Basic science and supporting knowledge



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AMSEC Musculoskeletal Competency Checklist


BASIC SCIENCE AND SUPPORTING KNOWLEDGE

Biomedical sciences

Understands the key basic biomedical science concepts and principles (including anatomy, physiology, pathology, pharmacology, microbiology, genetics and biostatistics), relates them to fundamental normal and abnormal processes in medicine throughout life, and applies them to the clinical sciences underlying current and emerging medical practice.




Local Learning Outcomes

1106.4 Predict the speed of locomotion of any terrestrial vertebrate on the basis of its limb morphology
Identify and name the bones of the skeleton in any vertebrate
Describe, using correct anatomical terminology, the movements at joints of the body in terrestrial vertebrate
Identify, name and describe the action of major muscle groups in humans

2202.1 Identify the surface landmarks and major bone points used in clinical examination

2202.3 Define and discuss normal structure and function of the major joints in the body

2202.6 Compare and contrast the structure, function and innervation of the upper and lower limbs

2202.7 Identify and describe the anatomy of the head and neck

2202.11 Describe physiological processing in motor and sensory pathways and the relationship to perceptual performance and motor sensory deficits and correlate with clinical testing, diagnosis and location of pathological processes

2202.15 Describe and identify the macroscopic anatomy of the nervous system

3343.12: Describe the pathogenesis, morphological and clinical manifestations of basic pathological processes and a range of specific diseases of the musculoskeletal system

Discuss normal joint function.

Discuss normal bone physiology, structure and histology.

Describe the normal structure, function and metabolism of bones and joints.
Discuss fracture healing and repair.

4491: Apply anatomy, physiology, biochemistry, rheumatology and endocrinology knowledge to the musculoskeletal system

Describe the normal anatomy of the musculoskeletal system

Learning experiences

1106: Lectures, Tutorials, Laboratories, Self directed learning

2202: Lectures, Tutorials, Laboratories, Clinical skills

3343: Lectures, Tutorials, Self directed learning

4491: anatomy lab session


Assessment

1106: Practical/Clinical-Practical task, Written Assignment-Essay, Written Exam-Objective test items, Written Exam-Short Answer Questions

2202: Oral-Presentation,  Practical/Clinical-Structured exam



3343: Written Exam-Objective test items, Written Exam-Short Answer Questions

4491: MCQ questions





Behavioural and Social Science

Understands key concepts and principles of psychosocial development throughout life, the multitude of psychological and social factors influencing patient and professional behaviour and interactions, and applies these to the multiple domains of “professionalism” and the effective care of patients.




Local Learning Outcomes

2211.2 : Identify and discuss the causes of ill health considering both the national and international perspective

4491 - Apply anatomy, physiology, biochemistry, rheumatology and endocrinology knowledge to the musculoskeletal system



Demonstrate effective clinical and interpersonal skills related to musculoskeletal disorders

Identify musculoskeletal somatisation as a manifestation of psychiatric disorders
Describe the progressive nature of deforming arthropathies
Describe the psycho-social impact of deforming arthropathies on patients and their carers
Demonstrate sensitivity to patients with problems of the musculoskeletal system who must frequently present with pain and disability
Demonstrate awareness and sensitivity of patients with skeletal failure fractures and particularly proximal femoral fractures who often have associated dementia

Learning experiences

2211 Lectures, Tutorials, Clinical skills

IMED 4491 ward work, attendance at outpatient clinics



Assessment

IMED 4491 workbook?

2212 : Participation-Tutorials,  Written Assignment-Literature Review,  Written Assignment-Portfolio,  Written Assignment-Report, Written Assignment-Report,  Written Exam-Essay,  Written Exam-Short Answer Questions



Professionalism:

Understands the core concepts and principles underlying the key non-technical” professional” roles in health including communicator, advocate, scholar, manager, leader, educator, collaborator, legal and ethical and relates these to the lifelong advancement of professional practice in health care.




Local Learning Outcomes

Demonstrate effective clinical and interpersonal skills related to musculoskeletal disorders

personal and professional development, 5th and 6th year



Learning experiences

IMED 4491 ward work, attendance at outpatient clinics

Assessment

IMED 4491 workbook?



