A Comprehensive and Modality Diverse Cervical Spine and Back Musculoskeletal Physical Exam Curriculum for Medical Students.

Journal of education & teaching in emergency medicine Pub Date : 2025-07-31 eCollection Date: 2025-07-01 DOI:10.21980/J8RQ0N
Konnor Davis, Aaron Frank, Trinidad Alcala-Arcos, Claire Godenzi, Melissa Allison, Clara Riggle, Sangeeta Sakaria, Ariana M Nelson, Alisa Wray, Brian Y Kim
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These videos can also be used for other health care professionals such as physicians, physician associates, nurses, or nurse practitioners learning or refreshing their physical exam skills.</p><p><strong>Introduction: </strong>The physical exam (PE) is one of the core components of a physician's toolkit and learning to perform the neck and back exam is important. When done correctly, physical exams are a useful tool in evaluating patients and in creating a differential diagnosis. This is especially true for many patient concerns such as neck and back pain and in specialties such as neurology where diagnoses may be established using empiric observation by trained clinicians.1Beginning in 2019, the University of California, Irvine, School of Medicine (UCISOM) revised the physical exam portion of the Clinical Foundations (CF; \"doctoring\" course) which serves as a four-year longitudinal course for UCISOM students to learn, practice, and improve their history-taking, physical exam, differential diagnosis, and physicianship skills. Focusing on the PE component of the curriculum, a team of physicians reviewed the materials utilized to teach all PE sessions, and these videos specifically, the cervical spine and back musculoskeletal PE for the first- and second-year students. These materials included book chapters and third-party videos; additionally, student and physician feedback were reviewed. Previous student feedback felt that the third-party videos were not engaging and too long (run length per video was upwards of 60 minutes), and students requested videos with slightly more detail for future clinical exams. Utilizing the UCISOM clinical faculty and standardized patients (SP), a team of physician educators and students researched PE best practices for the cervical spine and back musculoskeletal physical exam and developed new video scripts and slides, and ultimately filmed, edited, and produced a series of eight videos demonstrating the cervical and back musculoskeletal PE maneuvers. These videos were one part of a series of fifty-six PE videos developed for learners of a comprehensive physical exam. Other portions of the series focus on vital signs, the cardiovascular exam, pulmonary exam, gastrointestinal exam, neurological exam, head, eyes, ears, nose and throat, and upper and lower extremity exams.</p><p><strong>Educational objectives: </strong>By the end of this session, students will be able to: 1) demonstrate how to properly perform a cervical spine and back physical exam, 2) understand the reasoning behind cervical spine and back PE maneuvers, 3) identify the proper technique and equipment to use for the cervical spine and back PE, 4) understand normal and abnormal findings in the cervical spine and back PE, 5) accurately record and report exam findings for the cervical spine and back PE.</p><p><strong>Educational methods: </strong>The first-year medical student physical exam small group sessions used a flipped classroom model with the videos serving as a learning resource center (LRC) followed by an in-person, hands-on PE session with standardized patients (SP) led by a Dean's Scholar.Prior to the in-person session, the students were required to watch, at minimum, the English cervical spine and back \"Full Video\" physical exam. Bilingual Spanish speaking students in the UCISOM PRIME-LC (Program in Medical Education for the Latino Community) cohort were also encouraged to watch the Spanish \"Full Videos\" because their hands-on sessions are completed in Spanish. Learners were also given the option to read about the physical exam, its purpose and steps to perform each maneuver via the Bates Guide to Physical Examination and History Taking which is available via the UCISOM Library.The in-person, hands-on cervical spine and back musculoskeletal PE sessions occurred in a large group setting with approximately fifty students and four to six faculty members present; students were separated into groups of three to six students at a table with a standardized patient, and the session occurred over the span of two hours. When students arrived at the PE didactic session, the cervical spine and back musculoskeletal exam was discussed, and then groups would practice the PE with the facilitator and standardized patient using the video to guide the examination.</p><p><strong>Research methods: </strong>After completion of the small group session, learners from the first- and second-year medical school classes were encouraged to complete a Qualtrics survey regarding the videos and small group sessions. The survey asked students if they felt the videos were helpful, whether they made them more confident at performing physical exams, and if they had high production quality.</p><p><strong>Results: </strong>As of January 2023, the musculoskeletal cervical spine and back videos received 372 views and downloads, 318 unique viewers, and delivered 1,776 minutes of content. Thirty-one learners (response rate of approximately 25%) responded to the survey. The educational quality of all the musculoskeletal videos, including cervical spine and back, averaged 4.71 out of 5, the usefulness averaged 4.63 out of 5, and the production quality averaged 4.56 out of 5.</p><p><strong>Discussion: </strong>Based on the results from our survey as well as end-of-course feedback and verbal feedback sessions with leaners, we deem this educational content efficacious. The videos and all content related to them (eg, scripts, graphics, voice over) were assessed by a team of seven physicians. We feel the efficacy of the videos increases when implemented with other modalities of LRC such as written material or podcasts. Using multiple other modalities allows learners to experiment and utilize the modality that will aid their learning the best. Importantly, we also learned from the implementation of the videos that auto-generated subtitles for the videos in Spanish were often incorrect. 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引用次数: 0

Abstract

Audience: The target audience for this small group session focused on the cervical spine and back musculoskeletal physical exam is medical students of all levels, although it is most useful for those early in their career such as first- and second-year medical students. These videos can also be used for other health care professionals such as physicians, physician associates, nurses, or nurse practitioners learning or refreshing their physical exam skills.

