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BRIEF
REPORTS
Competency in Musculoskeletal
and Sports Medicine:
Evaluating a PGY-1 Curriculum
Steve A. Watts, MD; Zhen Zhang, PhD
BACKGROUND AND OBJECTIVES: The introduction of a pre- All PGY-1 residents in the 2006–
scribed curriculum and a clinical rotation in the PGY-1 year of 2009 academic years completed a
family medicine training can enhance learning in musculoskeletal clinical rotation in primary care
and sports medicine. Combining learning experiences in sports sports medicine (PCSM) and group
medicine and musculoskeletal medicine in the early stages of sessions in orthopedic and musculo-
training establishes a base to master the required competencies skeletal skills labs. This more formal
by the completion of the training program. exposure and training in PCSM for
METHODS: All PGY-1 residents from 2006 to 2009 were assigned our residents during the first year of
to a clinical rotation in sports medicine. Pretest and posttest were training in family medicine empha-
used to assess medical knowledge. The overall learning experi- sizes musculoskeletal evaluation and
ences were measured by the performance analysis by the resi- treatment as seen in general prac-
dent for the rotation. tice and general orthopedic clinics.
RESULTS: The mean score for pretest was 51.9 (standard de- Methods
viation [SD]=10.3), while the mean score for posttest was 63 From July 1, 2006, to June 30, 2009,
(SD=7.2). Paired t tests were performed for posttest scores and all PGY-1 residents in the family
pretest scores, stratified by year/gender. Overall or stratified by medicine residency program at our
year, there is a significant difference between posttest and pretest institution were enrolled in a formal
scores. Across all 3 years, the mean score increase is 12.4, with rotation in PCSM. Faculty members
95% confidence interval (9.1, 15.7). Average performance analysis with a certificate of added qualifica-
rated by the residents was 4.65 on a scale of 5.
tions in PCSM served as teachers
CONCLUSIONS: PGY-1 prescribed curriculum provides significant for this rotation. The resident physi-
improvement in basic medical knowledge in musculoskeletal medi- cians started the rotation when the
cine, launches the learner toward the goal of competency, and fos- sports medicine faculty members
ters an appreciation for the role of musculoskeletal medicine in were available for clinical teaching.
the practice of family medicine. All residents were exposed to the
(Fam Med 2011;43(9):659-63.) same clinical setting and the same
clinical faculty members. All PGY-1
ompetency in musculoskele- improve musculoskeletal medicine residents attended two clinical labs
tal medicine has consistently competency. Resident physicians in in musculoskeletal medicine: casting
Cbeen reported as a shortcom- family medicine begin with various and splinting and joint and tendon
ing of medical training in the United levels of deficiency in musculoskel- injections. Each workshop lasted 4
1-5 hours and included hands-on expe-
States. More specifically, this defi- etal knowledge and skills. Therefore, rience.
cit is reflected in surveys of physi- a program was initiated in 2006 to
cians who have completed family assess the needs and address the ba-
6,7
medicine residency training. The sic knowledge and skills. This study
family medicine residency program was granted an exemption by the From the Department of Family Medicine
of the University of Mississippi Med- Institutional Review Board of the and Department of Orthopedic Surgery and
Rehabilitation (Dr Watts) and Center for
ical Center has implemented a re- University of Mississippi Medical Biostatistics and Bioinformatics (Dr Zhang),
quired rotation for PGY-1 residents Center. University of Mississippi Medical Center,
in primary care sports medicine to Jackson, MS.
FAMILY MEDICINE VOL. 43, NO. 9 • OCTOBER 2011 659
BRIEF
REPORTS
All PGY-1 family medicine resi- Figure 1 : Box Plots of Pretest Versus Posttest Scores by Year
dents completed a 46-question mul-
tiple choice pretest at the beginning
of the rotation and a 100-question
posttest at the end of the rotation.
The test questions included in the
pretest and posttest were selected
from the American College of Sports
Medicine’s Sports Medicine Review
publication and those written by the
sports medicine faculty. The ques-
tions were piloted through a 3-year
process prior to the study. Only val-
idated questions were included in
the study. The same faculty mem-
ber administered the testing for all
the residents. The percent correct
was recorded for each resident tak-
ing the exam.
In addition, each resident an-
swered a question to characterize
their area of interest now that the correct was recorded for the pretest participated in the posttest. Twenty-
course was completed. The choices and posttest for each resident. Resi- eight residents participated in both
given to the resident were as follows: dents were de-identified for both test exams. Residents who did not com-
(1) to become a team physician on a scores. Paired t test statistical anal- plete both exams were either ill or
college campus, (2) to improve my ysis was performed on the pretest on vacation for the exam. The mean
musculoskeletal skills for clinical scores and posttest scores and was pretest score was 51.9 with a stan-
practice, (3) to prepare for a career stratified by the year the test was dard deviation (SD) of 10.3, while the
in academic medicine, and (4) to pre- taken and the gender of the resident. mean post-test score was 63.0 with
pare for a fellowship in PCSM. Unlike a Student’s t test, which com- an SD of 7.2. There was a significant
During the rotation, the residents pares group means, a paired t test difference between posttest and pre-
attended clinic with the PCSM fac- compares individual scores. It as- test scores (P<.001), both overall and
ulty at the orthopedics and sports sumes that the differences between by year. Across all 3 years, the mean
medicine clinics affiliated with the the two sets of observations (before score increased by 12.4 (95% confi-
University of Mississippi Medical and after) are 0 and test whether or dence interval 9.1, 15.7). (Figure 1)
Center. Curriculum content includ- not this assumption is true. The scores of both male and female
ed clinical experience in an athletic residents significantly improved.
