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 / 1106.4Predict 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
2202.1Identify the surface landmarks and major bone points used in clinical examination
2202.3Define 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
2202.7Identify and describe the anatomy of the head and neck
2202.11Describe 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
2202.15Describe 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 / 1106.4Describe, 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
2202.2Interpret radiographic (x-ray) images of the normal skeleton and CT and MRI images of the limbs, head and neck
2202.3Define 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:
a.Acute pain presentation
b.Chronic pain presentation
c.Traumatic injury presentation
d.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
(a)Applies physical examination principles to MSK physical examinations
(b)Able to perform general screening examinations (e.g. GALS)
(c)Able to perform systematic examination for inflammatory conditions
(d)Able to perform examinations in acute trauma settings
(e)Able to perform regional examinations of the spine and extremities
(f)Able to apply principles of critical reasoning to examination findings
(g)Understands effect of validity, sensitivity and specificity to interpretation of MSK examination findings
(h)Considers effect of acute pain on performance and interpretation of MSK examination findings
(i)Considers effect of chronic pain on performance and interpretation of MSK examination findings
(j)Considers effect of psychosocial “yellow flags” on performance and interpretation of MSK examination findings
Local Learning Outcomes / 2211.13.4Describe 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 3.4.2.1Demonstrate 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:
  2. Laboratory tests
  3. Imaging modalities
  4. 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
Critical Reasoning and Diagnostic Formulation: Relates MSK problem-based assessment findings to anatomical and pathological aetiologies; recognizes features used to discriminate between specific MSK conditions (ie understands differential diagnosis of MSK conditions); and applies the principles of critical reasoning and diagnostic formulation in the construction of appropriate differential diagnosis
Local Learning Outcomes / IMED 4491 4.4.1.3: Describe and explain the pathological features, clinical assessment and management of specific musculoskeletal related health conditions
IMED 5531 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 / IMED 4491 lectures, including intro lecture, ward and outpatient clinic attendance
5531: Tutorials, Problem based learning, Lectures, Clinical skills, Placement
Assessment / IMED 4491 MCQ, IMED 4491 workbook
5531: Practical/Clinical-Simulation, Written Assignment-Log Book
Related Management Issues: Understands the key broader community, legal, environmental and technical issues that may impact on the management of individual patient.
Local Learning Outcomes / 4491.2.3 Describe the psycho-social impact of deforming arthropathies on patients and their carers
4491.6.1 Identify and describe the high incidence and prevalence of low back pain in the community and the issues of continuing care for chronic disorder
4491.6.2 Identify and describe the scope for prevention of musculoskeletal disorders such as gout, viral arthritis and osteoporosis
Learning experiences / 4491 lectures, PBLs
Assessment / 4491 end-of-term MCQ
Procedural Skills: Understands the general principles of safe procedural performance and equipment usage, and is able to perform procedures or use equipment at the prescribed level, (including limb realignment, splintage and injection use in MSK conditions).
Local Learning Outcomes / 4491.4.3 Perform safe application and removal of a forearm plaster backslab
4491.4.4 Perform safe application of a triangular broad arm sling, a collar and cuff shoulder sling
4491.4.5 Describe how to order and accurately interpret synovial fluid laboratory studies
4491.4.6 Describe how to order and accurately interpret bone densitometry
4491.4.7 Describe the indications for use of a triangular broad arm sling, a collar and cuff shoulder sling
Learning experiences / 4491 lectures (gout, OP), PBL (OP)
Assessment / 4491 end of term MCQ
Prioritization: Understands the principles of prioritizing conditions in health and education (both professional and patient) based on urgency, frequency and amenable to intervention. This incorporates factors such as the impact on the individual patient, the community and the population, financial resources, incidence, prevalence, projected changes and emerging issues.
Local Learning Outcomes
Learning experiences
Assessment
Management:
Understands the key principles of management of conditions that have a broad application across health including pain, wound management and general trauma.
Local Learning Outcomes / 4491.3: Describe and explain the pathological features, clinical assessment and management of specific musculoskeletal related health conditions
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 / IMED 4491 lectures, PBLs, case studies, ward and outpatient clinics
5531: Tutorials, Problem based learning, Lectures, Clinical skills, Placement
Assessment / IMED 4491 end-of-term MCQ, MEQ, OSCE
5531: Practical/Clinical-Simulation, Written Assignment-Log Book
Management:
Understands the general and related patient management modalities and describes their application in the holistic management of MSK conditions including therapeutic (operative and non-operative); rehabilitiation; patient education and self-management, shared care and referral; prevention; and complementary and alternative medicine modalities.
Local Learning Outcomes / 4491.5.1 Describe and explain the role of ancillary health professionals, e.g. physiotherapists, occupational therapists, and podiatrists in the acute and chronic care of musculoskeletal disease.
Learning experiences / 4491: t-OSCE, ward and outpatient clinics
Assessment
Management:
Applies knowledge of general and MSK related basic and clinical science to describe the basic aetiology, pathogenesis, characteristics clinical manifestations and general principles of assessment and management for patients suffering from the broad range of MSK-related conditions and disorders. This includes the management of normal variation and special concern groups. Knowledge of specific conditions should be prioritized in detail towards the management of the “MSK/red-flag emergencies” and the national priority and high burden MSK conditions.
Local Learning Outcomes / 4491.3: Describe and explain the pathological features, clinical assessment and management of specific musculoskeletal related health conditions
Learning experiences / 4491: lectures, PBLs, ortho case studies, ward and inpatient experience
Assessment / 4491: end of term MCQ, MEQ

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