Orthopedics and Traumatology Skill Matrix for Musculoskeletal System Approach by Medical Graduates

Siqueira, Eduardo Martins de; Pereira, Alexandre de Araújo; Oliveira, Isaac Abu Kamel Marques de

doi:10.1055/s-0043-1776771

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Revista Brasileira de Ortopedia

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Original Article • Rev. bras. ortop. 58 (6) • 2023 • https://doi.org/10.1055/s-0043-1776771 copy

Orthopedics and Traumatology Skill Matrix for Musculoskeletal System Approach by Medical Graduates

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to build a matrix of orthopedics and traumatology skills focusing on the musculoskeletal system for graduates of a medical course in Brazil.

Methods

The study used the e-Delphi methodology to retrieve opinions anonymously. The first proposal included 42 items determined at a bibliographical review and their epidemiological relevance. This proposal was available via Google Forms, and we sent it using the instant messaging application WhatsApp. We grouped the panel of 26 specialists into three categories: Orthopedics and Traumatology professors, Primary Care doctors, and Emergency Physicians. We reached a consensus after three rounds, with at least 75% agreement between the items initially presented. We also considered the following four indicators: prerequisite, essential, desirable, and advanced skills.

Results

We created a matrix with 34 musculoskeletal system-related skills, including diagnostic and management actions for all age groups.

Conclusion

We devised a skill matrix in Orthopedics and Traumatology for medical graduation for complete or partial use according to the institutional curriculum.

Keywords
education, medical; orthopedics; traumatology

Skill leveling	Description
Prerequisite	Skills expected from a graduate student at the end of the basic cycle
Essential	Skills expected from a student at the end of medical school
Desirable	Skills expected from a differentiated general practitioner who can advance beyond core skills
Advanced	Skills expected from a professional proficient in more complex competencies acquired through additional training

STATEMENT	CONSENSUS
PREREQUISITE LEVEL
To apply the basic anatomy of the osteoarticular system in medical practice	96.1%
To apply the basic vascular and neurological anatomy of the upper and lower limbs in medical practice	92.3%
To apply the basic physiology of bone tissue in medical practice	84.7%
To apply basic physiology of the muscular system in medical practice	92.4%
ESSENTIAL LEVEL
To perform anamnesis and physical examination focused on the general semiology of the musculoskeletal system per the patient’s complaints	96.2%
To correctly request radiological views of the affected site and to differentiate normal radiological anatomy from potential alterations	80.7%
To request and interpret main laboratory tests in Orthopedics and Traumatology	92.3%
To recognize an open fracture and provide the correct referral, taking the necessary initial measures	96.2%
To understand the concept of dislocation and recognize it as urgent	100%
To recognize the signs and symptoms of a compartment syndrome, referring the patient as an emergency	100%
To diagnose an open-book fracture-dislocation (HIP), taking necessary measures for vital functions support and referring the patient	96.2%
To detect the signs and symptoms of osteoarticular infections (osteomyelitis and septic arthritis) and refer the patient as an emergency	100%
To make judicious use of the main drugs prescribed in orthopedics and traumatology	96.1%
To know non-pharmacological treatment options for treating chronic pain, including psychosocial approaches	80.7%
To guide ergonomic measures to prevent orthopedic problems	76.9%
To diagnose and refer the patient in cases of osteoarthritis, especially in knees, hips, and spine	77%
DESIRABLE LEVEL
To diagnose and provisionally manage proximal humeral and distal radial fractures in elderly patients	76.9%
To diagnose and refer cases of transtrochanteric and femoral neck fractures	84.6%
To recognize and evaluate patients with symptoms consistent with carpal tunnel syndrome	76.9%
ADVANCED LEVEL
To perform a knee joint puncture	76.9%

STATEMENT	CONSENSUS
PREREQUISITE LEVEL
To correctly request radiological views for the affected location	84%
To correctly evaluate cases of low back pain, making a differential diagnosis list of potential causes and indicating appropriate follow-up	92%
To carry out initial treatment of wounds on upper and lower limbs and provide the correct referral in cases of suspected tendon and peripheral nerve injuries	84%
DESIRABLE LEVEL
To provide temporary immobilization of the injured limb to control pain, comfort, and transport the patient; to indicate, create, and correctly apply immobilizations (splints)	84%
To evaluate radiographic examinations and differentiate normal radiological anatomy from potential alteration, i.e., suspect radiographic changes even without precisely defining the diagnosis	84%
To educate the patient in cases of osteoporosis	80%
ADVANCED LEVEL
To provide initial care for polytrauma patients	84%
To perform differential diagnosis for the main inflammatory arthropathies	76%
To identify characteristic injuries in cases of suspected abuse	78%
To educate children and adolescents regarding spinal deformities: hyperkyphosis, hyperlordosis, and scoliosis	76%
Suspect fractures in the most commonly affected bones in newborns (birth injury): clavicle, humerus, and femur	84%
To recognize the pattern of supracondylar fractures of the humerus and diaphyseal fractures of the forearm and wrist in children and adolescents and provide initial care	80%
Recognize the patterns of tibial shaft fractures and ankle epiphysiolysis in children and adolescents and provide initial care	80%

STATEMENT	CONSENSUS
PREREQUISITE LEVEL
To provide initial care in cases of amputation (care at the trauma site, conservation, and correct packaging of the amputated limb) and refer the patient	79.2%
ADVANCED LEVEL
To provide primary care in humeral shaft fractures, forearm bone shaft fractures, distal radial fractures, and scaphoid fractures in adults	78.8

	Skills
Advanced	To perform the initial approach to a patient complaining of torticollis
	To perform the initial approach to a patient with a knee sprain
	To perform the initial approach to the most prevalent myofascial pains
	To perform the initial approach to a patient with an ankle sprain
	To suspect benign, malignant, and metastatic bone tumors per radiographic findings
	To perform initial care in cases of patellar, tibial plateau, and metatarsal fractures in adults
	To know the physical examination maneuvers for detecting developmental hip dysplasia in children
	To know the conditions requiring electroneuromyography as a supplementary test
	To differentiate the main congenital foot deformities in children
	To differentiate the main knee deformities in children and adolescents
	To address primarily adult patients complaining of shoulder pain
	To recognize cases of painful pronation, educate parents, and refer the patient
	To correctly indicate physical therapy and/or exercises to prevent and rehabilitate the main musculoskeletal conditions

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Alexandre de Araújo Pereira, Rua Professor Moraes, 562–805, Savassi, 30150-370, Belo Horizonte, MG, Brasil (e-mail: alex68@uol.com.br).