Orthopedic Injections: A Longitudinal Musculoskeletal Curriculum in a Family Medicine Residency

Overview

Journal Fam Med

Specialty Public Health

Date 2024 Aug 29

PMID 39207789

Authors

Jason Xu

John Billimek

Brian Y Kim

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Musculoskeletal (MSK) complaints comprise more than 20% of all visits to health care providers each year. Despite required experiences in MSK care, family physicians report low confidence in diagnosing and treating MSK conditions. The purpose of this study was to analyze the effects of early and longitudinal exposure to MSK education on residents' confidence in and likelihood of performing MSK physical exams and injections in future practice.

Methods: From 2017 to 2019, residents completed an annual survey assessing confidence in, frequency of, and future intentions to perform exams and injections for MSK conditions. We compared responses between family medicine residents who completed a 176-hour longitudinal sports medicine (LSM) curriculum distributed over all 3 years of residency and a comparable cohort of family medicine residents who completed a 188-hour concentrated MSK curriculum primarily in the final year of residency. We made comparisons using the Fisher exact test for categorical variables and an independent samples t test for numeric variables.

Results: We analyzed the 98 total responses from 50 residents. The proportion of residents reporting high ratings of their residency MSK education (26% to 60%), performing >5 injections (38% to 73%), reporting confidence in performing injections (12% to 40%), and indicating likelihood to perform MSK injections in the future (52% to 65%) were all greater in the LSM versus concentrated MSK curriculum cohorts (P<.05 for all).

Conclusions: Early and longitudinal exposure to MSK care and sports medicine in family medicine residency led to both an increase in MSK injections during residency training and a greater desire to perform these injections in postresidency practice.

References

Perrig M, Berendonk C, Rogausch A, Beyeler C . Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills--a controlled study. BMC Med Educ. 2016; 16:35. PMC: 4731988. DOI: 10.1186/s12909-016-0554-z. View

March L, R Smith E, Hoy D, Cross M, Sanchez-Riera L, Blyth F . Burden of disability due to musculoskeletal (MSK) disorders. Best Pract Res Clin Rheumatol. 2014; 28(3):353-66. DOI: 10.1016/j.berh.2014.08.002. View

Lynch J, Schmale G, Schaad D, Leopold S . Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians. J Bone Joint Surg Am. 2006; 88(7):1589-95. DOI: 10.2106/JBJS.E.01365. View

Routt E, Mansouri Y, Moll E, Bernstein D, Bernardo S, Levitt J . Teaching the Simple Suture to Medical Students for Long-term Retention of Skill. JAMA Dermatol. 2015; 151(7):761-5. DOI: 10.1001/jamadermatol.2015.118. View

Burgess A, van Diggele C, Roberts C, Mellis C . Tips for teaching procedural skills. BMC Med Educ. 2020; 20(Suppl 2):458. PMC: 7712522. DOI: 10.1186/s12909-020-02284-1. View

Lynch T, Hellwinkel J, Jobin C, Levine W . Curriculum Reform and New Technology to Fill the Void of Musculoskeletal Education in Medical School Curriculum. J Am Acad Orthop Surg. 2020; 28(23):945-952. DOI: 10.5435/JAAOS-D-20-00485. View

Pohl S, Van Hala S, Ose D, Tingey B, Leiser J . A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program. Fam Med. 2020; 52(8):570-575. DOI: 10.22454/FamMed.2020.679626. View

McDaniel C, Forlenza E, Kessler M . Effect of Shortened Preclinical Curriculum on Medical Student Musculoskeletal Knowledge and Confidence: An Institutional Survey. J Surg Educ. 2020; 77(6):1414-1421. DOI: 10.1016/j.jsurg.2020.04.011. View

Rowat J, Johnson K, Antes L, White K, Rosenbaum M, Suneja M . Successful implementation of a longitudinal skill-based teaching curriculum for residents. BMC Med Educ. 2021; 21(1):346. PMC: 8207581. DOI: 10.1186/s12909-021-02765-x. View

10.

Wu V, Goto K, Carek S, Petrizzi M, Deck J, Sulapas I . Family Medicine Musculoskeletal Medicine Education: A CERA Study. Fam Med. 2022; 54(5):369-375. DOI: 10.22454/FamMed.2022.975755. View

11.

Petravick M, Marsh J, Karam M, Dirschl D . A Survey on Recent Medical School Graduate Comfort With the Level 1 Milestones. J Surg Educ. 2017; 75(4):911-917. DOI: 10.1016/j.jsurg.2017.10.004. View

12.

Amoako A, Amoako A, Pujalte G . Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States. Open Access J Sports Med. 2015; 6:81-6. PMC: 4378281. DOI: 10.2147/OAJSM.S71457. View

13.

Storheim K, Zwart J . Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis. 2014; 73(6):949-50. DOI: 10.1136/annrheumdis-2014-205327. View

14.

Matheny J, Brinker M, Elliott M, Blake R, Rowane M . Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop (Belle Mead NJ). 2001; 29(12):945-52. View

15.

Kelm D, Ratelle J, Azeem N, Bonnes S, Halvorsen A, Oxentenko A . Longitudinal Ultrasound Curriculum Improves Long-Term Retention Among Internal Medicine Residents. J Grad Med Educ. 2015; 7(3):454-7. PMC: 4597960. DOI: 10.4300/JGME-14-00284.1. View

16.

Matzkin E, Smith E, Freccero D, Richardson A . Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005; 87(2):310-4. DOI: 10.2106/JBJS.D.01779. View

17.

Bakewell C, Gardner G . A survey of arthrocentesis and soft-tissue injection procedures performed in primary care practice: effect of resident training and using data to shape curriculum. J Rheumatol. 2011; 38(9):1986-9. DOI: 10.3899/jrheum.110041. View

18.

Ferderber M, Adams A, Urbanek C, Cummings D . Musculoskeletal Injections Performed by Family Medicine Residents Participating in a Clinical Sports Medicine Track. Fam Med. 2022; 54(6):452-455. DOI: 10.22454/FamMed.2022.626280. View

19.

DiGiovanni B, Sundem L, Southgate R, Lambert D . Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum. Clin Orthop Relat Res. 2015; 474(4):901-7. PMC: 4773350. DOI: 10.1007/s11999-015-4511-7. View

20.

Monseau A, Nizran P . Common injections in musculoskeletal medicine. Prim Care. 2013; 40(4):987-1000, ix-x. DOI: 10.1016/j.pop.2013.08.012. View