The USBJI’s Project 100 works to increase formalized instruction in musculoskeletal medicine in medical schools. Under its auspices, the MS4 Task Force is developing an innovative, standardized 4-week MSK education elective for fourth year medical students that will enter primary care residencies. The elective will employ the latest concepts in medical education, including the “flipped classroom” with extensive use of on-line mini lectures, small group discussions, case studies, hands-on physical examination labs for each region of the anatomy and varied clinical experiences. These are being developed with a focus on increasing the students’ knowledge about correct and timely diagnosis, treatment, and appropriate and timely referral to specialists for conditions affecting each region of the musculoskeletal system.
The course is organized by anatomic region and specific disorders. Team leaders from different MSK specialties and primary care were recruited to lead the development of each segment (see the list below). The teams they lead will produce the on-line mini lectures that students will view independently, create the case presentations, design the hands-on laboratories for physical examination and set the goals for recommended clinical experiences. A separate team of anatomists lead by Kelly M. Harrell, PhD, MPT, will create a series of consistent MSK anatomy videos that will be included with the on-line mini-lectures for each anatomic region.
The team leaders have reviewed the draft course outline, revised and shortened the excessively long list of subjects proposed for the mini-lectures, taken from the table of contents of the course text, Essentials of Musculoskeletal Care
. Charged with limiting the content to one-hour of viewing per evening or weekend, they chose the most important subjects to present and organized them into a series of ten-minute mini-lectures.
Model Sample Videos Created
- Low Back Pain - Jonathan Kirschner, MD, RMSK, Physiatrist, HSS-Cornell, NY
- Cervical Spine - Nora Foster, MD, Orthopaedic Spine Surgeon, Duke, NC
- Shoulder - Vani Sebesan, MD, Orthopaedic Shoulder and Elbow Surgeon, Cleveland Clinic, FL
- Upper Extremity - Marty Boyer, MD, Hand Surgeon, WUSL MO and Fraser Leversedge, MD, Hand Surgeon, Duke, NC
- Hip & Thigh - Mike Bolognese, MD, Total Joint Surgeon, Duke, NC and Sam Wellman, MD, Total Joint Surgeon, Duke, NC
- Pain Management - Andre Boezaart, MD, PhD, Anesthesiologist, UFL, FL, Ajay Antony, MD, Anesthesiologist, UFL, FL and Richa Wardhan, MD, Anesthesiologist, UFL, FL
- Knee and Lower Leg - Priya Radhakrishnan, MD, Primary Care, Honor Health, AZ, Kristina Wilson, MD, Primary Care Sports Med, U Arizona, AZ and Sameer Dixit, MD Johns Hopkins, MD, Primary Care Sports Med
- Foot & Ankle - Lauren Geaney, MD, Orthopaedic Foot and Ankle Surgeon, UCHC, CT
- Osteoarthritis - Beth Jonas, MD, Rheumatologist, UNC, NC
- Inflammatory Arthritis - Christine Jones, MD, Rheumatologist, CVMC, VT
- Osteoporosis - Bart Clark, MD, PhD, Endocrinologist, Mayo, MN and Cathleen Colon-Emeric, MD, MHS, Geriatrician, Duke, NC
- Mechanical & Postural - Gene Lewis, DC, MPH, Duke, NC and Mike Reiman, PT, DPT, OCS, SCS, ATC, Duke, NC
- PCP, Specialist Coordination - Claudia Campos, MD, Wake Forest, NC
- MSK Anatomy - Kelly Harell, PhD, MPT, Anatomist, ECU, NC
The short, recorded mini-lectures on Low Back Pain by Anand Joshi,
MD, MHA, Duke Orthoapedic Director of PM&R, were recognized as a potential model for the MS4 on-line mini-lectures, but they were made as Power Points with disembodied voice over narration. On July 7, Dr. Derek Clewey and Dr. Sterling Lyon, from the DPT program in the Duke Orthopaedic Department, used their studio to film Dr. Joshi giving two of his mini-lectures. The edited versions created subsequently are outstanding model samples, and will be used as format guides for the MS4 mini-lectures. They will be shown, and the filming of videos will be discussed at the meeting outlined below.
