Osteoarthritis pain occurs in more than one-third of people over 65 and is typically reported to primary care providers (PCPs), as are other causes of musculoskeletal pain. Meeting the needs of this patient population—especially in rural areas—can be challenging and costly, with limited access to rheumatologists and other specialists who could perform exams and intraarticular injections of corticosteroids. In an attempt to improve cost effectiveness and quality of care, the U.S. Department of Veterans Affairs (VA) has launched a structured effort to develop an educational pilot program designed to strengthen the musculoskeletal care knowledge and skills of PCPs.
This pilot program was held periodically from April to September 2012 at the George E. Wahlen VA Medical Center in Salt Lake City. Conducted by Michael J. Battistone, MD, and colleagues, the program’s results were published in the February 2016 issue of Arthritis Care & Research.
“We developed a pilot, mixed-methods educational initiative,” write the authors. “The program is immersive, grounded in the needs and experiences of practicing PCPs, and provides a rich, multidisciplinary and interprofessional learning environment.”
Originally designed as a two-week program, the course was condensed to one week to accommodate the large number of applicants. Nineteen providers—13 in the two-week format and 6 in the revised one-week format—completed a musculoskeletal mini-residency. Participation was restricted to four providers a week. The course was accredited through the VA Employee Education System, with 40 hours of continuing professional education credit per week.
The course combined small group didactics, hands-on peer learning and technology-enhanced simulation. Each week included supervised reflective practice in orthopedic, rheumatology and musculoskeletal care clinics. The curriculum included shoulder and knee exams, risk and treatment of osteoporosis, joint injections and the diverse presentations, characteristics and care of rheumatic disease.
The Results
After the course, participants completed written surveys with a 100% response rate. Structured phone interviews were also conducted eight weeks after training. “All aspects of the course were rated highly and ratings of faculty were consistently, extremely positive,” write the authors. “All participants recommended this program for PCP training.”
Clinic data from 14 participants were also analyzed. An increase in monthly injections given by these PCPs was measured at six, 12 and 24 months after course completion. Two years after course completion, the mean number of joint injections increased from 0.3 to 3.4 monthly. The authors note that this increase in injections was not the case for all providers, possibly due to “factors in their [clinical] environment that were not assessed by our program.”
In their discussion, the authors reflect on the limitations of this small pilot program and suggest ways to improve the effectiveness and expand this program. “We are reflecting on our initial experience with this model and adapting this initiative into a format that can be disseminated to additional sites, developing a sustainable interdisciplinary educational program with a focus for future scholarship in this area of medical education,” conclude the authors.
Battistone MJ, Barker AM, Lawrence P, et al. Mini-residency in musculoskeletal care: An interprofessional, mixed-method educational initiative for primary care providers. Arthritis Care Res (Hoboken). 2015 Jun 19. doi: 10.1002/acr.22644. [Epub ahead of print]