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UBC Theses and Dissertations

A medical curriculum on common musculoskeletal disorders Craton, Neil


Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to, and comprise one of the greatest competency needs among primary care medical practitioners. However, each phase of the medical education process typically fails to provide student physicians and interns with adequate knowledge and skill training in this area. Most primary care physicians receive no clinical undergraduate or postgraduate training in musculoskeletal disorders and, those that do, are commonly rated as possessing inadequate cognitive and manual skills by their program supervisors. Available elective training in musculoskeletal injuries and diseases is commonly taught by hospital-affiliated physicians and surgeons, but this teaching case-load is typically skewed toward serious and/or surgical problems. The disparity between the clinical competence required for musculoskeletal problems in clinical practice and the content and format of medical education has not yet been addressed by changes in medical school curricula. One potential explanation for this is that the diagnostic coding systems commonly used in primary care medical practice are incomplete and imprecise with respect to musculoskeletal diagnoses. Morbidity statistics based on such codes can not be relied upon for an accurate needs assessment of the common disorders seen in clinical practice. As a result, data obtained using these codes cannot be used to define the competencies required by primary care physicians. To address this disparity, the purpose of this thesis was to develop a new curriculum for musculoskeletal disorders. The curriculum's content was selected using a competency based curriculum planning technique. Physicians from the disciplines of sports medicine, family medicine, orthopedic surgery, physical medicine and rheumatology (n=20 in each group) were surveyed with respect to the most common musculoskeletal conditions they encountered in their clinical practice. The 20 most common musculoskeletal problems selected by the five groups of practitioners were used to develop two forms of learning objective curricula. The first curriculum included terminal and enabling learning objectives grouped around a particular clinical problem. The enabling objectives were subdivided into knowledge, skill and attitude sections. The second curriculum involved a more traditional content knowledge approach, with each disorder being presented as a clinical scenario followed by detailed learning objectives regarding essential anatomy of the region, regional physical examination, specific physical findings, diagnosis, treatment, associated disorders and a brief selection of references. Also, five musculoskeletal disorders which communicate important principles in musculoskeletal medicine were presented in a similar fashion. The content of the curriculum was validated using an expert validity survey, and consensus outcome measures. Both documented that the curriculum content was valid, and a useful addition to the medical education process. It is concluded that these curricula are a first step toward correcting the disparity between the burden of musculoskeletal problems seen in primary care medical practice, and the current competency requirements of the medical education process. Mastery of these learning objectives will enable the physician to competently deal with common musculoskeletal problems. Key Words: Musculoskeletal disorders, medical education, curricula, competency

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