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Assessment of Musculoskeletal Examination Skills

Physiatry Residents as Evaluators and Models

Button, Jeanne H., MD; Bruel, Brian M., MD; Francisco, Gerard E., MD

American Journal of Physical Medicine & Rehabilitation: November 2007 - Volume 86 - Issue 11 - p 926-934
doi: 10.1097/PHM.0b013e318152027b
Education & Administration: Residency Training
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Button JH, Bruel BM, Francisco GE: Assessment of musculoskeletal examination skills: physiatry residents as evaluators and models. Am J Phys Med Rehabil 2007;86:926–934.

Objective: To evaluate the musculoskeletal examination (MSKE) skills of junior (postgraduate year [PGY] 2) physical medicine and rehabilitation (PM&R) residents and self-confidence with these skills, and to demonstrate changes in self-confidence in the MSKE skills of senior (PGY3 and PGY4) residents, who served as evaluators and models.

Design: Forty-one PGY2–4 residents participated in this retrospective cohort study, which was conducted within a residency program affiliated with two medical schools. Senior residents attended an instructional session in performing and evaluating MSKE skills, taught by a musculoskeletal physiatrist. The following week, junior residents were tested on their MSKE skills; nine seniors served as models, and another nine served as evaluators. Six seniors attended the instructional session only and did not participate in the evaluation. Juniors received a posttest teaching session on MSKE skills, before an unannounced repeat evaluation 5 mos later. All residents completed a survey regarding self-confidence in MSKE skills pre- and posttest teaching sessions. Performance of MSKE skills (based on PASSOR guidelines) and application of ACGME core competencies (medical knowledge, professionalism, interpersonal skills) were measured, and a survey was administered regarding self-confidence in MSKE skills.

Results: Posttest results showed a significant improvement of MSKE skills among juniors in the shoulder, lumbar spine, and knee examinations (P < 0.008), with the most robust improvement in the shoulder exam (P < 0.0001). Self-confidence of juniors in their MSKE skills increased significantly (P < 0.005). There was significant improvement (P < 0.008) in self-confidence in the MSKE skills of seniors who served as models and evaluators, but not in those who only attended the instructional session (P = 0.06).

Conclusions: This evaluation and instructional method resulted in a significant improvement of MSKE skills of junior residents on formal testing. Using senior residents as evaluators and models improved their confidence in their own MSKE skills.

From Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine/University of Texas Health Science Center, Houston, Texas.

All correspondence and requests for reprints should be addressed to Gerard E. Francisco, MD, 1333 Moursund Avenue, Suite E-108, Houston, TX 77030.

Presented in part at the 67th Annual Assembly of the American Academy of Physical Medicine and Rehabilitation, November, 2006, Honolulu, HI.

© 2007 Lippincott Williams & Wilkins, Inc.