Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions
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.
To evaluate the impact of bedside feedback on learner’s shoulder examination skills, confidence, and knowledge of common shoulder conditions.
Four-week musculoskeletal clinic rotation.
UCSD third year medical students and internal medicine residents.
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.
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.
Direct observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.
KeywordsMusculoskeletal Shoulder examination Direct observation Competency-based medical education Primary care
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.
- 1.United States Bone and Joint Initiative. Why Is the United States Bone and Joint Initiative Important? Available at http://ww.usbji.org/about/impact. Accessed June 23, 2017.
- 5.US Department of Veteran Affairs. 2015. VA Health Care Utilization by Recent Veterans. Available at http://www.publichealth.va.gov/epidemiology/reports/oefoifond/health-care- utilization/. Accessed June 23, 2017.
- 6.United States Bone and Joint Initiative. The Burden of Musculoskeletal Diseases in the United States. The Big Picture: Health Care Utilization and Economic Cost. Available at http://www.boneandjointburden.org/2014-report/if0/health-care-utilization-and-economic-cost. Accessed June 23, 2017.
- 18.Association of American Medical Colleges. Report VII contemporary issues in medicine: musculoskeletal medicine education. Medical School Objectives Project. Available at: https://members.aamc.org/eweb/upload/Contemporary%20Issues%20in%20Med%20Musculoskeletal%20Med%20Report%20VII%20.pdf . Accessed June 23, 2017.
- 34.United States Bone and Joint Initiative. Project 100: undergraduate musculoskeletal education. Available at http://www.usbji.org/programs/project-100. Accessed June 23, 2017.
- 40.StatSoft, Inc. Electronic Statistics Textbook. Tulsa: StatSoft; 2013.Google Scholar
- 44.Halman S, Dudek N, Wood T et al. Direct observation of clinical skills feedback scale: development and validity evidence. Teach Learn Med 2016; 10:1-10.Google Scholar