A structured multimodal teaching approach enhancing musculoskeletal physical examination skills among undergraduate medical students

Abstract

Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions' total durations, facilitator's demonstration time, participants' practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants' hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator's demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

Keywords: Multimodal teaching; musculoskeletal; peer-assisted learning; physical examination skills; undergraduate; video-based learning.

Figure 1.

Flow of participants among the groups receiving multimodal and traditional teaching approaches. (OSCE: objective structured clinical examination, PE: physical examination).

Figure 2.

The structured multimodal approach for teaching musculoskeletal physical examination skills. (PE: physical examination, SP: simulated patient).

Figure 3.

(a) Proportion of passing students in the multimodal and traditional teaching groups at the institutional cutoff score of 60% and modified borderline grouping-based cutoff score of 70% for knee and shoulder OSCEs, combined and separately. (b) Global-ratings-based assessment of students among the multimodal and traditional bedside teaching approaches.