Deans of MS Education
July 14, Dr. David Pisetsky and Dr. Bruce Browner met with Vice Dean of Education Dr. Edward Buckley, Duke School of Medicine, to discuss the MS4 Course and consider establishing it as an MS4 Elective at Duke. He validated the need for the course nationally, noted it would be reasonable to implement as an elective at Duke and other medical schools and thought it might eventually be incorporated as a required course. Dr. Buckley applauded the use of the flipped classroom methodology, but cautioned that fourth year medical students would want to spend most of the day in clinical settings with patients rather than classrooms. He liked the immediate application of knowledge acquired from independent viewing of on-line min-lectures in hands-on labs and clinical settings. He reviewed our proposed distribution of time and said that spending afternoons only in the clinic would constitute minimal compliance with the expectations of students and education deans, and thus this should be revised. He noted the challenges of moving students between locations during the day and organizing faculty to teach each segment. Dr. Browner agreed to take the lead in applying for and organizing the elective at Duke, and met subsequently with Associate Curricular Dean Dr. Coleen Grochowsky to begin the process.
Day One of Course
Jonathan Kirschner, MD, and Paul Levin, MD are working together to develop the plan and material for the opening day of the course. After an introductory welcome by the local course coordinator and discussion of course logistics, the course will begin with a series of short videos designed to provide essential overview topics. Stuart Weinstein, MD, Co-Chair of the BMUS Steering Committee has already made a wonderful short video about BMUS which contains data on the prevalence, societal and economic cost of MSK diseases in the US, which represent a high level of the complaints seen in primary care practice. This video will be used as an introduction to the course. Similar videos will be made by Kim Templeton, MD, about sex, gender and cultural disparities; Paul Levin, MD, about abuse of imaging; Jonathan Kirschner, MD about the general approach to the MSK patient; a talk from an expert on the opioid epidemic and the use of alternatives for pain management. A session on motivated interviewing and comprehensive MSK patient physical examination will be developed.
September 16 Team Leaders Meeting at Duke
To achieve consistency across the course segments, in creation of the videos, case studies, lab designs and clinical experiences, a face-to-face meeting for the Team Leaders has been scheduled for September 16. Since half of the leaders come from Duke, UNC, Wake Forest and ECU, the one-day meeting was scheduled at Duke to allow local participants to drive and save on travel expenses. Fortunately, at least one of the leaders from each team will be able to attend.
The main agenda items are:
- MS4 MSK Rationale & organization
- Medical Education-new pedagogy
- Course schedule-four week general and two week supplements
- Role of local course coordinators
- USBJI produced resources-videos, cases, labs, assessments
- Management of USBJI Course Material-copyright, website, fees, course text
- Daily activities-discussions, case presentations, PE labs, clinics, logistics, faculty availability
- Videos for independent viewing-anatomy, Joshi demo, Essentials PE videos, time per evening, credit for speakers
- Video production-Studio filming, Mediasite/Camtasia, resources, timing
- Initial Implementation in Medical Schools
- Subsequent MSK Education Projects
We hope the meeting will lead to the Team Leaders developing a sense of shared ownership for the MS4 Course. Their collective input during discussions will be important to revise and perfect the course design. After working together to coordinate the design of course resources, learning about video production, the Team Leaders will be well positioned to work with their teams. In addition to people who have volunteered to work on the project team, they will engage others to help them with the creation of videos and case studies. We will seek to establish the MS4 MSK Elective in a variety of medical schools to trial the course. It is hoped that the Team Leaders will apply for elective in the schools where they work. We have generated great enthusiasm and momentum, but we now have to acquire sufficient funding to enable the next phase of development, and implementation.