Abstract
To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors’ surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system.
Key Points • Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes • Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders • An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine • A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray |
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Synopsis
Knowledge of musculoskeletal structure and function is essential in the practice of rheumatology. The authors describe an active learning, case-centered teaching methodology they have used in musculoskeletal clinical anatomy seminars since 2006. These seminars, with an optimal participant to instructor ratio of 10 to one, are based on case discussions and the cross-examination of participants and instructors. Pre-seminar surveys have consistently revealed a minimal recollection of the musculoskeletal anatomy as taught in medical school. There is no proof of the long-term efficacy of the method. However, the consistency of encouraging participants’ comments and the many invitations to replicate the seminars at regional and national rheumatologic meetings indicate a favorable perception of the method. Indeed, the short-term efficacy of the method was shown in three studies.
Part of the Topical Collection entitled ‘Empowering Medical Education to Transform: Learnings from an international perspective’
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Villaseñor-Ovies, P., Navarro-Zarza, J.E. & Canoso, J.J. The rheumatology physical examination: making clinical anatomy relevant. Clin Rheumatol 39, 651–657 (2020). https://doi.org/10.1007/s10067-019-04725-9
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DOI: https://doi.org/10.1007/s10067-019-04725-9