Wadey RCT MSK Short Case Simulations With FMED

Musculoskeletal Diseases or Conditions Clinical Trial

Official title:

Musculoskeletal (MSK) Educational Tool and Impact on Patients Randomized Control Trial - Pilot Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05914922
• Other study ID #: 5777
• Status: Recruiting
• Phase: N/A
• Start date: July 2, 2023
• Est. completion date: June 30, 2024

Study information

• Verified date: May 2024
• Source: Sunnybrook Health Sciences Centre
• Contact: Himani Anand, PG
• Phone: 416-967-8500
• Email: himani.anand[@]sri.utoronto.ca
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Study Agent/ Intervention/ Procedure The educational tool consisted of 20 short (MSK) case simulations of 15 minutes duration reflecting conditions of the upper extremity; lower extremity; spine; trauma and MSK infections were developed, reviewed and integrated into links that also contained demographic questionnaires; pre and post simulation knowledge questions and learner satisfaction surveys.

Outcome Measures

1. Demographic questionnaire for the Learner;

2. 100 MCQ (multiple-choice questionnaire) reflecting the same questions contained in the 20 MSK Short Case Simulations

3. Pre/Post multiple choice question knowledge questionnaire

4. Learner satisfaction questionnaire

5. Patient experience and satisfaction questionnaire - QR Code

6. Educator evaluation questionnaire - QR Code

7. Focus group questionnaire

Primary Objectives

1. To determine if learners working through the 20 MSK Short Case Simulations delivered through on-line links would improve their knowledge, skills and satisfaction in learning how to identify and initially manage patients with various MSK conditions when compared to learners not exposed to the same educational tool.

2. To determine patients' experience undergoing one of the 20 MSK assessments and initial management of their various MSK conditions by the learners and their satisfaction in receiving their initial care management in both groups

3. To determine if the assessment and initial management of the 20 MSK conditions by the learners on the patients was deemed to be competent by the educators in both groups

Description:

This study is an educational study and the intervention is the 20 Short Case Simulations. The educational tool consists of 20 short (MSK) case simulations of 15 minutes duration reflecting conditions of the upper extremity; lower extremity; spine; trauma and MSK infections. They've been developed, reviewed and integrated into links that also contain demographic questionnaires; pre and post simulation knowledge questions and learner satisfaction surveys. MSK complaints comprise up to 30% to 40% of primary care visits. Despite this, MSK curriculum vary widely among institutions, and there is little consistency in how physicians in training are prepared to treat MSK disorders. To address this need, these modules were developed specifically for frontline healthcare providers and a full content review was completed to generate an educational tool. The review and refinement process indicated the presence of a statistical difference when comparing post to pre-test knowledge scores; high internal consistency (Chronbach Alpha) and strong satisfaction scores among all participant learners.

Primary Hypothesis:

1. The study hypotheses that the family medicine resident learners being exposed at the start of an academic year to the MSK short case simulations will benefit their assessment and initial management of patients with 20 MSK conditions and that patient experiences will be enhanced when compared to family resident learners not exposed to the same educational tool.

Secondary Hypotheses:

1. The study hypothesize that the confounding variable of self-initiated learning of MSK content by family medicine residents not exposed to the 20 MSK case simulations may result in an increase in knowledge and skills and patient satisfaction.

2. The study further hypothesize that self-directed learning on the part of both CTL (Control) and EXP (Experimental) groups may lead to increase in knowledge and skills that may be a confounding variable reflected in the retention T3 scores.

The study is a Randomized Control Trial. Learners from the SBHSC Family Medicine Residency Training Program (FMRLs) will be recruited into this educational study from July 2nd, 2023 through to May 2024. Patients undergoing assessment and initial management of one of the 20 MSK Short Case Simulations will be recruited during the same study time period of June 2023 through to March 1 2024. Educators providing supervision of the FMRLs (Family Medicine Residents) and management of patients' MSK conditions will be recruited to participate during the same time period of July 2, 2023 through to March 1, 2024. Study Agent/ Intervention/ Procedure The educational tool consisted of 20 short (MSK) case simulations of 15 minutes duration reflecting conditions of the upper extremity; lower extremity; spine; trauma and MSK infections were developed, reviewed and integrated into links that also contained demographic questionnaires; pre and post simulation knowledge questions and learner satisfaction surveys.

Outcome Measures

1. Demographic questionnaire for the Learner;

2. 100 MCQ questionnaire reflecting the same questions contained in the 20 MSK Short Case Simulations

3. Pre/Post multiple choice question knowledge questionnaire

4. Learner satisfaction questionnaire

5. Patient experience and satisfaction questionnaire - QR Code

6. Educator evaluation questionnaire - QR Code

7. Focus group questionnaire

Sample Size Calculation:

N=24 Data Analysis

• Survey Monkey will be used to collect and analyze the data and SAS ( Statistical Analysis System) Version 9.4 or later will be used for statistical analyses

• QR Code will be utilized to collect the information from the patients in the learning environments where MSK conditions are being assessed and initially managed

• QR codes will be provided to the education supervisors after each clinical encounter of the FMRL to be assessed for competence

