Jenice Cheah, MD; Heather Bukiri, MD

Background and Purpose:

Of the physical exams, there is a lack of knowledge and comfort in performing musculoskeletal exams among residents. Our objective was to teach residents how to perform the rheumatologic joint exam to improve residents’ comfort in performing the joint exam.

Methods:

This project targeted UCLA Internal Medicine residents and consisted of two 45-minute sessions conducted at the WLAVA Morning Report. Session one focused on the hand and wrist exam and session two focused on the lower extremity exam. Sessions consisted of a didactic portion, an in-person demonstration, and a practice session. Pre- and post-surveys on participants’ self-assessment of comfort and proficiency at performing the rheumatologic exam on a Likert scale were collected.

Results:

In the first session on the rheumatologic hand and wrist exam, 11 participants completed the pre-survey and 10 participants completed the post-survey. Residents’ self-assessment of their confidence in “knowing the components” of the hand and wrist exam on a Likert scale (mean±SD) was 2.27±0.96 pre-intervention and 4.5±0.5 post-intervention. Residents’ assessment of their “ability to perform” the hand and wrist exam was 2.55±0.89 pre-intervention and 4.6±0.49 post-intervention. In the second session on the rheumatologic lower extremity exam, 3 participants completed the pre-survey and 5 participants completed the post-survey. Similarly, residents’ pre- and post-intervention assessments of their confidence in “knowing the components” (1.67±0.47 vs. 4.20±0.40) and their “ability to perform” (1.67±0.47 vs. 4.4±0.49) the lower extremity exam improved after the intervention.

Conclusion:

We conclude that focused didactic sessions with integrated practice can improve residents’ comfort in performing rheumatologic joint exams. Future sessions focusing on other parts of the rheumatologic exam with spaced repetition can further improve residents’ comfort in evaluating patients for rheumatologic conditions.