Undergraduate Clinical Teaching in Orthopedic Surgery: A Randomized Control Trial Comparing the Effect of Case-Based...

Musculoskeletal (MSK) complaints are the second most common reason for a hospital outpatient appointment in the US, and account for 19.5% of general practice consultations. Previous studies have shown that passive teaching in medical school does not imbue students with an adequate degree of confidence in MSK evaluation. The aim of this study was to conduct a randomized control trial to compare the effect of the gold standard small group tutorial of bedside teaching against case-based teaching (CBT) in relation to orthopedic surgery in medical students.

All third-year medical students at our institution were invited to participate in a randomized control trial comparing CBT and bedside tutorials in relation to MSK. The primary outcome was student performance in an Objective Structured Clinical Examination (OSCE). Participants were randomized into 2 groups, receiving either a bedside tutorial or a case-based tutorial. Participants were then assigned self-directed learning before undergoing a final OSCE assessment. Student feedback was attained through a poststudy questionnaire.

Complete data was acquired for 96 study participants (n = 45 CBT; n = 51 bedside tutorial). The results of a linear regression model used to assess differences in the final OSCE scores, adjusting for the baseline OSCE score, gender, age, previous problem-based learning exposure and whether English was their first language or not showed no evidence of a difference between the bedside teaching group and the CBT group (mean difference: 0.34; 95% confidence interval: -3.79 to 4.47; p = 0.872). Almost all (95%) of the study participants felt that CBT was an important component in their learning.

There was no difference in OSCE performance between groups. The introduction of CBT before clinical placement in medical school could accentuate the clinical skills of students before transition into the apprenticeship model of clinical attachment.