• Qualitative analysis will be done assessing for knowledge and skills resulting from the MSK Short Case Simulations

• Qualitative analysis will be completed on the focus group data that will determine information pertaining to the overall learning experience

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 24
• Est. completion date: June 30, 2024
• Est. primary completion date: June 1, 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Patients with an MSK condition included in the education tool of MSK Short Case Simulations 1-20 (Upper extremity; lower extremity; axial skeleton; trauma and MSK infections Patients) seen either in a family medicine clinic; emergency department; clinical ward in the hospital setting or sporting event at which FMRL were covering from a learners perspective

• Patients assessed by FMRLs between the months of July 2023 through to March 2024

• Patient must be free of cognitive impairment and be able to complete an English survey or have a translator present to assist with the translation

• Electronic devices to accommodate QR codes

Exclusion Criteria:

• non-English speaking participants

• an inability to complete QR codes

Related Conditions & MeSH terms

• Musculoskeletal Diseases
• Musculoskeletal Diseases or Conditions

Intervention

Other:
• Educational Tool
20 MSK short case simulations were developed based on authentic patient experiences. Strategies to optimize learning of MSK conditions to prepare learners for real-world clinical encounters would be important for family medicine resident learners. To address this need, 20 case simulations of 15 minute duration were developed. This study will determine if an online educational tool may be impactful for determining competency of family medicine resident learners in developing skills and knowledge of 20 MSK conditions while also determining if the tool impacts patient care and satisfaction.

Locations

Country	Name	City	State
Canada	Sunnybrook Health Sciences Center	Toronto	Ontario

Sponsors (1)

Lead Sponsor	Collaborator
Sunnybrook Health Sciences Centre

Country where clinical trial is conducted

Canada, 

References & Publications (12)

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Day CS, Yeh AC. Evidence of educational inadequacies in region-specific musculoskeletal medicine. Clin Orthop Relat Res. 2008 Oct;466(10):2542-7. doi: 10.1007/s11999-008-0379-0. Epub 2008 Jul 18. — View Citation

De Inocencio J. Epidemiology of musculoskeletal pain in primary care. Arch Dis Child. 2004 May;89(5):431-4. doi: 10.1136/adc.2003.028860. — View Citation

Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am. 2002 Apr;84(4):604-8. doi: 10.2106/00004623-200204000-00015. — View Citation

Glazier RH, Dalby DM, Badley EM, Hawker GA, Bell MJ, Buchbinder R. Determinants of physician confidence in the primary care management of musculoskeletal disorders. J Rheumatol. 1996 Feb;23(2):351-6. — View Citation

Matheny JM, Brinker MR, Elliott MN, Blake R, Rowane MP. Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop (Belle Mead NJ). 2000 Dec;29(12):945-52. — View Citation

Rules of Thumb, Gerald van Belle, 2002, Wiley

Sabesan VJ, Schrotenboer A, Habeck J, Lombardo D, Stine S, Jildeh TR, Meiyappan A. Musculoskeletal Education in Medical Schools: A Survey of Allopathic and Osteopathic Medical Students. J Am Acad Orthop Surg Glob Res Rev. 2018 Jun 28;2(6):e019. doi: 10.5435/JAAOSGlobal-D-18-00019. eCollection 2018 Jun. — View Citation

Visit-Specific Satisfaction Instrument (VSQ-9) | RAND

Wadey VM, Tang ET, Abelseth G, Dev P, Olshen RA, Walker D. Canadian multidisciplinary core curriculum for musculoskeletal health. J Rheumatol. 2007 Mar;34(3):567-80. Epub 2006 Dec 15. — View Citation

Watts SA, Zhang Z. Competency in musculoskeletal and sports medicine: evaluating a PGY-1 curriculum. Fam Med. 2011 Oct;43(9):659-63. — View Citation

Wu V, Goto K, Carek S, Petrizzi M, Deck JW, Sulapas I, DeStefano S, DeCastro AO, Rooks BJ, Mainous AG 3rd, Kulshreshtha A. Family Medicine Musculoskeletal Medicine Education: A CERA Study. Fam Med. 2022 May;54(5):369-375. doi: 10.22454/FamMed.2022.975755. — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Participant demographics	Questionnaire (Qualitative analyses)	up to 7 months
Primary	Pre and Post-test questionnaires for each of the 20 MSK short case simulations - paired T-tests	Knowledge questions	up to 7 months
Primary	Satisfaction questionnaire for EXP group on the educational experience of the MSK case simulations- qualitative analyses	The participants completing the 20 MSK short case simulations will complete a satisfaction questionnaire of the case simulations	up to 7 months
Primary	Patient experience of their individual clinical encounter with the FMRL	the patients will complete a link to a QR code (5 minutes) and indicate their level of satisfaction of their clinical encounter with the FMRL	up to 7 months
Primary	Educator evaluation of a FMRL	An educator who would normally supervisor the FMRL with patients would complete a link to a QR code (2 minutes) and indicate the competency of the FMRL	up to 7 months
Primary	Focus group	All participants will meet at the end of the study/academic year to review the process and their participation in the study	up to 7 months