Teaching a screening musculoskeletal examination: A randomized, controlledtrial of different instructional methods

Purpose. To develop and test a program to teach a rapid screening musculosk eletal examination. Method. In 1995, 191 medical and physician assistant students were randomiz ed to four intervention groups: written materials only (n = 47), written ma terials and videotape (n = 46), written materials and small-group sessions facilitated by fourth-year medical students (n = 55), and all three methods (n = 43). Assessments, in the form of a written test and standardized pati ent examinations, were conducted before the interventions (n = 40 randomly selected students), seven to ten days and again three months after the inte rventions (n = all 191 students), and 16 months after the interventions (n = 103 students). Results. While the four intervention groups' written test scores were appro ximately equal, their scores on the standardized patient examination differ ed significantly. The students taught in small groups demonstrated signific antly superior examination skills compared with the students taught with wr itten material or videotape at seven to ten days and retained this relative superiority after three and 16 months (p < .0001). Conclusion. Small-group instruction with hands-on supervised practice is su perior to more passive instructional methods for teaching musculoskeletal e xamination skills and can be successfully delivered by trained senior medic al student facilitators with minimal direct expenditure of faculty time.