Innovation Discovery Education and Scholarship) Office, Faculty of Medicine and Dentistry, University of Alberta.
MedEdPORTAL. 2020 Sep 4;16:10945. doi: 10.15766/mep_2374-8265.10945.
Musculoskeletal (MSK) disorders are very common, but suboptimal teaching of MSK medicine occurs and expert clinicians agree that MSK physical examination (PE) skills can be confusing and complicated for medical students. An innovative approach in introductory teaching of MSK PE skills was developed using constructivist theory for second-year medical students.
We implemented the MSK PE curriculum innovation in the second year of a four-year MD program, utilizing a standard framework with spaced practice and clinician coaching. We evaluated this curriculum by comparing the innovation group ( = 123) to a historical control group ( = 134) using an anonymous survey and OSCE station scores. Data analysis included repeated measures analysis of variance comparing students' self-confidence in MSK PE to students' self-confidence in other systems-based PEs, as well as independent -test comparisons of self-confidence scores and MSK-specific OSCE station scores between the historical and innovation groups.
The mean self-assessed confidence of the historical group was significantly lower for the MSK PE than all other PEs ( < 0.001), except for the neurological PE. Significant improvement in MSK PE self-confidence was noted with the innovation group ((259) = -4.05, < 0.001). OSCE scores significantly improved in MSK-specific stations, with medium to large effect size across the different stations.
We successfully used a framework of deconstruction, repetition, and spaced practice to develop fundamental MSK PE skills in preclerkship medical students. This curriculum structure provides an effective example for teaching introductory MSK PE skills to early medical learners.
肌肉骨骼（MSK）疾病非常常见，但医学专业的 MSK 教学效果并不理想，专家临床医生也认为，对于医学生来说，MSK 体格检查（PE）技能可能令人困惑且复杂。我们采用建构主义理论，为医学生的 MSK PE 技能引入了一种创新的入门教学方法。
我们在四年制医学课程的第二年实施了 MSK PE 课程创新，利用有间隔练习和临床医生辅导的标准框架。我们通过匿名调查和 OSCE 站点评分，将创新组（n = 123）与历史对照组（n = 134）进行比较，评估了这一课程。数据分析包括重复测量方差分析，比较学生对 MSK PE 的自我信心与学生对其他基于系统的 PE 的自我信心，以及历史组和创新组之间自我信心评分和 MSK 特定 OSCE 站点评分的独立样本 t 检验比较。
历史组的平均自我评估信心明显低于所有其他 PE（<0.001），除了神经 PE。创新组的 MSK PE 自我信心显著提高（t(259) = -4.05，<0.001）。MSK 特定站点的 OSCE 评分显著提高，不同站点的效应量为中到大。
我们成功地使用了解构、重复和有间隔练习的框架，在预科医学生中发展了基本的 MSK PE 技能。这种课程结构为向早期医学学习者教授入门 MSK PE 技能提供了一个有效的范例。