Specialized MSK: Understands the anatomical and basic science processes that underlie the normal form and function of specific MSK tissues throughout life including formation, maintenance and repair, calcium and phosphate metabolism and biomechanics as the basis for understanding and interpreting changes due to normal variation, ageing, abnormal forces and pathological conditions. Understands how the spectrum of pathological processes may affect MSK tissue; the specific reactions of MSK to disorders and injury; and how these may lead to deformity and dysfunction of bone and joints.










Local Learning Outcomes

1106.4 Describe, using correct anatomical terminology, the movements at joints of the body in terrestrial vertebrate
Identify, name and describe the action of major muscle groups in humans

2202.2 Interpret radiographic (x-ray) images of the normal skeleton and CT and MRI images of the limbs, head and neck

2202.3 Define and discuss normal structure and function of the major joints in the body

3343.12: Describe the pathogenesis, morphological and clinical manifestations of basic pathological processes and a range of specific diseases of the musculoskeletal system

Discuss normal joint function.

Discuss normal bone physiology, structure and histology.

Describe the normal structure, function and metabolism of bones and joints.
Discuss fracture healing and repair.

4491: Describe the pathophysiology of osteoporosis, osteomalacia, malignant bone disease and Paget's disease


Describe mechanisms of fracture and fracture healing
Describe mechanisms of tendon and ligament injury and healing
Describe mechanisms of nerve injuries and healing
Describe the pathophysiology of joint inflammation and joint degeneration and diffuse soft tissue pain
Describe and explain calcium and phosphate related biochemistry

Learning experiences

2202 – lectures, tutorials, labs, clinical skills

IMED 3343: Lectures, tutorials, SDL

IMED4491 ortho case study (trauma), PBLs (OP, RA)


Assessment

IMED 3343: Summative and formative, written exam objective test items, short answer questions

4491: self-assessment, oral presentation, practical skills, clinical structured exam, end of term MCQ



Imaging: Understands the fundamental concepts and principles associated with image production in the commonly used modalities; the resultant appearance of anatomical structures from these modalities; and identifies key radiological features and signs of normality as the basis for understanding and Interpreting changes due to normal variation, ageing, abnormal forces and pathological conditions. Understands how the spectrum of pathological processes are manifested in imaging studies; identifies specific reactions related to MSK disorders and injury; knows and interprets common signs of abnormality and deformity as well as commonly missed important fractures.




Local Learning Outcomes

2202.2 Interpret radiographic (x-ray) images of the normal skeleton and CT and MRI images of the limbs, head and neck

2202.3 Define and discuss normal structure and function of the major joints in the body


Learning experiences

2202: lectures, tutorials, labs, clinical skills

4491: lecture on general fracture principle, tOSCE presentation on dx imaging, ortho case study (fracture), ortho case study (mets), ward and outpatient experiences



Assessment

4491: MSK online self-assessments, end-of-year OSCE exams, end of term MCQ, clinical structured exam, oral presentation



CLINICAL SCIENCES AND SKILLS

Attitude and Communication Skills: Incorporates key concepts and principles of “Behavioural and Social Science” and “Professionalism” as the basis for effective communication (using both verbal and non-verbal techniques) with patients, their friends and families, health professionals and the general public. This includes collecting and conveying information clearly, considerately and sensitively and listening and responding to patient concerns

Local Learning Outcomes

Demonstrate effective clinical and interpersonal skills related to musculoskeletal disorders

3rd yr GP, 5th yr GP, personal and professional development, 5th and 6th year



Learning experiences

Mentor discussions, ward work and outpatient clinics

Assessment

PPD portfolio

Assessment: Able to communicate effectively with a patient and/or representative to construct an accurate and problem focussed MSK history, relate this to abnormalities identified by appropriately targeted physical examination and investigations, and interpret using the principles of critical reasoning and diagnostic formulation with consideration to any impairments, disabilities and/or functional limitations.




History

  1. Demonstrates ability to perform accurate and organized MSK screening

  2. Demonstrates ability to take accurate and organized MSK problem-focussed history in the following presentations:

  1. Acute pain presentation

  2. Chronic pain presentation

  3. Traumatic injury presentation

  4. Functional disability presentation

  1. Demonstrates understanding of general pathological processes and specific reactions of MSK tissues to disorders and injuries

Local Learning Outcomes

3345.42.2 Discuss the general principles of pain management

3345.42.3 Discuss the role of drugs in the overall management of chronic pain

3345.2.4 Discuss the problems arising from drug use in patients with chronic pain

3345.2.5 Be aware of the major practical issues in managing chronic pain

4491.3.1 Describe the clinical assessment and management of complaints of musculoskeletal pain including myalgia, arthralgia, arthritis and back pain.

