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Helping Hands Workshop: Teaching a Focused Rheumatologic Hand Examination With Assessment of Small Joint Swelling in
Ibtissam Gad1, Christopher Podgorski2, Lisa Zickuhr3
1Assistant Professor, Department of Medicine, University of Michigan.
Introduction:
Prompt, accurate identification of inflammatory arthritis can reduce patient morbidity and health care costs. However, internal medicine residents often do not receive adequate training in how to conduct an effective hand musculoskeletal examination. We created a short interactive workshop to teach the hand exam using our low-cost, easy-to-make 3-dimensional hand model for inflammatory arthritis.
Methods:
We designed a 30-minute hand musculoskeletal exam workshop for internal medicine residents rotating through a rheumatology elective. The workshop included a 3-minute video, a hand exam demonstration, hands-on practice, and a 3-station objective structured clinical exam (OSCE) with clinical vignettes and hand models of 3 types of inflammatory arthritis. Participants were scored on OSCE performance by experienced rheumatologists using a 1-5 global rating scale. A survey was used to evaluate participants' perspectives on the workshop and confidence in performing the hand exam and assessing small joint swelling before and after the workshop.
Results:
A total of 36 residents participated in the workshop. The mean global rating scale for OSCEs revealed proficient hand exam performance (4.67 [SD = 0.65] on a 5-point scale). Residents reported significantly higher confidence in performing the hand exam and assessing small joint swelling after participating in the workshop (P < .001). All residents reported being "likely" or "very likely" to use skills learned from this workshop in clinical practice.
Discussion:
Our simulation-based workshop for teaching the hand musculoskeletal exam, which included hands-on practice and assessment with an OSCE, shows promise in improving residents' confidence in performing the hand exam.
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