Davis Konnor, Frank Aaron, Alcala-Arcos Trinidad, Godenzi Claire, Allison Melissa, Riggle Clara, Sakaria Sangeeta, Nelson Ariana M, Wray Alisa, Kim Brian Y
University of California, Irvine, School of Medicine, Irvine, CA.
University of California, Davis, Department of Emergency Medicine, Sacramento, CA.
J Educ Teach Emerg Med. 2025 Jul 31;10(3):SG1-SG8. doi: 10.21980/J8RQ0N. eCollection 2025 Jul.
The target audience for this small group session focused on the cervical spine and back musculoskeletal physical exam is medical students of all levels, although it is most useful for those early in their career such as first- and second-year medical students. These videos can also be used for other health care professionals such as physicians, physician associates, nurses, or nurse practitioners learning or refreshing their physical exam skills.
The physical exam (PE) is one of the core components of a physician's toolkit and learning to perform the neck and back exam is important. When done correctly, physical exams are a useful tool in evaluating patients and in creating a differential diagnosis. This is especially true for many patient concerns such as neck and back pain and in specialties such as neurology where diagnoses may be established using empiric observation by trained clinicians.1Beginning in 2019, the University of California, Irvine, School of Medicine (UCISOM) revised the physical exam portion of the Clinical Foundations (CF; "doctoring" course) which serves as a four-year longitudinal course for UCISOM students to learn, practice, and improve their history-taking, physical exam, differential diagnosis, and physicianship skills. Focusing on the PE component of the curriculum, a team of physicians reviewed the materials utilized to teach all PE sessions, and these videos specifically, the cervical spine and back musculoskeletal PE for the first- and second-year students. These materials included book chapters and third-party videos; additionally, student and physician feedback were reviewed. Previous student feedback felt that the third-party videos were not engaging and too long (run length per video was upwards of 60 minutes), and students requested videos with slightly more detail for future clinical exams. Utilizing the UCISOM clinical faculty and standardized patients (SP), a team of physician educators and students researched PE best practices for the cervical spine and back musculoskeletal physical exam and developed new video scripts and slides, and ultimately filmed, edited, and produced a series of eight videos demonstrating the cervical and back musculoskeletal PE maneuvers. These videos were one part of a series of fifty-six PE videos developed for learners of a comprehensive physical exam. Other portions of the series focus on vital signs, the cardiovascular exam, pulmonary exam, gastrointestinal exam, neurological exam, head, eyes, ears, nose and throat, and upper and lower extremity exams.
By the end of this session, students will be able to: 1) demonstrate how to properly perform a cervical spine and back physical exam, 2) understand the reasoning behind cervical spine and back PE maneuvers, 3) identify the proper technique and equipment to use for the cervical spine and back PE, 4) understand normal and abnormal findings in the cervical spine and back PE, 5) accurately record and report exam findings for the cervical spine and back PE.
The first-year medical student physical exam small group sessions used a flipped classroom model with the videos serving as a learning resource center (LRC) followed by an in-person, hands-on PE session with standardized patients (SP) led by a Dean's Scholar.Prior to the in-person session, the students were required to watch, at minimum, the English cervical spine and back "Full Video" physical exam. Bilingual Spanish speaking students in the UCISOM PRIME-LC (Program in Medical Education for the Latino Community) cohort were also encouraged to watch the Spanish "Full Videos" because their hands-on sessions are completed in Spanish. Learners were also given the option to read about the physical exam, its purpose and steps to perform each maneuver via the Bates Guide to Physical Examination and History Taking which is available via the UCISOM Library.The in-person, hands-on cervical spine and back musculoskeletal PE sessions occurred in a large group setting with approximately fifty students and four to six faculty members present; students were separated into groups of three to six students at a table with a standardized patient, and the session occurred over the span of two hours. When students arrived at the PE didactic session, the cervical spine and back musculoskeletal exam was discussed, and then groups would practice the PE with the facilitator and standardized patient using the video to guide the examination.
After completion of the small group session, learners from the first- and second-year medical school classes were encouraged to complete a Qualtrics survey regarding the videos and small group sessions. The survey asked students if they felt the videos were helpful, whether they made them more confident at performing physical exams, and if they had high production quality.
As of January 2023, the musculoskeletal cervical spine and back videos received 372 views and downloads, 318 unique viewers, and delivered 1,776 minutes of content. Thirty-one learners (response rate of approximately 25%) responded to the survey. The educational quality of all the musculoskeletal videos, including cervical spine and back, averaged 4.71 out of 5, the usefulness averaged 4.63 out of 5, and the production quality averaged 4.56 out of 5.
Based on the results from our survey as well as end-of-course feedback and verbal feedback sessions with leaners, we deem this educational content efficacious. The videos and all content related to them (eg, scripts, graphics, voice over) were assessed by a team of seven physicians. We feel the efficacy of the videos increases when implemented with other modalities of LRC such as written material or podcasts. Using multiple other modalities allows learners to experiment and utilize the modality that will aid their learning the best. Importantly, we also learned from the implementation of the videos that auto-generated subtitles for the videos in Spanish were often incorrect. This was in part due to the learning management system used to maintain the videos, but also could have been alleviated by including subtitles within the videos themselves. Overall, video content demonstrating these maneuvers, both with and without additional graphics and voice-over, and in two languages, was highly efficacious for UCISOM students in the CF course.
