title: Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students.
abstract: OBJECTIVE
  To identify whether there was measurable impact of a specific computer-assisted learning (CAL) package, "Virtual Rheumatology," on the learning of musculoskeletal examination skills by medical students.
  
  
  METHODS
  We conducted 2 parallel, cluster-randomized controlled trials using undergraduate curricula at 2 locations: Newcastle and London, UK. Medical students attending a musculoskeletal rotation were allocated to the intervention (Virtual Rheumatology CD) or the control arm of the study by placement group. A formative 14-item objective structured clinical examination (OSCE) assessment on the examination of shoulder and/or knee joints was the main outcome measure at Newcastle. At London, a 17-item knee station formed part of the summative OSCE. We also used a questionnaire including a 15-item confidence log (C-Log) for self assessment of musculoskeletal examination skills and knowledge. Analysis was by intention to teach.
  
  
  RESULTS
  At Newcastle, there were 112 students in the CD allocated group and 129 in the non-CD group. The CD allocated group performed significantly better on the OSCE (P = 0.002) and C-Log (P = 0.005) than the non-CD group. At London, there were 48 students in the CD allocated group and 65 in the non-CD group. The CD allocated group performed better on the knee OSCE than the non-CD group (adjusted P = 0.040), but there was little difference in the change in C-Log scores from baseline to followup between the 2 groups (P = 0.582).
  
  
  CONCLUSIONS
  The Virtual Rheumatology CD has a positive impact on the acquisition of musculoskeletal examination skills in medical students. Further study is needed to see if similar advantages could be gained in other clinical specialities and how CAL resources could be effectively integrated into the medical curriculum.
authors.affiliation: Keele University, North Staffordshire, UK. pra23@keele.ac.uk
authors.forename: Pirashanthie
authors.initials: P
authors.lastname: Vivekananda-Schmidt
authors.forename: Martyn
authors.initials: M
authors.lastname: Lewis
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Hassell
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D003479:Curriculum; D019937:Diagnostic Techniques and Procedures; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D009141:Musculoskeletal System / Q000503:physiopathology; D009985:Orthopedics / Q000193:education*; D011897:Random Allocation; D012219:Rheumatology / Q000193:education*; D011795:Surveys and Questionnaires