Assessment of musculoskeletal examination skills: physiatry residents as evaluators and models.
OBJECTIVE
To evaluate the musculoskeletal examination (MSKE) skills of junior (postgraduate year [PGY] 2) physical medicine and rehabilitation (PM&R) residents and self-confidence with these skills, and to demonstrate changes in self-confidence in the MSKE skills of senior (PGY3 and PGY4) residents, who served as evaluators and models.


METHODS
Forty-one PGY2-4 residents participated in this retrospective cohort study, which was conducted within a residency program affiliated with two medical schools. Senior residents attended an instructional session in performing and evaluating MSKE skills, taught by a musculoskeletal physiatrist. The following week, junior residents were tested on their MSKE skills; nine seniors served as models, and another nine served as evaluators. Six seniors attended the instructional session only and did not participate in the evaluation. Juniors received a posttest teaching session on MSKE skills, before an unannounced repeat evaluation 5 mos later. All residents completed a survey regarding self-confidence in MSKE skills pre- and posttest teaching sessions. Performance of MSKE skills (based on PASSOR guidelines) and application of ACGME core competencies (medical knowledge, professionalism, interpersonal skills) were measured, and a survey was administered regarding self-confidence in MSKE skills.


RESULTS
Posttest results showed a significant improvement of MSKE skills among juniors in the shoulder, lumbar spine, and knee examinations (P < 0.008), with the most robust improvement in the shoulder exam (P < 0.0001). Self-confidence of juniors in their MSKE skills increased significantly (P < 0.005). There was significant improvement (P < 0.008) in self-confidence in the MSKE skills of seniors who served as models and evaluators, but not in those who only attended the instructional session (P = 0.06).


CONCLUSIONS
This evaluation and instructional method resulted in a significant improvement of MSKE skills of junior residents on formal testing. Using senior residents as evaluators and models improved their confidence in their own MSKE skills.
Physical Medicine and Rehabilitation Alliance, Baylor College of Medicine/University of Texas Health Science Center, Houston, Texas 77030, USA.
Jeanne H
JH
Button
Brian M
BM
Bruel
Gerard E
GE
Francisco
D002983:Clinical Competence; D005069:Evaluation Studies as Topic; D006801:Humans; D007396:Internship and Residency; D009141:Musculoskeletal System; D010808:Physical Examination; D010810:Physical and Rehabilitation Medicine / Q000193:education*; D012189:Retrospective Studies; D012649:Self Concept