title: Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training.
abstract: OBJECTIVE
  While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents.
  
  
  METHODS
  Prospective, uncontrolled, observational.
  
  
  METHODS
  A major Midwestern tertiary referral center and academic medical center.
  
  
  METHODS
  The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE.
  
  
  RESULTS
  Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%.
  
  
  CONCLUSIONS
  We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.
authors.affiliation: Department of Orthopedics, Ohio State University, Columbus, OH 43221, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Griesser
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Beran
authors.forename: David C
authors.initials: DC
authors.lastname: Flanigan
authors.forename: Michael
authors.initials: M
authors.lastname: Quackenbush
authors.forename: Corey
authors.initials: C
authors.lastname: Van Hoff
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Bishop
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D009985:Orthopedics / Q000193:education*; D010808:Physical Examination / Q000379:methods*; D018794:Problem-Based Learning / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement; D011795:Surveys and Questionnaires; D014481:United States