Development and National Validation of a Musculoskeletal Emergency Medicine Assessment Tool

Abstract

Introduction Musculoskeletal (MSK) complaints and injuries are the fourth most common primary diagnosis in the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, new emergency medicine (EM) residency graduates report feeling unprepared to treat MSK complaints. Currently, there are no reported means to assess MSK knowledge in EM resident physicians. The purpose of this study is to develop a validated and peer-reviewed multiple-choice assessment tool focused on MSK knowledge relevant to EM to allow us to better assess the knowledge of resident physicians. Methods A group of EM/Sports Medicine subject-matter experts (SMEs) created an initial list of the most important MSK topics in EM to generate a relevant question bank. The questions were validated by a different group of SMEs using a three-round modified Delphi method to obtain consensus on the importance of each question. Based on these results, the assessment was formed. Results From a list of 99 MSK topics, SMEs developed a final list of 37 MSK topics relevant to EM. Following round one, free-marginal kappa was 0.58, 95% CI [0.50, 0.66], with a moderate overall agreement of 71.95%. Following round two, the calculated free-marginal kappa increased to 0.88, 95% CI [0.83, 0.92], with an overall agreement of 91.79%. Using a five-point Likert scale, a threshold of an average score less than four was used to exclude questions in round three of validation and to create a final 50-question assessment tool. Conclusion Our proposed exam, titled Musculoskeletal Emergency Medicine Assessment Tool (MEAT), was successfully validated by experts in our field. It evaluates clinically important topics and offers a tool for assessing MSK knowledge in EM resident physicians. Future studies are needed to determine the feasibility of administering the tool and to establish a baseline score among different populations within the practicing field of EM.

Keywords: knowledge assessment; medical resident education; musculoskeletal system; orthopedic sports medicine; teaching in emergency medicine.

Figure 1. Anteroposterior radiograph of the pelvis

Case courtesy of Hani Makky Al Salam, Radiopaedia.org

Figure 2. Anteroposterior radiograph of the wrist

Image courtesy of Ian Bickle, Radiopaedia.org

Figure 3. Longitudinal ultrasound view of the left hindfoot

Image courtesy of Matthew Negaard

Figure 4. Lateral radiograph of the wrist

Image courtesy of Will Denq

Figure 5. Anteroposterior radiograph of the chest

Case courtesy of Ian Bickle, Radiopaedia.org

Figure 6. Lateral radiograph of the digit

Case courtesy of Andrew Taylor, Radiopaedia.org

Figure 7. Photo of the affected digit

Image courtesy of Adam Rosh, Rosh Review

Figure 8. Anteroposterior radiograph of the shoulder

Case courtesy of Henry Knipe, Radiopaedia.org