Introduction: The physical exam (PE) is one of the core components of a physician's toolkit and learning to perform the neck and back exam is important. When done correctly, physical exams are a useful tool in evaluating patients and in creating a differential diagnosis. This is especially true for many patient concerns such as neck and back pain and in specialties such as neurology where diagnoses may be established using empiric observation by trained clinicians.1Beginning in 2019, the University of California, Irvine, School of Medicine (UCISOM) revised the physical exam portion of the Clinical Foundations (CF; "doctoring" course) which serves as a four-year longitudinal course for UCISOM students to learn, practice, and improve their history-taking, physical exam, differential diagnosis, and physicianship skills. Focusing on the PE component of the curriculum, a team of physicians reviewed the materials utilized to teach all PE sessions, and these videos specifically, the cervical spine and back musculoskeletal PE for the first- and second-year students. These materials included book chapters and third-party videos; additionally, student and physician feedback were reviewed. Previous student feedback felt that the third-party videos were not engaging and too long (run length per video was upwards of 60 minutes), and students requested videos with slightly more detail for future clinical exams. Utilizing the UCISOM clinical faculty and standardized patients (SP), a team of physician educators and students researched PE best practices for the cervical spine and back musculoskeletal physical exam and developed new video scripts and slides, and ultimately filmed, edited, and produced a series of eight videos demonstrating the cervical and back musculoskeletal PE maneuvers. These videos were one part of a series of fifty-six PE videos developed for learners of a comprehensive physical exam. Other portions of the series focus on vital signs, the cardiovascular exam, pulmonary exam, gastrointestinal exam, neurological exam, head, eyes, ears, nose and throat, and upper and lower extremity exams.

Educational objectives: By the end of this session, students will be able to: 1) demonstrate how to properly perform a cervical spine and back physical exam, 2) understand the reasoning behind cervical spine and back PE maneuvers, 3) identify the proper technique and equipment to use for the cervical spine and back PE, 4) understand normal and abnormal findings in the cervical spine and back PE, 5) accurately record and report exam findings for the cervical spine and back PE.

Educational methods: The first-year medical student physical exam small group sessions used a flipped classroom model with the videos serving as a learning resource center (LRC) followed by an in-person, hands-on PE session with standardized patients (SP) led by a Dean's Scholar.Prior to the in-person session, the students were required to watch, at minimum, the English cervical spine and back "Full Video" physical exam. Bilingual Spanish speaking students in the UCISOM PRIME-LC (Program in Medical Education for the Latino Community) cohort were also encouraged to watch the Spanish "Full Videos" because their hands-on sessions are completed in Spanish. Learners were also given the option to read about the physical exam, its purpose and steps to perform each maneuver via the Bates Guide to Physical Examination and History Taking which is available via the UCISOM Library.The in-person, hands-on cervical spine and back musculoskeletal PE sessions occurred in a large group setting with approximately fifty students and four to six faculty members present; students were separated into groups of three to six students at a table with a standardized patient, and the session occurred over the span of two hours. When students arrived at the PE didactic session, the cervical spine and back musculoskeletal exam was discussed, and then groups would practice the PE with the facilitator and standardized patient using the video to guide the examination.

Research methods: After completion of the small group session, learners from the first- and second-year medical school classes were encouraged to complete a Qualtrics survey regarding the videos and small group sessions. The survey asked students if they felt the videos were helpful, whether they made them more confident at performing physical exams, and if they had high production quality.

Results: As of January 2023, the musculoskeletal cervical spine and back videos received 372 views and downloads, 318 unique viewers, and delivered 1,776 minutes of content. Thirty-one learners (response rate of approximately 25%) responded to the survey. The educational quality of all the musculoskeletal videos, including cervical spine and back, averaged 4.71 out of 5, the usefulness averaged 4.63 out of 5, and the production quality averaged 4.56 out of 5.

Discussion: Based on the results from our survey as well as end-of-course feedback and verbal feedback sessions with leaners, we deem this educational content efficacious. The videos and all content related to them (eg, scripts, graphics, voice over) were assessed by a team of seven physicians. We feel the efficacy of the videos increases when implemented with other modalities of LRC such as written material or podcasts. Using multiple other modalities allows learners to experiment and utilize the modality that will aid their learning the best. Importantly, we also learned from the implementation of the videos that auto-generated subtitles for the videos in Spanish were often incorrect. This was in part due to the learning management system used to maintain the videos, but also could have been alleviated by including subtitles within the videos themselves. Overall, video content demonstrating these maneuvers, both with and without additional graphics and voice-over, and in two languages, was highly efficacious for UCISOM students in the CF course.

