title: Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study.
abstract: BACKGROUND
  The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills.
  
  
  METHODS
  All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test.
  
  
  RESULTS
  At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2.
  
  
  CONCLUSIONS
  Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.
authors.affiliation: Department of General Internal Medicine, University Hospital of Berne, Berne, Switzerland. martin.perrig@insel.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Perrig
authors.affiliation: Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010, Berne, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berendonk
authors.affiliation: Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010, Berne, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Rogausch
authors.affiliation: Assessment and Evaluation Unit, Institute of Medical Education, University of Berne, 3010, Berne, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Beyeler
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000379:methods / Q000458:organization & administration*; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003162:Competency-Based Education / Q000379:methods / Q000458:organization & administration*; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000458:organization & administration; D005246:Feedback; D005260:Female; D006126:Group Processes; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007400:Interprofessional Relations; D008297:Male; D008487:Medical History Taking / Q000379:methods / Q000592:standards; D009141:Musculoskeletal System / Q000473:pathology / Q000503:physiopathology; D010379:Peer Group; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D010817:Physician-Patient Relations; D018709:Statistics, Nonparametric; D013557:Switzerland
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