Musculoskeletal - M2

Overall Goals and Objectives

This sequence is a nine day unit designed to:

1. Introduce students to the wide range of disorders affecting the musculoskeletal system
2. Reinforce skills in examining and detecting pathology of the musculoskeletal system
3. Present approaches to diagnosis and treatment of musculoskeletal conditions
4. Introduce students to the different specialties involved in musculoskeletal medicine

Structure of the Sequence

Because ‘musculoskeletal diseases’ are managed by multiple medical and surgical specialties, the various teaching exercises will be done by faculty drawn from multiple departments, including Internal Medicine, Pediatrics and Communicable Diseases, Orthopedic Surgery, Pathology, Physical Medicine and Rehabilitation, and Radiology. Some of the important diseases will be discussed several times from different points of view, so some repetition is intentional.

The sequence will consist of:

• Didactic lectures on important concepts and disease processes
• Two patient presentations, to allow students to hear about diseases from the patients’ perspective and have the opportunity to directly ask the patients questions. Attendance is required for these presentations; students are not required to wear white coats during these lectures.
• Pathology laboratories (some of which will cover topics not presented elsewhere in the sequence)
• A large group shoulder and knee examination session
• Several different small group activities:
  • Patient Partner sessions: Trained patient educators with rheumatoid- and osteo-arthritis will lead a small group session where students will have the opportunity to examine arthritic joints. Students are required to wear white coats to these sessions. Please take the time to briefly review the medical history of the Partner you will be working with prior to the session (included in the syllabus).
  • CCA Practice sessions: to review the musculoskeletal examination to help prepare for the CCA. Students should wear loose, comfortable clothing (similar to what you wear for CFM sessions; ie. no blue jeans), as you will be practicing the examination on each other.
  • Pathology-Based Physical Diagnosis sessions: Students will rotate through three stations and learn about common problems affecting the hand/wrist, elbow/hip, and ankle/foot.
  • Small group case discussions with rheumatology faculty. The first page of the case is included in your syllabus; please fill out and bring to the session, as you will need this to work through the rest of the case.

Reading Material

Bernstein, Musculoskeletal Medicine

Greene, Essentials of Musculoskeletal Care (3rd edition)

Klippel et al., Primer on the Rheumatic Diseases (13th edition)

Johnson et al., Essentials of Musculoskeletal Imaging

Imboden et al., CURRENT Rheumatology: Diagnosis and Treatment (LANGE CURRENT Series, 2nd edition)

Examination and Grading

Students can take the on-line final examination starting at 5 pm on Tuesday, December 9 until 11:59 pm, December 11. The composite final score will be calculated as follows:

Final Comprehensive 80%
Pathology Final Practice 10%
Patient Partner Session Attendance 2.5%
Small Group Discussion Attendance 2.5%
CCA Practice Session Attendance 2.5%
Path Based Physical Diagnosis Attendance 2.5%

Total: 100%

Grading will comply with M2 grading policies. A pass/fail system will be used, and a cumulative grade of 75% or higher will be required for a passing score. Cumulative grades of 74.99% or lower will be assigned a failing grade.

Required Experiences

In this sequence there are several required experiences. In the RARE circumstance where a student cannot attend, the student must contact their class counselor in advance (or as soon as possible in an emergency) to request a deferral. (Please do NOT contact the sequence director with requests for or explanations of deferrals.) Absences will be approved or denied by class counselors based on the same guidelines used for Quiz and Exam deferrals. Should you obtain a deferral from your class counselor, make up for the required experiences (found below) should be followed.

Required experiences:

• Patient Partner Sessions, Small Group Discussions, Pathology Based Physical Diagnosis Sessions, CCA Practice Sessions: Students who do not attend these sessions will forfeit 2.5% of their final grade per missed session. For counselor-approved absences, a 2 page paper on a topic pertaining to the missed session will be due by Friday, December 12 at 5 pm in order to receive credit. Students should email the course director AFTER their absence is approved to obtain the topic.
• Patient Presentations: After viewing the video of the session, a 2 page paper discussing the patient’s presentation will be due by Friday, December 12 at 5 pm.

Bernstein, Musculoskeletal Medicine

Greene, Essentials of Musculoskeletal Care (3rd edition)

Klippel et al., Primer on the Rheumatic Diseases (13th edition)

Johnson et al., Essentials of Musculoskeletal Imaging

Imboden et al., CURRENT Rheumatology: Diagnosis and Treatment (LANGE CURRENT Series, 2nd edition)