Using peer role-playing to improve students’ clinical skills for musculoskeletal physical examinations

Abstract

Background The traditional curriculum for medical students in Japan does not include sufficient opportunities for students to develop their skills for musculoskeletal (MSK) examination and clinical reasoning and diagnosis. Therefore, an effective programme is required to help medical students and residents improve their clinical skills in MSK. This paper aims to assess the clinical skills of medical students who have participated in a peer role-playing simulation programme using a mini clinical evaluation exercise (mini-CEX). Methods Participants were 90 female medical students who were completing their first orthopaedic clinical clerkship. They were divided into two groups. The simulation group participated in a role-play focussed on MSK cases as low-fidelity simulation, a structured debriefing with the course supervisor, and a self-reflection on Day 1 (n = 64). The control group did not participate in the role-play due to randomised clerkship schedules (n = 26). On Day 2 of the intervention, we observed and assessed all participants’ performances during MSK outpatient encounters using the mini-CEX. We compared the mini-CEX score between the simulation group and the control group; the Wilcoxon rank-sum test was used for statistical analysis. Results The mini-CEX scores for physical examination, clinical reasoning and diagnosis, and overall clinical competency were significantly higher in the simulation group than in the control group (p < .05, physical examination: p = .014, clinical reasoning: p = .042, overall: p = .016). These findings suggest that medical students who partake in a peer role-playing simulation programme could experience improved clinical skills for physical examination, clinical reasoning and diagnosis, and overall clinical competency in real-life MSK outpatient encounters. Conclusions Through a mini-CEX assessment, our findings indicate that medical students who participated in our peer role-playing simulation programme have improved clinical skills. Peer role-playing as a low-fidelity simulation and practical educational opportunity will enable educators to polish the competency of medical students in musculoskeletal physical examinations and clinical reasoning and diagnosis in a clinical setting.

Musculoskeletal education in undergraduate medical curricula–A systematic review

“…PAL and NPL draw on Vygotsky's “zone of proximal development”, 70 where in order to learn something new, 1 must be at the right distance between prior and new knowledge, something often more easily appreciated by peers as distinct from faculty experts. Our review of the 4 studies evaluating both PAL and NPL in musculoskeletal education demonstrate promising results in 2 levels of Kirkpatrick learning outcomes, or all 3 domains of knowledge, skills and attitude/perception 44–47 . Although studies are limited, these findings are promising given the amenability of NPL and PAL, particularly in the setting of poor resources or economic constraints.…”

“…The 1st study evaluating PAL resulted in greater knowledge gain on assessment in PAL group vs didactic learning group, with good appreciation by students of most aspects of PAL 46 . The second study assessing PAL evaluated clinical skills via an mini‐clinical evaluation exercise examination, demonstrating significantly higher physical examination, clinical reasoning and overall competency using PAL vs control 47 …”

“…Two studies evaluated near peer learning (NPL) 44,45 and 2 further studies evaluated peer‐assisted learning (PAL) 46,47 . Studies evaluating NPL 44,45 assessed both knowledge and perception, with the first demonstrating a median Freedman and Bernstein score of 83.6% post‐NPL, with 95% deeming NPL excellent 44 .…”

“…Our review of the 4 studies evaluating both PAL and NPL in musculoskeletal education demonstrate promising results in 2 levels of Kirkpatrick learning outcomes, or all 3 domains of knowledge, skills and attitude/perception. [44][45][46][47] Although studies are limited, these findings are promising given the amenability of NPL and PAL, particularly in the setting of poor resources or economic constraints.…”

Use of Alternative Methodologies in Veterinary Medicine Learning and Acceptance of Students

“…However, this is the first study where a role-play game has been applied to teaching in veterinary medicine. Role-play games are common practice in other disciplines such as physiotherapy [11,27], human medicine [9,32,33], and nursing [12,13], among others. Given the curricular similarities between these disciplines [34], acquiring this type of alternative teaching practices would be interesting for veterinary medicine students, from the point of view of active teaching and improving learning.…”