Efficacy of a checklist as part of a physical medicine and rehabilitation clerkship to teach medical students musculoskeletal physical examination skills: A prospective study

Objective: The aim of this study was to evaluate the efficacy of a checklist as part of a physical medicine clerkship to teach medical students physical examination maneuvers. Design: This is a prospective study performed on fourth year medical students enrolled in a 2-wk mandatory clerkship of the Department of Physical Medicine and Rehabilitation. At the start and end of the rotation, the participating students were tested by performing 20 physical examination maneuvers on an investigator who was both the standardized patient and the evaluator. At the end of the rotation, the students also completed a survey. Data were analyzed using the Bernoulli trial model, with the percentage of students who performed the maneuver correctly on the pretest as the a priori probability. A full Bonferroni correction was applied. Results: The authors enrolled 141 of the 176 fourth year medical students; 121 completed testing. At prerotation, approximately 35% of the physical examination maneuvers were performed correctly; at postrotation, 82%. For 19 of 20 maneuvers, the improvement was statistically significant at P < 0.01. The survey results indicated that the students felt that they had limited exposure to musculoskeletal examination skills at prerotation, that this rotation helped them achieve competency in performing the maneuvers, and that this would improve their future patient care irrespective of field of choice. Conclusions: Considering the high prevalence of musculoskeletal disorders and the anticipated rise in the future, the authors strongly recommend teaching musculoskeletal physical examination maneuvers in medical school, which can be accomplished via a mandatory physical medicine and rehabilitation rotation. The authors conclude that checklists as part of this rotation can effectively help in teaching physical examination skills to medical students.