training room with a certified ath- Results (P<.001) (Table 1).
letic trainer. Residents were also re- A total of 37 residents participat- All evaluations for the rotation
quired to attend games covered by ed in the pretest, and 30 residents were reviewed. The average score
the PCSM faculty. All residents were
also required to read selected chap- Table 1: Stratified Test Scores
ters from recently published mus-
culoskeletal and sports medicine
textbooks. All residents attended Score increase for female residents
one-on-one didactic teaching ses- n Mean 95% CI P Value
sions during the clinical rotation,
providing opportunity for questions 9 14.9 (11.3–18.5) <.0001
and discussion of the various topics. Score increase for male residents
Residents also read assigned texts
and reviewed selected articles and n Mean 95% CI P Value
consensus statements. 12 7.8 (2.5–13.1) <.0001
At the completion of the rotation
each resident completed the posttest Score increase for all residents
and an anonymous electronic eval- n Mean 95% CI P Value
uation of the program. The percent
28 12.4 (9.1–15.7) <.0001
660 OCTOBER 2011 • VOL. 43, NO. 9 FAMILY MEDICINE
BRIEF
REPORTS
Table 2: Primary Care Sports Medicine Performance
1. Hands-on participation in activities
Average Minimum Maximum Non-Zero Count Scale SD
4.74 3 5 23 1 to 5 0.54
Answer Value Answer Choices Choice Count Percentage (%)
0 Unable to Access 1 4
1 Unsatisfactory 0 0
2 Below Average 0 0
3 Average 1 4
4 Above Average 4 17
5 Outstanding 18 75
2. Patient load/variety
Average Minimum Maximum Non-Zero Count Scale SD
4.57 3 5 23 1 to 5 0.66
Answer Value Answer Choices Choice Count Percentage (%)
0 Unable to Access 1 4
1 Unsatisfactory 0 0
2 Below Average 0 0
3 Average 2 8
4 Above Average 6 25
5 Outstanding 15 63
3. Instructor’s availability
Average Minimum Maximum Non-Zero Count Scale SD
4.78 4 5 23 1 to 5 0.42
Answer Value Answer Choices Choice Count Percentage (%)
0 Unable to Access 1 4
1 Unsatisfactory 0 0
2 Below Average 0 0
3 Average 0 0
4 Above Average 5 21
5 Outstanding 18 75
4. Instructor teaching
Average Minimum Maximum Non-Zero Count Scale SD
4.87 4 5 23 1 to 5 0.34
Answer Value Answer Choices Choice Count Percentage (%)
0 Unable to Access 1 4
1 Unsatisfactory 0 0
2 Below Average 0 0
3 Average 0 0
4 Above Average 3 13
5 Outstanding 20 83
SD—standard deviation
FAMILY MEDICINE VOL. 43, NO. 9 • OCTOBER 2011 661
BRIEF
REPORTS
Table 3: Overall Performance
on a scale of 1 to 5 for overall ex- Overall Experience
perience was 4.65 with a SD of 0.49 Average Minimum Maximum Scale SD
(Table 2 and 3).
When asked about their interest 4.65 3 5 1 to 5 0.49
in musculoskeletal training in the Answer Value Answer Choices (%)
pretest, 80% of residents stated the
desire to improve musculoskeletal 0 Unable to Access 1.4
skills for clinical practice as the pri- 1 Unsatisfactory 0.0
mary goal for the rotation, while 30%
stated an interest in primary care 2 Below Average 0.0
sports medicine fellowship training 3 Average 0.0
and 3% an interest in academic fam-
ily medicine. All others were <10%. 4 Above Average 8.3
5 Outstanding 85.6
Table 4: Competencies in Sports Medicine in Family Medicine, by Year
Medical Knowledge
Level Learning Activity Measure
PGY-1 PCSM rotation Objective testing
PGY-2 Quarterly sports medicine symposium Resident evaluations
PGY-2 Sports medicine in-training exam (proposed) Test scores
Osteopathic manipulation training course Course evaluation
PGY-3 Quarterly Sports Medicine Symposium Resident evaluations
PGY-3 Sports medicine in-training exam (proposed) Test scores
Osteopathic manipulation training course Course evaluation
Patient Care
Level Learning Activity Measure
PGY-1 PCSM clinical office (4 weeks) Rotation evaluation
Seminar on injections of joints (4 hours) Seminar evaluation
Splinting and casting workshop (4 hours) Workshop evaluation
PGY-2 FM clinical experience in FM clinic Supervisor evaluation
Orthopedic surgery rotation Supervisor evaluation
Elective in primary care sports medicine Preceptor evaluation
PGY-3 FM clinical experience in FM clinic Supervisor evaluation
Professionalism
Level Learning Activity Measure
PGY-1 Game and field experience in sports events Observational
PGY-2 Game and field experience in sports events Observational
Performance of pre-participation examinations Supervised by faculty
PGY-3 Game and field experience in sports events Observational
Performance of pre-participation examinations Supervised by faculty
(continued on next page)
662 OCTOBER 2011 • VOL. 43, NO. 9 FAMILY MEDICINE
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