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Evidence of educational inadequacies in region-specific musculoskeletal medicine.

ABSTRACT: Recent studies suggest US medical schools are not effectively addressing musculoskeletal medicine in their curricula. We examined if there were specific areas of weakness by analyzing students' knowledge of and confidence in examining specific anatomic regions. A cross-sectional survey study of third- and fourth-year students at Harvard Medical School was conducted during the 2005 to 2006 academic year. One hundred sixty-two third-year students (88% response) and 87 fourth-year students (57% response) completed the Freedman and Bernstein cognitive mastery examination in musculoskeletal medicine and a survey eliciting their clinical confidence in examining the shoulder, elbow, hand, back, hip, knee, and foot on a one to five Likert scale. We specifically analyzed examination questions dealing with the upper extremity, lower extremity, back, and others, which included more systemic conditions such as arthritis, metabolic bone diseases, and cancer. Students failed to meet the established passing benchmark of 70% in all subgroups except for the others category. Confidence scores in performing a physical examination and in generating a differential diagnosis indicated students felt below adequate confidence (3.0 of 5) in five of the seven anatomic regions. Our study provides evidence that region-specific musculoskeletal medicine is a potential learning gap that may need to be addressed in the undergraduate musculoskeletal curriculum.

SUBMITTER: Day CS

PROVIDER: S-EPMC2584311 | biostudies-other | 2008 Oct

REPOSITORIES: biostudies-other

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Project description:IntroductionWhile many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts.MethodsAn 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels.ResultsStudents demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups.DiscussionAn intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

Project description:BackgroundMusculoskeletal (MSK) disorders are less likely to be reported as an underlying cause of death (UCD) and since cause of death studies are generally limited to the UCD, little is known about socioeconomic inequalities in MSK disorders as cause of death in the general population. Using multiple-cause-of-death data, we aimed to quantify and compare educational inequalities in musculoskeletal (MSK) disorders- with non-MSK disorders-related mortality.MethodsAll residents aged 30-99 years in the Skåne region, Sweden, during 1998-2013 (n = 999,148) were followed until their 100th birthday, death, relocation outside Skåne, or end of 2014. We identified any mention of rheumatoid arthritis (RA) or other MSK disorders on death certificates using multiple-cause-of-death data. We retrieved and linked individual-level data from Statistics Sweden on highest level of education. We used Cox regression and additive hazards models with age as time-scale adjusted for sex, marital status, and country of birth to calculate slope and relative indices of inequality (SII/RII).ResultsDuring a mean follow-up of 12.2 years, there were 1407 (0.8% of all deaths) and 3725 (2.1% of all deaths) death certificates with mention of RA and other MSK disorders, respectively, and 171,798 death certificates without any mention of a MSK disorder. Age-standardized RA mortality rate was 2.2 (95% confidence interval [CI]: 2.0-2.8) times greater in people with 0-9 years of education compared with those with > 12 years of education. Corresponding figure for other MSK disorders was 1.5 (95% CI: 1.4-1.6). Both RIIs and SIIs revealed statistically significant educational inequalities in RA/other MSK disorders mortality favouring high-educated people. The RIIs of MSK disorders-related deaths were generally greater than non-MSK disorders-related deaths.ConclusionWe found substantial educational inequality in mortality from MSK disorders. Further research is needed to investigate underlying pathways driving these inequalities.

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Evidence of educational inadequacies in region-specific musculoskeletal medicine.

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