Journal of General Internal Medicine

, Volume 32, Issue 11, pp 1261–1265 | Cite as

Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions

  • Michal Kalli Hose
  • John Fontanesi
  • Manjulika Woytowitz
  • Diego Jarrin
  • Anna Quan
Innovation and Improvement: Innovations in Medical Education

Abstract

Background

Deficiencies in musculoskeletal knowledge are reported at every stage of learning. Medical programs are looking for effective ways to incorporate competency-based training into musculoskeletal education.

Aim

To evaluate the impact of bedside feedback on learner’s shoulder examination skills, confidence, and knowledge of common shoulder conditions.

Setting

Four-week musculoskeletal clinic rotation.

Participants

UCSD third year medical students and internal medicine residents.

Program description

Learners completed three baseline evaluations: videotaped shoulder examination, attitude survey, and knowledge test. During the 4-week intervention learners received bedside observation and feedback from musculoskeletal experts while evaluating patients with shoulder conditions. Post-intervention learners repeated the three assessments.

Program evaluation

Eighty-nine learners participated. In the primary outcome measure evaluating the pre/post videotaped shoulder examination, significant improvement was seen in 21 of 23 shoulder examination maneuvers. Secondary outcomes include changes in learner confidence and knowledge. Greatest gains in learner confidence were seen in performing the shoulder examination (61.5% improvement) and performing injections (97.1% improvement). Knowledge improved significantly in all categories including anatomy/examination interpretation, diagnosis, and procedures.

Discussion

Direct observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.

Keywords

Musculoskeletal Shoulder examination Direct observation Competency-based medical education Primary care 

Notes

Acknowledgements

The authors would like to offer appreciation to Leonie Heyworth in the General Internal Medicine Department of the San Diego VA Medical Center for her editorial assistance. Funding for the standardized patients was supported by the Center for Applied Research in Education through the UCSD Department of Medicine, Division of General Internal Medicine. The authors received no funding for this study and report no declarations of interest. A poster of this article was presented at the Society of General Internal Medicine California-Hawaii Regional meeting on 1/21/17, where it received first place in the innovations category.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

Supplementary material

11606_2017_4143_MOESM1_ESM.docx (16 kb)
Online Appendix A(DOCX 15 kb)
11606_2017_4143_MOESM2_ESM.docx (14 kb)
Online Appendix B(DOCX 13 kb)
11606_2017_4143_MOESM3_ESM.docx (15 kb)
Online Appendix C(DOCX 15 kb)
11606_2017_4143_MOESM4_ESM.docx (15 kb)
Online Appendix D(DOCX 15 kb)
11606_2017_4143_MOESM5_ESM.docx (73 kb)
Online Appendix E(DOCX 72 kb)

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Copyright information

© Society of General Internal Medicine (outside the USA) 2017

Authors and Affiliations

  • Michal Kalli Hose
    • 1
    • 2
  • John Fontanesi
    • 3
  • Manjulika Woytowitz
    • 1
    • 2
  • Diego Jarrin
    • 1
    • 2
  • Anna Quan
    • 1
    • 2
  1. 1.VA San Diego Healthcare SystemSan DiegoUSA
  2. 2.University of California San DiegoLa JollaUSA
  3. 3.Family and Preventive MedicineUniversity of California San DiegoLa JollaUSA

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