title: Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents.
abstract: BACKGROUND
  Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum.
  
  
  METHODS
  We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills.
  
  
  RESULTS
  The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%.
  
  
  CONCLUSIONS
  We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.
authors.affiliation: Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Beran
authors.forename: Hisham
authors.initials: H
authors.lastname: Awan
authors.forename: David
authors.initials: D
authors.lastname: Rowley
authors.forename: Julie Balch
authors.initials: JB
authors.lastname: Samora
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Griesser
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Bishop
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D009141:Musculoskeletal System; D009985:Orthopedics / Q000193:education*; D010808:Physical Examination / Q000592:standards*; D010820:Physicians / Q000523:psychology*