Adaptations in Teaching the Musculoskeletal System

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Adaptations in Teaching the Musculoskeletal
System David L. Bolender, Ph.D. Medical College
of Wisconsin
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Research has shown that recent medical school
graduates lack cognitive mastery of
musculoskeletal medicine and lack the necessary
confidence in the subject Joseph Bernstein,
Penn Chair of Project 100
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Types of Schools Represented in the Survey
Results
Health Professional Schools Colleges and
Universities Community and Technical
Colleges High School
Types of Students Medical and Dental 53 Other
Health Professional 36
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Curricula Represented 40 Traditional 13 Case-Bas
ed/PBL/Organ Based 47 Hybrid
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Is there a special section of your anatomy course
devoted To musculoskeletal system? (60/40)
Do you teach Kinesiology principles? (70/30)
Do you teach assessment of musculoskeletal
system? (50/40)
With Respect to Arthrology Do you have specific
lectures? (60/40) Labs? (70/25) Clinical
correlations? (60/30) Sessions on fractures or
dislocations? (50/46)
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Innovative Clinical Correlations
Several programs have students doing assessments
Quick-time movies of operations available in
lab Trip to the zoo Reflex hammers in lab
Relate personal experience with injury
Interactive OR surgeries linked to classroom
Real patients in class Third year students
teaching first year students     mini OSCE on
lab exam
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Clinical Correlations specifically Related to
Arthrology
Lectures by clinicians Case studies Common
injuries or pathology
Students given cases studies to research and
report back to class Live hook up to surgeries
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What is missing that should be included?
More on the back Arthrology Biomechanics
and kinesiology imaging and assessment
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How much musculoskeletal anatomy is taught
outside of the Intro Anatomy Course?
The best follow-up coverage appears to occur in
Osteopathic and Physical Therapy Programs.
A group of first year students asked PT faculty
to present discussions on muscle testing. Three 3
hour sessions on UL, Back, LL, Pelvic, etc.
resulted and were well received.
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Applied Anatomy Questions for Small Group
Assessment Exercises
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Rotator Cuff Exercise Yale, Larry
Rizzolo Three Patients with anatomically related
problems A tennis player -cant raise arm over
head A sedentary office worker - shoulder pain
when reaching    for supplies from a high shelf
A house painter - shoulder pain when painting
ceilings
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A Thought Experiment Related to the Rotator Cuff
Imagine there is no rotator cuff, only the middle
portion of the deltoid muscle. Which movie
depicts the action of the deltoid in this
circumstance?
Provided by Larry Rizzolo, Yale University
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If you chose this one, you are informed about the
normal axis of rotation of the humerus (the black
dot) and asked what holds the the axis in place.
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If you chose this movie, you are credited with a
correct answer and given an explanation. Then
you are asked about what fills the space between
the head of the humerus and the acromion.
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To keep the axis in place something must resist
the deltoid
Then you are asked for three ways that the
supraspinatus and other cuff muscles can resist
unwanted deltoid motion.