P043: Education innovation: a postgraduate emergency medicine musculoskeletal medicine curriculum

Abstract

Introduction / Innovation Concept: Musculoskeletal medicine (MSKM) complaints account for a significant portion of emergency room visits. Furthermore, MSKM diagnostic and management skills are poorly taught in undergraduate medicine and emergency medicine (EM). Here, we successfully developed an MSKM curriculum resulting in objectively improved resident acumen. Methods: Curriculum development was achieved by surveying local EM residents on their perceived MSKM deficits, and effective MSK teaching strategies. A literature search was also completed identifying MSKM teaching shortcomings. Finally, orthopaedic surgeons were asked which clinical entities they thought should be emphasized in our curriculum. Curriculum, Tool, or Material: A case-based MSKM curriculum was created. Cases emphasized commonly occurring emergency department presentations, topics that EM practitioners self-identified as requiring further teaching, commonly missed problems at first presentation, and high-risk cases if mismanaged. Curriculum implementation consisted of three, half-day, workshops. Workshops included didactic lectures, MSKM physical exam practice, and MSKM cases. MSKM cases required resident history taking and physical exam practice, radiography interpretation, and management plan formulation. Objective assessments of resident MSKM knowledge and skill were given to the learners before and after the workshops. Survey questions were grouped into 3 categories: MSK assessment, investigation, and management. Questions were scored on a 5-point Likert scale, ranging from “not at all confident” to “very confident”. A Wilcoxon Signed Rank Test indicated statistically significant improvement in learner confidence within all three domains after the first workshop (n=19 learners; assessment: p<0.001, investigation: p<0.001, management: p<0.001), and after the second workshop (n=24 learners; assessment: p<0.001, investigation: p<0.001, management: p<0.001). Conclusion: We successfully incorporated MSKM teaching into our academic curriculum based on previously identified weaknesses, resulting in improved resident MSKM case management. Further MSKM teaching sessions and evaluations to facilitate knowledge and skill maintenance are currently under development.