Denq William, Lane Allison D, Tomesch Alex, Zagroba Sara, Cahir Thomas M, Waterbrook Anna
Emergency Medicine/Sports Medicine, University of Arizona College of Medicine - Tucson, Tucson, USA.
Emergency Medicine/Sports Medicine, University of Missouri, Columbia, USA.
Cureus. 2022 Dec 22;14(12):e32830. doi: 10.7759/cureus.32830. eCollection 2022 Dec.
Introduction Musculoskeletal (MSK) complaints and injuries account for a significant percentage of presenting chief complaints to the emergency department in the United States (US). Despite the prevalence of disease and economic impact on the US healthcare system, there is a documented deficiency in MSK education at all training and practicing levels in the US medical system. The purpose of this study is to determine MSK knowledge acquisition after an orthopedic or primary care sports medicine (PCSM) rotation in three emergency medicine (EM) residency programs at a single institution. Methods A total of 115 EM post-graduate year 1 (PGY-1) residents participated in and completed this study over five academic years. Based on existing residency program curricula, the participants were categorized into two groups. One group completed a traditional four-week Orthopedic Surgery rotation and the other group completed a four-week Sports Medicine rotation. The validated written Freedman and Bernstein MSK examination (FB-MSK) was administered to all participants at the start of residency and at completion of their rotation. Fifty-nine of the participants participated in a longitudinal secondary study over five academic years. The FB-MSK was offered to all participants every year following the completion of their rotation during their residency. Results Post-rotation scores improved regardless of which group the resident belonged to. The orthopedic group improved an average of 3.11 points (p = <0.0001, CI 2.39 to 3.82) and the average improvement in the PCSM group was 3.97 points (p = <0.0001, CI 2.81 to 5.83). The post-rotation scores were similar regardless of the group (p = 0.4287, CI -0.73 to 1.70). The amount of improvement in scores between the two groups was not statistically significant (p = 0.209, CI -0.49 to 2.21). Of the longitudinal participants, PGY-3+ significantly scored higher than PGY-1 (p = 0.0325, 95% CI 0.165 to 3.658). Conclusion Regardless of rotation type, MSK knowledge acquisition appears to significantly improve. EM senior residents demonstrate significant MSK knowledge acquisition during residency. Further studies on a multi-institutional level are needed to account for MSK curriculum variability in residency programs.
肌肉骨骼（MSK）疾病和损伤占美国急诊科就诊主要主诉的很大比例。尽管该疾病普遍存在且对美国医疗系统有经济影响，但美国医疗系统在所有培训和实践层面的MSK教育都存在记录在案的不足。本研究的目的是确定在单一机构的三个急诊医学（EM）住院医师培训项目中，经过骨科或初级保健运动医学（PCSM）轮转后，MSK知识的获取情况。方法：在五个学年中，共有115名EM一年级（PGY-1）住院医师参与并完成了本研究。根据现有的住院医师培训项目课程，将参与者分为两组。一组完成了为期四周的传统骨科手术轮转，另一组完成了为期四周的运动医学轮转。在住院医师培训开始时和轮转结束时，对所有参与者进行了经过验证的书面弗里德曼和伯恩斯坦MSK考试（FB-MSK）。59名参与者在五个学年中参与了一项纵向二次研究。在住院医师培训期间，每年在他们轮转结束后，都向所有参与者提供FB-MSK考试。结果：无论住院医师属于哪一组，轮转后的分数都有所提高。骨科组平均提高了3.11分（p = <0.0001，置信区间2.39至3.82），PCSM组的平均提高分数为3.97分（p = <0.0001，置信区间2.81至5.83）。无论哪一组，轮转后的分数相似（p = 0.4287，置信区间 -0.73至1.70）。两组之间分数提高的幅度没有统计学意义（p = 0.209，置信区间 -0.49至2.21）。在纵向参与者中，PGY-3及以上的得分显著高于PGY-1（p = 0.0325，95%置信区间0.165至3.658）。结论：无论轮转类型如何，MSK知识的获取似乎都有显著提高。EM高级住院医师在住院医师培训期间表现出显著的MSK知识获取。需要在多机构层面进行进一步研究，以考虑住院医师培训项目中MSK课程的差异。
