A RANDOMIZED TRIAL OF PHYSICIANS AND PHYSICAL-THERAPISTS AS INSTRUCTORS OF THE MUSCULOSKELETAL EXAMINATION

Objective. To evaluate the effectiveness of physicians vs physical the rapists as instructors of the musculoskeletal examination to second ye ar medical students. Methods. A randomized trial conducted over 3 cons ecutive years in a physical diagnosis course at The University of Nort h Carolina. During the first (baseline) year, medical students receive d education about the musculoskeletal examination from a lecture and s upervision by clinical preceptors. This increased in the second and th ird (intervention) years where random halves of each class received su pplementary clinical instruction which included a structured manual, a videotape, and supervised practice with either general internal medic ine physicians or physical therapists. Outcomes were measured from stu dent performance on a practical test of clinical skills, and by writte n student evaluations of the supplementary instruction. Results. As me asured on the clinical examination, performance during the interventio n years improved over that during the baseline year in both interventi on groups. Measures of medical students' clinical skills did not corre late with measures of academic aptitude. Conclusions. Clinical educati on about the musculoskeletal examination should be structured and syst ematic. Medical students prefer clinical education that is active, pro vides clear directions, and gives them performance feedback.