Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial

Abstract

Purpose To assess the use of peer-assisted learning (PAL) of complex manipulative motor skills with respect to gender in medical students. Methods In 2007-2010, 292 students in their 3rd and 4th years of medical school were randomly assigned to two groups [Staff group (SG), PAL group (PG)] led by either staff tutors or student-teachers (ST). The students were taught bimanual practical and diagnostic skills (course education module of eight separate lessons) as well as a general introduction to the theory of spinal manipulative therapy. In addition to qualitative data collection (Likert scale), evaluation was performed using a multiple-choice questionnaire in addition to an objective structured clinical examination (OSCE). Results Complex motor skills as well as palpatory diagnostic competencies could in fact be better taught through professionals than through ST (manipulative OSCE grades/ diagnostic OSCE score; SG vs. PG; male: P = 0.017/ P \ 0.001, female: P \ 0.001/P \ 0.001). The registration of theoretical knowledge showed equal results in students taught by staff or ST. In both teaching groups (SG: n = 147, PG: n = 145), no significant differences were observed between male and female students in matters of manipulative skills or theoretical knowledge. Diagnostic competencies were better in females than in males in the staff group (P = 0.041) Overall, students were more satisfied with the environment provided by professional teachers than by ST, though male students regarded the PAL system more suspiciously than their female counterparts. Conclusions The peer-assisted learning system does not seem to be generally qualified to transfer such complex spatiotemporal demands as spinal manipulative procedures.

Learning spinal manipulation: A best-evidence synthesis of teaching methods*

“…The weaknesses of the excluded studies included failure to describe adequate methods for retrieving selected articles in a systematic review, 14 studies not relevant to key question, 2,3,16,17 a longitudinal observational study, 15 poster presentations, 18,19 and study population not directed toward chiropractic students. 20 The 11 included studies were deemed to be of acceptable quality using the RCT and cohort studies SIGN checklists. 21 No articles were found to be of high quality.…”

“…1,3,4,5,[8][9][10][11][12][13][14][15][16][17][18][19][20] These teaching methods may be implemented into the core curriculum of the doctor of chiropractic program as teaching aids to maximize student retention, performance, and acquisition of skills necessary to effectively utilize SMT as a therapeutic technique. 1,3,4,5,[8][9][10][11][12][13][14][15][16][17][18][19][20] These teaching aids have a place in the future of chiropractic education and can help students develop their skills most effectively while minimizing the risk of injury from the current methods utilized for teaching. 6 This literature review attempts to showcase the importance of incorporating various forms of teaching aids into the core curriculum of a chiropractic education.…”

“…Future research is necessary to determine if these methods have the potential to translate into better clinical outcomes for patients. 1,3,4,5,[8][9][10][11][12][13][14][15][16][17][18][19][20] Advantages in the educational process of learning and performing SMT may be attained with the integration of teaching methods such as instrumented CPR manikins, TMC manikins, padded contact with load cells, instrumented treatment tables, or Dynadjust instruments as outlined in this review of the chiropractic core curriculum. It is possible earlier acquisition of spinal manipulation skills may result in improvement in clinical outcomes related to patient care and safety and foster a strong foundation to optimize clinical training during the internship years of chiropractic education.…”

“…It is possible earlier acquisition of spinal manipulation skills may result in improvement in clinical outcomes related to patient care and safety and foster a strong foundation to optimize clinical training during the internship years of chiropractic education. 1,3,4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Practicing SMT techniques by incorporating the various teaching methods identified in this study could also minimize the risk of injuries that may occur while students practice spinal manipulations on classmates during chiropractic education. 5 In summary, the evidence presented does not offer a comparison or suggest a clearly superior form of teaching method to be applied as a gold standard for incorporation into the core curriculum of doctor of chiropractic programs.…”

“…Several articles have shown the effectiveness of these teaching methods in the learning experience of chiropractic students. 1,[3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20] The purpose of our literature synthesis review was to evaluate the effectiveness of various teaching methods used to teach SMT procedures in chiropractic students as a population.…”