Musculoskeletal Injection Skills Competency in Physical Medicine and Rehabilitation Residents

Abstract

An educational module was developed in attempt to satisfy two main objectives: to develop and implement a methodology for instruction of generally encountered injection techniques in the practice of physical medicine and rehabilitation and to implement an objective assessment format to measure attainment of these skills. Guidelines for this module were developed in consideration of Accreditation Council for Graduate Medical Education (ACGME) physical medicine and rehabilitation residency program requirements and ACGME Outcome Project. Eleven physical medicine and rehabilitation residents participated in a 1-day didactic/laboratory workshop covering injection education and techniques, followed by a supervised 2-wk practice session. Knowledge acquisition and skill attainment were measured via before and after multiple-choice written examination and simulated patient encounters utilizing anatomic models. An increase in knowledge was observed on the multiple-choice examination from pretest to posttest (pretest, 59.3%; posttest, 90.6%). Before instruction, 0 of 11 residents were able to perform any of the injection techniques (14 injection techniques and one sterile technique). At completion of the module, 7 of 11 residents (64%) competently performed 15 of 15 techniques (100%), 3 of 11 (26%) competently performed 14 of 15 techniques (93%), and 1 of 11 (9%) competently performed 11 of 15 techniques (73%). Participation in this module resulted in substantial acquisition of knowledge and skills regarding musculoskeletal injections for physical medicine and rehabilitation residents. This workshop provided a framework for the definition of baseline competency in this clinical skill area.

Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke

“…According to some theories [45,47,48], even if the issue is still controversial, recovery of movements from stroke in the upper extremity begins with the development of a flexor synergy (shoulder abduction-elbow flexion) followed by an extensor synergy (shoulder adduction- elbow extension) pattern [49], while isolated joint movements remain still compromised. This may result into the disruption of movement in terms of the required interjoint coordination.…”

Musculoskeletal Injection

“…30 Aggregate results from 28 trials (1973 combined participants) comparing intraarticular corticosteroids vs placebo, hyaluronidate, joint lavage, or other corticosteroids showed that intra-articular corticosteroids were more effective for pain reduction and patient global assessment at 1 week (number needed to treat, [3][4] and that pain reduction lasted for 2 to 3 weeks. However, evidence for functional improvement with corticosteroids was lacking, and at 4 to 24 weeks after injection, no evidence was found for improvement in pain or function.…”

“…Although musculoskeletal injection is one of the most frequently performed procedures among practicing internists, 2 physicians receive inadequate training regarding musculoskeletal diseases and injection technique. [3][4][5][6] The Accreditation Council for Graduate Medical Education 7 and the American Board of Internal Medicine 8 require resident physicians to understand arthrocentesis, yet residency training programs have traditionally provided limited instruction on this topic. Consequently, some training programs have instituted special musculoskeletal curricula that have been shown to improve physicians' confidence and ability with joint injections.…”

“…Consequently, some training programs have instituted special musculoskeletal curricula that have been shown to improve physicians' confidence and ability with joint injections. [3][4][5] The Mayo Clinic Division of General Internal Medicine (GIM) has created a musculoskeletal injection clinic. Our physicians perform musculoskeletal injections on patients and teach injection technique to internal medicine residents.…”

Impact of Web-Based Review on Long-Term Retention of Simulation-Acquired Knee and Shoulder Aspiration and Injection Skills

“…4 Simulation-based learning provides a low risk, predictable, and reproducible environment that has been embraced as a solution to teach learners new procedures without compromising patient safety. 5,6 Many studies, [7][8][9][10][11] including a few that specifically examined teaching arthrocentesis and intra-articular injection techniques, report preintervention to postintervention increases in…”