The utility of trained arthritis patient educators in the evaluation and improvement of musculoskeletal examination skills of physicians in training

Objective. To determine the level of examination skills of internal medicin e residents and to assess whether an intervention by trained persons with a rthritis could have a greater impact on their examination skills than parti cipation in an ambulatory care training experience. Methods. Twenty-seven residents attended a 6-week ambulatory care rotation that included didactic teaching as well as attendance at an outpatient arth ritis clinic with supervision by rheumatologists. Sixteen residents were ra ndomly assigned to have a training encounter with an arthritis educator alo ng with the standard experience in the arthritis clinic, whereas II residen ts received training in the arthritis clinic only. Arthritis educators eval uated the musculoskeletal examination skills of each resident during the fi rst week of the rotation. The 16 residents in the intervention group receiv ed instruction on joint examination techniques by the arthritis educator im mediately following their evaluation. At the end of the 6-week rotation, th e groups were reevaluated by a different arthritis educator. A group of 21 rheumatologists was also asked to perform a comprehensive musculoskeletal e xamination on individual arthritis educators. The arthritis educators asses sed the examination of the rheumatologists using the same evaluation instru ment that was used to assess the residents. Results. Initially, internal medicine residents carried out the musculoskel etal examination poorly (34.2 +/- 0.09% correct, n = 27). By contrast, the rheumatologists carried out a significantly greater amount of the examinati on correctly (54.5 +/- 0.05%). The musculoskeletal examination skills of th e residents who received additional training from an arthritis educator wer e significantly greater at the end of the rotation than the group who did n ot receive this intervention (50.5 +/- 0.10% versus 41.9 +/- 0.14% correct, P = 2.15 x 10(-5)). Conclusion. internal medicine residents carried out the musculoskeletal exa mination poorly. However, an intervention by arthritis educators improved t he musculoskeletal examination skills of internal medicine residents signif icantly and more effectively than the standard clinical teaching in a rheum atology outpatient clinic. The impact of the arthritis educator interventio n persisted for at least 5 weeks.