title: Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course.
abstract: BACKGROUND
  Professional bodies have expressed concerns that medical students lack appropriate knowledge in musculoskeletal medicine despite its high prevalence of use within the community. Changes in curriculum and teaching strategies may be contributing factors to this. There is little evidence to evaluate the degree to which these concerns are justified.
  
  
  OBJECTIVE
  To design and evaluate an assessment procedure that tests the progress of medical students in achieving a core level of knowledge in musculoskeletal medicine during the course.
  
  
  METHODS
  A stratified sample of 136 volunteer students from all 5 years of the medical course at Sheffield University.
  
  
  METHODS
  The progress test concept was adapted to provide a cross-sectional view of student knowledge gain during each year of the course. A test was devised which aimed to provide an assessment of competence set at the standard required of the newly qualified doctor in understanding basic and clinical sciences relevant to musculoskeletal medicine. The test was blueprinted against internal and external guidelines. It comprised 40 multiple-choice and extended matching questions administered by computer. Six musculoskeletal practitioners set the standard using a modified Angoff procedure.
  
  
  RESULTS
  Test reliability was 0.6 (Cronbach's alpha). Mean scores of students increased from 41% in Year 1 to 84% by the final year. Data suggest that, from a baseline score in Year 1, there is a disparate experience of learning in Year 2 that evens out in Year 3, with knowledge progression becoming more consistent thereafter. All final year participants scored above the standard predicted by the Angoff procedure.
  
  
  CONCLUSIONS
  This short computer-based test was a feasible method of estimating student knowledge acquisition in musculoskeletal medicine across the undergraduate curriculum. Tested students appear to have acquired a satisfactory knowledge base by the end of the course. Knowledge gain seemed relatively independent of specialty-specific clinical training. Proposals from specialty bodies to include long periods of disciplinary teaching may be unnecessary.
authors.affiliation: Academic Unit of Medical Education, University of Sheffield, Northern General Hospital, Sheffield, UK.
authors.forename: Subhashis
authors.initials: S
authors.lastname: Basu
authors.forename: Chris
authors.initials: C
authors.lastname: Roberts
authors.forename: David I
authors.initials: DI
authors.lastname: Newble
authors.forename: Michael
authors.initials: M
authors.lastname: Snaith
mesh_terms: D003201:Computers; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000592:standards; D004739:England; D006801:Humans; D009141:Musculoskeletal System; D010865:Pilot Projects; D015203:Reproducibility of Results