Topics: Physical exam, cervical spine, neck, back, low back, musculoskeletal, video, voice-over, medical student education.

Abstract Image

Abstract Image

医学生颈椎及背部肌肉骨骼综合检查课程。
听众:这个以颈椎和背部肌肉骨骼体检为重点的小组会议的目标听众是所有级别的医学生,尽管它对那些职业生涯早期的学生(如一年级和二年级的医学生)最有用。这些视频也可用于其他卫生保健专业人员,如医生、医师助理、护士或护士从业人员学习或刷新他们的体检技能。体格检查(PE)是医生工具箱的核心组成部分之一,学习执行颈部和背部检查是重要的。如果做得正确,体格检查是评估病人和鉴别诊断的有用工具。对于许多患者的担忧,如颈部和背部疼痛,以及神经病学等专业,这一点尤其正确,这些专业的诊断可以通过训练有素的临床医生的经验观察来建立。从2019年开始,加州大学欧文分校医学院(UCISOM)修订了临床基础(CF;“医生”课程),为UCISOM学生提供为期四年的纵向课程,以学习,实践和提高他们的病史,体检,鉴别诊断和医生技能。专注于课程的体育部分,一组医生审查了用于教授所有体育课程的材料,特别是这些视频,一年级和二年级学生的颈椎和背部肌肉骨骼体育。这些材料包括书籍章节和第三方视频;此外,对学生和医生的反馈进行了回顾。之前的学生反馈认为第三方视频不吸引人,而且太长(每个视频的长度超过60分钟),学生要求视频在未来的临床考试中更详细一些。利用UCISOM临床教师和标准化患者(SP),一个由医师教育者和学生组成的团队研究了颈椎和背部肌肉骨骼体检的最佳体育实践,并开发了新的视频脚本和幻灯片,最终拍摄、编辑和制作了一系列八个视频,展示了颈椎和背部肌肉骨骼的体育演习。这些视频是一系列56个体育视频的一部分,这些视频是为全面体检的学习者开发的。该系列的其他部分侧重于生命体征,心血管检查,肺部检查,胃肠道检查,神经系统检查,头部,眼睛,耳朵,鼻子和喉咙,以及上肢和下肢检查。教育目标:在本课程结束时,学生将能够:1)演示如何正确进行颈椎和背部身体检查,2)理解颈椎和背部体育运动背后的原因,3)识别颈椎和背部体育运动使用的正确技术和设备,4)了解颈椎和背部体育运动的正常和异常结果,5)准确记录和报告颈椎和背部体育的检查结果。教育方法:一年级医学生体检小组会议采用翻转课堂模式,视频作为学习资源中心(LRC),随后是由院长学者领导的标准化患者(SP)亲自动手的体育课程。在面对面的课程之前,学生们被要求至少观看英语颈椎和背部“完整视频”体检。还鼓励UCISOM PRIME-LC(拉丁裔社区医学教育方案)队列中说双语西班牙语的学生观看西班牙语“完整视频”,因为他们的实践课程是用西班牙语完成的。学习者还可以通过UCISOM图书馆提供的《贝茨体检和病史指南》阅读有关体检的内容、目的和执行每个动作的步骤。亲自动手的颈椎和背部肌肉骨骼体育课程在一个大的团体环境中进行,大约有50名学生和4到6名教师在场;学生们被分成三到六人一组,与一名标准化的病人坐在一张桌子旁,疗程持续两个小时。当学生到达体育教学环节时,讨论颈椎和背部肌肉骨骼检查,然后小组在辅导员和标准化患者的指导下进行体育练习,使用视频指导检查。研究方法:小组课程结束后,鼓励医学院一年级和二年级的学生完成一项关于视频和小组课程的质量调查。调查询问学生们是否觉得这些视频有帮助,是否让他们在做身体检查时更有信心,以及这些视频的制作质量是否高。 结果:截至2023年1月,颈椎和背部肌肉骨骼视频获得372次观看和下载,318次独立观看,交付1,776分钟的内容。31名学习者(回复率约为25%)对调查进行了回应。包括颈椎和背部在内的所有肌肉骨骼视频的教育质量平均为4.71(满分5分),有用性平均为4.63(满分5分),制作质量平均为4.56(满分5分)。讨论:根据我们的调查结果,以及课程结束后的反馈和与学习者的口头反馈,我们认为这个教育内容是有效的。视频和所有与之相关的内容(如脚本、图像、旁白)由7名医生组成的团队进行评估。我们认为,当与其他LRC方式(如书面材料或播客)一起实施时,视频的效果会增加。使用多种其他模式可以让学习者实验和利用最有助于他们学习的模式。重要的是,我们还从视频的实现中了解到,自动生成的西班牙语字幕经常是不正确的。这部分是由于用于维护视频的学习管理系统,但也可以通过在视频本身中添加字幕来缓解。总的来说,演示这些操作的视频内容,无论是有或没有额外的图形和画外音,用两种语言,对UCISOM学生在CF课程中都非常有效。主题:体检,颈椎,颈部,背部,腰背,肌肉骨骼,视频,画外音,医学生教育。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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