Background: A recent survey of medical and surgical residents in the
United States suggested that our current training of physicians may be
inadequate to meet the increasing demand for diagnosis and treatment of
musculoskeletal disorders. In response, we developed an integrated,
multidisciplinary course to teach knowledge and skills related to
musculoskeletal disease to second-year medical students. A three-year
prospective outcomes study was conducted to evaluate the new course.
Methods: The primary outcomes that were studied during the first
year of the new course were the gains in knowledge, changes in levels of
confidence, and long-term retention of skills. Secondary outcomes consisted of
student and faculty satisfaction. Ten-item pre-tests and post-tests covering
core course concepts were administered to students. A matched-pairs t test was
used to evaluate the difference between pre-test and post-test scores.
Students were also asked to rate, on a 10-point scale, how much confidence
they had in their ability to perform the musculoskeletal physical examination
before and after the institution of the new curriculum. A general linear model
analysis with post hoc pairwise comparisons (F test) was used to evaluate the
changes in the confidence levels of the students. Also, a knee examination
station was organized to compare students' scores before and after revision of
the course. At the conclusion of the course, students rated each aspect of it
on a scale of 1 to 5. Instructors were asked to rate the effectiveness of all
elements of the course on the same scale.
Results: On the basis of student satisfaction and confidence and
faculty satisfaction, the most effective changes in the curriculum were the
introduction of a physical examination workshop and simulated clinical
situations. Students' knowledge increased significantly (p < 0.001), and
their level of confidence increased significantly in thirteen specifically
targeted areas (p < 0.0001). On the end-of-the-year examination assessing
retention of physical examination skills, the scores for the skills emphasized
in the revised course increased significantly whereas the scores for a skill
not emphasized in the course remained the same. Revisions made in the second
and third years after implementation of the course expanded the more
successful elements and further improved student ratings.
Conclusions: Integration of the three clinical disciplines related
to musculoskeletal disease—orthopaedics, rheumatology, and physical
medicine and rehabilitation—resulted in a highly effective introductory
course for second-year medical students. The heuristic strategy of introducing
core content through lectures and workshops followed by small-group teaching
sessions for practice with the new knowledge effectively increased students'
knowledge, confidence, and satisfaction.