Influence of an interactive joint model injection workshop on physicians' musculoskeletal procedural skills

Abstract

Objective: To assess the effect of an intervention workshop designed to improve intraarticular (IA) and periarticular (PA) injection skills among primary care physicians.

Methods: An interactive joint model injection workshop was designed for family practice and internal medicine residents and faculty, aimed at improving their skill performing IA and PA procedures. The workshop covered indications, contraindications, complications and supplies required to perform procedures, formulations of steroidal preparations, volumes used for injection, skin preparation, method of needle insertion, synovial fluid aspirations, aftercare, and processing of the synovial fluid. Interactive prewired models of shoulders, wrist, hand, knee, ankle, and foot provided feedback with an audible buzz for correctly performed procedure. A survey was administered immediately following the workshop and after 10 months.

Results: Of 60 participants, 39% were residents and 21% faculty. The mean age (+/- SD) of participants was 32.7 +/- 7.7 years. The mean duration of followup was 10.5 months. The mean +/- SD comfort scores on theoretical and practical aspects of the procedures surveyed prior to the workshop were 4.8 +/- 2.5 and 4.4 +/- 2.5, respectively; and after the workshop were 8.0 +/- 1.7 (p = 0.001) and 7.8 +/- 1.7 (p = 0.001), respectively. The mean change in comfort scores in practical aspects of IA and PA procedures did not correlate with the age of participants, but rather with their training/faculty status (p = 0.01). The mean changes in comfort scores with practical aspects of these procedures were highest among first-year residents (4.5+/- 2.1), followed by faculty (3.1 +/- 1.7). On followup, the mean comfort scores on theoretical and practical aspects of the procedures were 6.3 +/- 1.7 and 6.0 +/- 1.8, respectively, significantly higher than the pre-workshop scores (p = 0.03, p = 0.02).

Conclusion: Joint injection workshops using interactive joint models can improve the comfort scores of physicians learning IA and PA injection skills, in both theoretical and practical aspects of the procedure. Faculty and first-year residents in training seem to benefit the most; significant improvement in comfort scores was seen across the spectrum of physicians. Thus acquired comfort with knowledge and practical aspects of joint procedures may undergo attrition over time; however, significant residual benefits are still appreciable over time.