4491.3.12Describe and explain the pathological features, clinical assessment and management of common orthopaedic injuries of wrist,ankle, femoral neck, soft tissue (knee and shoulder), elbow, clavicle, hand (including nerve, tendon, bone injury and loss of function)

5531.5.4 Conduct a consultation including taking a history, requesting and interpreting appropriate investigations, formulating a diagnosis and a management plan with a patient presenting with low back pain, neck pain, knee pain and headache

Identify common causes of low back pain, neck pain and knee pain, and of chronic headache in general practice

5531.5.16 – broad mgmt. of chronic pain




Learning experiences

3345 – tutorials, case based learning

4491 ward work and outpatient clinics, PBLs for rheumatology, ortho case studies, general fracture and polytrauma lectures



Assessment

4491 workbook, end of term MCQ,

3345 written exam short answer, MCQ








Examination

  1. Applies physical examination principles to MSK physical examinations

  2. Able to perform general screening examinations (e.g. GALS)

  3. Able to perform systematic examination for inflammatory conditions

  4. Able to perform examinations in acute trauma settings

  5. Able to perform regional examinations of the spine and extremities

  6. Able to apply principles of critical reasoning to examination findings

  7. Understands effect of validity, sensitivity and specificity to interpretation of MSK examination findings

  8. Considers effect of acute pain on performance and interpretation of MSK examination findings

  9. Considers effect of chronic pain on performance and interpretation of MSK examination findings

  10. Considers effect of psychosocial “yellow flags” on performance and interpretation of MSK examination findings

Local Learning Outcomes

2211.13.4 Describe and demonstrate regional physical examinations of the musculoskeletal system with the use of appropriate tools and techniques

4491. 3: Describe and explain the pathological features, clinical assessment and management of specific musculoskeletal related health conditions

4491.4.1: Perform examination of peripheral joints and the back/spine, hip, shoulder and neck accurately and efficiently
4491.4.2: Perform examination of frequently problematic soft tissue structures accurately and efficiently

4491 3.4.2.1 Demonstrate how clinical examination and functioning tests relate to the anatomy and physiology of the musculoskeletal system

5531.5.4 Conduct a consultation including taking a history, requesting and interpreting appropriate investigations, formulating a diagnosis and a management plan with a patient presenting with low back pain, neck pain, knee pain and headache

Learning experiences

2211 – tutorials, clinical skills

4491: physical examination tutorials week 1, ward work and outpatient clinics

5531: Tutorials, Problem based learning, Lectures, Clinical skills, Placement

Assessment

2211: Practical/Clinical-Observed encounter, Portfolio, Workbook/lab book, Essay, Short Answer Questions

4491: workbook, end of term MCQ, MEQ

5531: Practical/Clinical-Simulation, Written Assignment-Log Book




Investigations

  1. Demonstrates the appropriate selection of the following investigative modalities for MSK conditions, with consideration of risk/benefit ratio, accessibility, cost effectiveness, validity, sensitivity and specificity:

    1. Laboratory tests

    2. Imaging modalities

    3. Special diagnostic modalities

Local Learning Outcomes

2202.2: Interpret radiographic (x-ray) images of the normal skeleton and CT and MRI images of the limbs, head and neck

4491.4.4.1.4 Describe how to order and accurately interpret synovial fluid laboratory studies
Describe how to order and accurately interpret bone densitometry

5531.5.4 Conduct a consultation including taking a history, requesting and interpreting appropriate investigations, formulating a diagnosis and a management plan with a patient presenting with low back pain, neck pain, knee pain and headache



Learning experiences

2202: Lectures, Tutorials, Laboratories, Clinical skills

4491 lectures (OA – joint aspiration), (laboratory tests), ortho case study

5531: Tutorials, Problem based learning, Lectures, Clinical skills, Placement


Assessment

2202: Oral-Presentation, Practical/Clinical-Structured exam

4491 – MCQ

5531: Practical/Clinical-Simulation, Written Assignment-Log Book



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