Physical exam, cervical spine, neck, back, low back, musculoskeletal, video, voice-over, medical student education.
本次聚焦于颈椎和背部肌肉骨骼体格检查的小组课程的目标受众是各级医学生，不过对于那些处于职业生涯早期的学生，如一年级和二年级医学生最为有用。这些视频也可用于其他医疗保健专业人员，如医生、医师助理、护士或执业护士，用于学习或复习他们的体格检查技能。
体格检查（PE）是医生工具包的核心组成部分之一，学习进行颈部和背部检查很重要。如果操作正确，体格检查是评估患者和进行鉴别诊断的有用工具。对于许多患者关心的问题，如颈部和背部疼痛，以及在神经学等专科中，通过训练有素的临床医生的经验观察来建立诊断时，情况尤其如此。1从2019年开始，加利福尼亚大学欧文分校医学院（UCISOM）修订了临床基础（CF；“临床实践”课程）的体格检查部分，该课程是UCISOM学生学习、练习和提高病史采集、体格检查、鉴别诊断和临床技能的四年纵向课程。专注于课程的体格检查部分，一组医生审查了用于教授所有体格检查课程的材料，特别是这些视频，即针对一年级和二年级学生的颈椎和背部肌肉骨骼体格检查。这些材料包括书籍章节和第三方视频；此外，还审查了学生和医生的反馈。以前的学生反馈认为第三方视频缺乏吸引力且过长（每个视频时长超过60分钟），学生们要求为未来的临床检查提供更详细一些的视频。利用UCISOM临床教员和标准化病人（SP），一组医生教育工作者和学生研究了颈椎和背部肌肉骨骼体格检查的最佳实践，并编写了新的视频脚本和幻灯片，最终拍摄、编辑并制作了一系列八个视频，展示颈椎和背部肌肉骨骼体格检查动作。这些视频是为全面体格检查学习者开发的56个体格检查视频系列的一部分。该系列的其他部分聚焦于生命体征、心血管检查、肺部检查、胃肠道检查、神经学检查、头、眼、耳、鼻、喉以及上肢和下肢检查。
在本课程结束时，学生将能够：1）演示如何正确进行颈椎和背部体格检查，2）理解颈椎和背部体格检查动作背后的原理，3）识别用于颈椎和背部体格检查的正确技术和设备，4）理解颈椎和背部体格检查中的正常和异常发现，5）准确记录和报告颈椎和背部体格检查的结果。
一年级医学生体格检查小组课程采用翻转课堂模式，视频作为学习资源中心（LRC），随后由院长奖学金获得者带领进行与标准化病人（SP）面对面的实践体格检查课程。在面对面课程之前，学生至少需要观看英语版本的颈椎和背部“完整视频”体格检查。UCISOM PRIME-LC（拉丁裔社区医学教育项目）队列中会说西班牙语的双语学生也被鼓励观看西班牙语“完整视频”，因为他们的实践课程是用西班牙语完成的。学习者还可以选择通过UCISOM图书馆提供的《贝茨体格检查与病史采集指南》阅读有关体格检查、其目的以及执行每个动作的步骤。与标准化病人面对面的颈椎和背部肌肉骨骼体格检查课程在一个大约有50名学生和4至6名教员在场的大组环境中进行；学生们被分成每组三到六名学生，与一名标准化病人坐在一张桌子旁，课程持续两个小时。当学生到达体格检查理论课程时，会讨论颈椎和背部肌肉骨骼检查，然后各小组在指导教师和标准化病人的指导下，使用视频来指导检查，进行体格检查实践。
在小组课程结束后，鼓励医学院一年级和二年级的学生完成一份关于视频和小组课程的Qualtrics调查问卷。该调查询问学生他们是否觉得视频有帮助，是否让他们在进行体格检查时更有信心，以及视频的制作质量是否高。
截至2023年1月，肌肉骨骼颈椎和背部视频获得了372次观看和下载，318名独立观看者，提供了1776分钟的内容。31名学习者（回复率约为25%）回复了调查问卷。所有肌肉骨骼视频，包括颈椎和背部的视频，教育质量平均为4.71分（满分5分），有用性平均为4.63分（满分5分），制作质量平均为4.56分（满分5分）。
根据我们的调查结果以及课程结束时的反馈和与学习者的口头反馈会议，我们认为这个教育内容是有效的。视频以及与它们相关的所有内容（如脚本、图形、画外音）由一组七名医生进行了评估。我们认为，当与书面材料或播客等其他学习资源中心的形式一起实施时，视频的效果会增强。使用多种其他形式可以让学习者进行尝试，并利用最有助于他们学习的形式。重要的是，我们也从视频的实施过程中学到，西班牙语视频的自动生成字幕经常有误。这部分是由于用于维护视频的学习管理系统，但也可以通过在视频本身中包含字幕来缓解。总体而言，展示这些动作的视频内容，无论有无额外的图形和画外音，以及两种语言版本，对CF课程中的UCISOM学生都非常有效。
体格检查、颈椎颈椎、颈部、背部、下背部、肌肉骨骼、视频、画外音、医学生教育
