title: Design and implementation of a system-based course in musculoskeletal medicine for medical students.
abstract: BACKGROUND
  The amount of time devoted to musculoskeletal medicine in the typical undergraduate curriculum is disproportionately low compared with the frequency of musculoskeletal complaints that occur in a general practice. Consequently, whether because of the quantity or quality of the education, the competence level of graduating physicians regarding musculoskeletal problems is inadequate. Our purposes were to design a self-contained, system-based course in musculoskeletal medicine for medical students in the preclinical years and to measure the level of competence achieved by a class of first-year medical students who took the course.
  
  
  METHODS
  The course was formulated by faculty from the departments of orthopaedic surgery, anatomy, and rheumatology and included elements of both objectives-based and problem-centered curricular models. The clinical lectures were preceded by pertinent anatomy lectures and dissections to provide a context for the clinical information. The lectures on basic science were designed to rationalize and explicate clinical practices. Small-group activities were incorporated to permit engagement of the students in critical thinking and problem-solving. A general musculoskeletal physical examination was taught in two two-hour-long small-group sessions with the orthopaedic residents serving as instructors. Cognitive competency was evaluated with use of comprehensive anatomy laboratory and written examinations, the latter of which included a validated basic competency examination in musculoskeletal medicine. Process-based skills were evaluated in the small-group meetings and in a timed, mock patient encounter in which each student's ability to perform the general musculoskeletal physical examination was assessed.
  
  
  RESULTS
  The course lasted six weeks and consisted of forty-four lecture hours, seventeen hours of small-group meetings, and twenty-eight hours of anatomy laboratory. The average student score on the basic competency examination was 77.8%, compared with 59.6% for a historical comparison group (p < 0.05). Each student demonstrated the ability to adequately perform a general musculoskeletal physical examination in twenty minutes. The survey of student opinion after the course indicated a high level of student satisfaction.
  
  
  CONCLUSIONS
  The main features of the course were: (1) an emphasis on both cognitive and process-based knowledge; (2) more contact hours and broader content than in previously described courses in musculoskeletal medicine; (3) the use of small groups to focus on problem-solving and physical examination competencies; (4) basic-science content directly related to clinical goals. These features might be used at other institutions that employ a system-based curriculum for the preclinical years to help improve competence in musculoskeletal medicine.
authors.affiliation: Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center-Shreveport, PO Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Bilderback
authors.forename: Jane
authors.initials: J
authors.lastname: Eggerstedt
authors.forename: Kalia K
authors.initials: KK
authors.lastname: Sadasivan
authors.forename: Leonard
authors.initials: L
authors.lastname: Seelig
authors.forename: Robert
authors.initials: R
authors.lastname: Wolf
authors.forename: Shane
authors.initials: S
authors.lastname: Barton
authors.forename: Richard
authors.initials: R
authors.lastname: McCall
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Chesson
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Marino
mesh_terms: D000715:Anatomy / Q000193:education*; D002983:Clinical Competence; D003071:Cognition; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D006801:Humans; D009985:Orthopedics / Q000193:education*; D010808:Physical Examination; D016730:Program Development; D015397:Program Evaluation; D012219:Rheumatology / Q000193:education*