assessment of a new undergraduate module

8/7/2019 Assessment of a New Undergraduate Module

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Assessment of a New

Undergraduate Module

in Musculoskeletal Medicine

By Joseph M. Queally, MRCS, FionnanCummins, MRCS, Stephen A. Brennan,

MRCS,Martin J. Shelly, MRCS, FFRRCSI, and JohnM. OByrne, FRCS(Tr&Orth)


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Abstract


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Introduction

Musculoskeletal disorders are common,

particularly in primary care, where they are the

second most common reason for consultation

after presentation for a general medical

examination with no specific complaint

Such disorders account for 10% to 28% of allconsultations across the United States and

Europe


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In emergency departments, musculoskeletal disordersare the second most common reason for presentationafter respiratory illness

Despite the high prevalence of musculoskeletaldisorders in primary care and emergency departmentsettings, numerous studies have demonstrateddeficiencies in the adequacy of musculoskeletaleducation at multiple stages of the medical educationalprocess, from medical-school level both in the UnitedStates and Europe6-9 to the level of primary careprovider


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Having demonstrated deficiencies in the adequacy ofmusculoskeletal education at undergraduate level in ourinstitution, we subsequently designed an undergraduatemodule aimed at improving the competency of medical

students in musculoskeletal medicine

This module, which was designed to cover the commonorthopaedic disorders that are often seen by primary care

providers or in patients who present with musculoskeletalmedical emergencies, made use of an integrated approachthat included core lectures, bedside clinical examination,and demonstration of basic practical procedures.


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Materials and Methods

The module was designed by faculty from the Department ofTrauma and Orthopaedic Surgery of the Royal College of Surgeonsin Ireland.

The aim of the module was to provide students with a foundation inmusculoskeletal medicine, with an emphasis on the commonorthopaedic conditions seen in primary care and orthopaedicemergencies.

At the end of the orthopaedic module, students were expected to

have an understanding of common musculoskeletal disorders, to beable to perform a clinical examination of the musculoskeletalsystem, and to be able to perform basic procedures, such as jointinjection and cast application.


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Module Design

The module was delivered over a 2 week period togroups of 30 students.

A curriculum was developed whereby 9musculoskeletal topics were covered by means of anintegrated approach of three fifty-minute lectures,

clinical bedside demonstrations of physical examinations, demonstration of basic practical procedures,

and small group-directed and/or student-directed learningactivities, such as case presentations.


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The final day consisted of student case

presentations and an assessment that

consisted of multiple-choice questions.


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Module Administration

The module was delivered by a variety ofeducators from a variety of disciplines.

Four lecturers (orthopaedic research fellows)were responsible for the overall running of themodule.

Lectures were delivered by consultantorthopaedic surgeons, lecturers, aphysiotherapist, and a consultant radiologist.


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The lectures were available online on an Internet-based teaching platform as PowerPointpresentations

Students were expected to have read the lecturesprior to participating in the module

Each lecture was similarly structured so thatrelevant clinical anatomy was presented first,followed by a discussion of the pathology andmanagement of common conditions.


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Lectures ended with a series of case

discussions in a problem-based learning

format.


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Student Assessment

Students were assessed at the end of the modulewith use of a multiple-choice questionnaireexamination.

Throughout the module, a real-time assessmentsystem was used to provide students with real-time feedback on their performance.

Multiple-choice questionnaires were interspersedthroughout the lectures.


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Students made use of a remote handheld

answering device, which they were given at the

beginning of the module, to answer the multiple-

choice questionnaires.

After answering each multiple-choice

questionnaire, they were given the correctanswers along with a data set describing how

they performed in comparison with their peers.


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Module Assessment

For this study, we used a previously validatedexamination in musculoskeletal medicine that wasdesigned specifically for medical students and hadbeen used previously in studies in both the U.S. and

Europe

The examination was administered to ninety-twostudents at the end of the two-week module.

These students were in year four of a six-year courseand had no previous formal education inmusculoskeletal medicine.


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The group consisted of sixty-one undergraduate

and thirty-one graduate entry students.

A historical control group was used for

comparison and consisted of seventy-two

undergraduate (year four of six) students who

completed the examination in 2006 after taking aone-week course in orthopaedic surgery prior to

the design of the current module.


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It was validated by orthopaedic surgeons as wellas internal medicine program directors in theU.S., who set a passing score of 70%.

It consisted of twenty-five short-answer, open-ended questions.

On the basis of the validation process, aweighted marking system was used, with partialcredit given for partially correct answers.


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The mean scores of each group were

compared with use of a two-tailed Student t

test.

Proportions were compared with use of the

Pearson chi-square test.

The level of significance was set at p < 0.05.


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Results

Results compared with historical group showed asignificant improvement (62.3% for the 2009group versus 54.3% for the 2006 group; p 70%) for the 2009 studentgroup relative to the control 2006 group (38.4%versus 12.5%, respectively; p = 0.0002


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This represents significant progress in

educational terms and proves that

appropriate curriculum design can address

deficiencies in musculoskeletal medical

education.

assessment of a new undergraduate module

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