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The Journal of Bone and Joint Surgery (American) 86:1653-1658 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Development and Evaluation of an Integrated Musculoskeletal Disease Course for Medical Students

Khaled Saleh, MD, MSc, FRCSC1, Ronald Messner, MD2, Sara Axtell, PhD3, Ilene Harris, PhD3 and Maren L. Mahowald, MD4

1 Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Charlottesville, VA 22908
2 Division of Rheumatology, Department of Medicine, University of Minnesota, 492-420 Delaware Street S.E., Minneapolis, MN 55455
3 Medical School Office of Education, Educational Development and Research, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN 55455
4 Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55455

Investigation performed at University of Minnesota, Minneapolis, Minnesota

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Veterans Administration, the Herz Family Fund, the Minnesota Medical Foundation Rheumatology Research and Education Fund, and the Orthopaedic Research and Education Foundation. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (Smith and Nephew and Stryker Orthopaedics) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.


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