Implementing an established musculoskeletal educational curriculum in a new context: a study of effectiveness and feasibility

摘要

Background: Musculoskeletal (MSK) problems are common, yet many primary care (PC)providers feel inadequately trained to manage these conditions. Previous studies describesuccessful MSK educational innovations at single sites, but none have reported on subse-quent attempts to replicate or adapt these innovations to new contexts. This article presentsa study of a national Veterans Affairs MSK training program modified to fit an existing PCeducational program.Objectives: (1) To evaluate the effectiveness and feasibility of an adapted MSK curriculum ina new context. (2) To provide a model for adaptation studies in health professions education.Design: A national MSK shoulder and knee curriculum was adapted for San Francisco VA PCtrainees, which included a small-group workshop and workplace learning within a newly-created MSK clinic. Effectiveness was evaluated by assessments of trainee confidence in examand injection skills (via 5-point Likert scale) and faculty-observed performance of knee andshoulder exams (reported as percent of maximum possible score). Feasibility was evaluatedby determining acceptability of the program to PC trainees (via 5-point Likert scale) andability to implement the curriculum using local resources.Results: 52 trainees completed the training during a 2-year period. Trainees’ confidence inMSK exam skills improved from 3.3 to 4.5 for shoulder, and from 3.5 to 4.6 for knee.Confidence performing joint injections improved from 2.6 to 4.2 (shoulder) and 2.5 to 4.5(knee) (p < 0.001 for all). Observed performance improved markedly – from 50% to 92% forshoulder, and 57% to 90% for knee. Feasibility was evident in high acceptability (5.0 for MSKclinic, and 4.9 for workshops), and successful and sustained implementation.Conclusions: Adapting an established MSK curriculum to a new context was effective andfeasible. This may serve as a more efficient model for improving trainee education than denovo curriculum design at individual sites.