OSCE-Based Teaching of the Musculoskeletal Exam to Internal Medicine Residents and Medical Students: Neck and Spine

Abstract

Abstract Studies have demonstrated that musculoskeletal complaints are the most common presenting illness in the primary care setting and account for up to 30% of office visits. Despite the high burden of musculoskeletal disorders, physicians are often underprepared to manage patients with complaints due to inadequate training in musculoskeletal medicine during medical school and residency. We developed a new experiential curriculum to train internal medicine residents in the musculoskeletal exam using the OSCE model. The OSCE provides learners with disease-specific history of illness, from which a hypothesis-driven physical exam is generated. Each workshop consists of an interactive 60− 90 minute lecture that reviews relevant anatomy, history, physical exam findings, work up and treatment for each relevant musculoskeletal disorder. The interactive portion of the workshop consists of three to four OSCE stations through which residents rotate over a 90-minute period. Each OSCE station is facilitated by a cadre of workshop instructors, which include Yale Primary Care faculty, chief residents, or senior residents who had previously been exposed to the workshop. In advance of the workshop, all workshop instructors collectively or independently review the relevant exam with the workshop director to ensure uniformity in instruction. Volunteer second-year medical students from Yale served as standardized patients, after receiving 40 minutes of training by the workshop director prior to the workshops. At each OSCE station, residents are evaluated via an OSCE checklist on inspection, palpation, assessment of range of motion, special maneuvers, and appropriateness of differential diagnosis and therapeutic plan. Incorrectly performed maneuvers are not corrected until after the conclusion of the exam, though the correct outcome of specific maneuvers is revealed to the resident so as not to impair their ability to generate an appropriate differential diagnosis and therapeutic plan. At the conclusion of each OSCE station, immediate feedback is given to resident participants based on the OSCE checklist, from both instructors as well as the medical student standardized patients. In this way, residents are able to utilize the feedback given in one station to enhance their performance at subsequent stations. After each workshop, both residents and medical students are asked to evaluate their impressions of the workshop in an anonymous survey.

Keywords

• OSCE
• Musculoskeletal System
• Musculoskeletal Exam
• Experiential Learning