MedEdPORTAL (Apr 2013)
Basic Skills in Musculoskeletal Examination: Hands-on Training Workshop
Abstract
Abstract Introduction Findings from a proper musculoskeletal (MSK) examination are extremely useful in diagnosing rheumatologic disorders, especially where gold-standard diagnostic tests are lacking. Thus, there should be much emphasis in undergraduate and postgraduate curricula on basic MSK examination skills. However, there is significant lack of competencies in MSK examination skills among clinicians reported in the literature. This workshop is designed to help medical students, internal medicine or family medicine residents, and general practitioners develop an approach to early arthritis. Methods The workshop starts with a 45-minute presentation featuring a case in which the approach to early arthritis is implemented following European League Against Rheumatism recommendations. Throughout the presentation, there is thorough discussion on the differential diagnosis of arthritis and on the use and interpretation of autoantibodies in early arthritis. The presentation also goes over the principles of early arthritis management. A demonstration of the MSK examination by an expert (30 minutes) and hands-on training conducted by knowledgeable trainers (60 minutes) follow the presentation. Four booklets with colored illustrations and simple language are included to be distributed to all participants during the workshop. The last half hour covers a group discussion summarizing the skills to be mastered and time for participants' feedback. Including a 15-minute break in the middle, the entire workshop lasts 3 hours. Results This workshop was conducted five times. Participants were excited to have hands-on training. They were also eager to know how to examine small joints of the hands and wrists, as these are the most common joints affected by rheumatoid arthritis. Most participants appreciated the emphasis on certain skills at the end of the workshop, as this was the major take-home message that should not be forgotten. The booklets provided for the participants were well received, and we were asked for more for those who could not attend the workshops. Discussion For the hands-on training on basic skills in MSK examination, there should be a ratio of one trainer to five participants. Trainers might be colleague rheumatologists, rheumatology fellows, senior residents, and/or trained interns. However, most trainers in our workshops were motivated senior medical students and interns. There should be time to train the trainers prior to the scheduled workshop.
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