A randomized trial of physicians and physical therapists as instructors of the musculoskeletal examination

Objective. To evaluate the effectiveness of physicians vs physical therapists as instructors of the musculoskeletal examination to second year medical students. Methods. A randomized trial conducted over 3 consecutive years in a physical diagnosis course at the University of North Carolina. During the first (baseline) year, medical students received education about the musculoskeletal examination from a lecture and supervision by clinical preceptors. This increased in the second and third (intervention) years where random halves of each class received supplementary clinical instruction which included a structured manual, a videotape, and supervised practice with either general internal medicine physicians or physical therapists. Outcomes were measured from student performance on a practical test of clinical skills, and by written student evaluations of the supplementary instruction. Results. As measured on the clinical examination, performance during the intervention years improved over that during the baseline year in both intervention groups. Measures of medical students' clinical skills did not correlate with measures of academic aptitude. Conclusions. Clinical education about the musculoskeletal examination should be structured and systematic. Medical students prefer clinical education that is active, provides clear directions, and gives them performance feedback.