title: Development and validation of a musculoskeletal physical examination decision-making test for medical students.
abstract: OBJECTIVE
  Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees.
  
  
  METHODS
  We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate.
  
  
  METHODS
  Academic medical center in the Midwestern United States.
  
  
  METHODS
  Orthopedic residents, chairmen, and medical students.
  
  
  RESULTS
  Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, p<0.001). The physical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, p<0.001), but were not significantly different for either class.
  
  
  CONCLUSIONS
  The physical examination decision-making test was found to be internally consistent in exposing the deficiencies of musculoskeletal education skills of our medical students and differentiated between ability levels in musculoskeletal physical examination decision-making (residents vs recently instructed musculoskeletal students vs 1 year post-musculoskeletal instruction).
authors.affiliation: Department of Orthopaedics, Ohio State University Medical Center, Columbus, Ohio 43221, USA. Julie.Bishop@osumc.edu
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Bishop
authors.forename: Hisham M
authors.initials: HM
authors.lastname: Awan
authors.forename: David M
authors.initials: DM
authors.lastname: Rowley
authors.forename: Rollin W
authors.initials: RW
authors.lastname: Nagel
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D003657:Decision Making; D004501:Education, Medical / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000175:diagnosis*; D009985:Orthopedics / Q000193:education*; D010808:Physical Examination