Family Physicians' Knowledge Level of Musculoskeletal System Anatomy: Cross-Sectional Study in Kahramanmaras City

Year 2019, Volume: 13 Issue: 3, 305 - 310, 20.09.2019

Bülent Güneri Murat Uzel Adem Doğaner

https://doi.org/10.21763/tjfmpc.610659

Abstract

Objective: Family physicians (FP) frequently
encounter musculoskeletal system (MSS) disorders. Physicians, capable of making
fine physical examination, are required for family health centers since
diagnostic equipment is limited. Fine physical examination depends on adequate
human anatomy (HA) knowledge. The aim of this study is to investigate the HA
knowledge level on MSS among FP practicing in Kahramanmaras. Materials and
Methods: This study was approved by institutional review board. 184 FP
attended instructional seminars organized by City General Secretariat of Public
Hospitals Association and 85 (46.1%) volunteered to be involved in the study.
Volunteers were subjected to test including 20 multiple-choice questions on MSS
anatomy. The test included four question groups (bone-ligament, muscle-tendon,
nerve and vascular anatomy), each of which were comprised of five questions.
The results were recorded and subjected to statistical analysis. Results:
The average point of all volunteers was 8.1±3.2. According to question groups,
average points were 3.0±1.0 for vascular, 2.4±1.3 for bone-ligament, 1.3±1.1
for muscle-tendon and 1.2±0.9 for nerve group with significant difference
(p=0.001). Insignificant negative correlation was detected between reported
duration of professional experience and received points considering question
groups. Besides, there was no statistically significant difference between FP
practicing in province and districts with regard to average points considering
question groups. Conclusion: We believe further studies are required to
evaluate knowledge level and interest of FP to HA. Besides, necessity for
reinforcement of pre-graduate HA education and potentiality of postgraduate
instructional seminars including practices for HA to improve health service
quality and motivation of FP should be considered.

 

Amaç: Aile hekimleri (AH) kas-iskelet
sistemi (KİS) sorunları ile sık karşılaşmaktadır. Aile sağlığı merkezlerinde
tanısal cihaz donanımının sınırlı olması nedeniyle iyi fizik muayene yapabilen
hekimlere ihtiyaç duyulmaktadır. İyi fizik muayene yeterli Tıbbi Anatomi (TA)
bilgisine dayanmaktadır. Çalışmamızda Kahramanmaraş’ta görev yapan AH’nin KİS
üzerine TA bilgi düzeyinin araştırılması amaçlanmıştır. Yöntem:
Çalışmamız yerel etik kuruldan onay almıştır. İl Kamu Hastaneler Birliği Genel
Sekreterliği’nin düzenlemiş olduğu bilgi yenileme seminerlerine iştirak eden
184 aile hekiminden 85’i (%46,1) çalışmaya gönüllü olarak katıldı. Gönüllüler
KİS anatomisi üzerine toplam 20 çoktan seçmeli sorudan oluşan teste tabi
tutuldu. Test her biri beşer adet soru içeren dört soru grubundan
(kemik-ligament, kas-tendon, sinir ve damar anatomisi) oluşuyordu. Sonuçlar
kaydedildi ve istatistiksel değerlendirmeye tabi tutuldu. Bulgular: Tüm
katılımcıların puan ortalaması 8,1±3,2 idi. Soru gruplarına göre puan
ortalamaları yüksekten düşüğe doğru şu şekilde sıralanabilir: damar grubu
3,0±1,0; kemik-ligament grubu 2,4±1,3; kas-tendon grubu 1,3±1,1; sinir grubu
1,2±0,9. Soru grupları arasındaki farkın istatistiksel olarak anlamlı olduğu
tespit edildi (p=0.001). Bildirilen mesleki tecrübe süreleri ile alınan grup
puanları arasında anlamlı olmayan negatif yönlü bir ilişki saptandı. Ayrıca il merkezi
ve ilçelerde görev yapan AH arasında, soru gruplarına göre puan ortalamaları
açısından istatistiksel anlamlı fark saptanmadı. Sonuç: Daha ileri
çalışmalarla AH’nin TA konusundaki bilgi düzeylerinin ve ilgilerinin
değerlendirilmesinin gerekliliğine inanmaktayız. Ayrıca mezuniyet öncesi TA
eğitiminin güçlendirilmesinin gerekliliği; pratik eğitimleri de kapsayan
mezuniyet sonrası TA bilgi yenileme programlarının sağlık hizmetleri kalitesini
ve AH’nin motivasyonunu artırması olasılığı göz önünde bulundurulmalıdır.

Keywords

Family practice, physical examination, musculoskeletal system, anatomy

References

• 1. Ballas M, Tytko J, Mannarino F. Commonly missed orthopedic problems. Am Fam Physician 1998;15;57(2): 267-74.
• 2. Boon JM, Meiring JH, Richards PA. Clinical anatomy as the basis for clinical examination: Development and evaluation of an introduction to clinical examination in a problem-oriented medical curriculum. Clin Anat 2002;15(1): 45-50.
• 3. Akman M. Strength of primary care in Turkey. Türk Aile Hek Derg 2014; 18 (2): 70-8. doi: 10.2399/tahd.14.00070.
• 4. Gregory JK, Lachman N, Camp CL, Chen LP, Pawlina W. Restructuring a basic science course for core competencies: an example from anatomy teaching. Med Teach 2009;31(9): 855-61.
• 5. Cottam WW. Adequacy of medical school gross anatomy education as perceived by certain postgraduate residency programs and anatomy course directors. Clin Anat 1999;12(1):55-65.
• 6. Papa V, Vaccarezza M. Teaching anatomy in the XXI century: new aspects and pitfalls. Scientific World Journal 2013,7;2013:310348. doi: 10.1155/2013/310348.
• 7. Staśkiewicz GJ, Walczak E, Torres K, Torres A, Mazgaj M, Kostek H, et al. What do clinicians think of the anatomical knowledge of medical students? Results of a survey. Folia Morphol (Warsz). 2007;66(2): 138-42.
• 8. Yalman F, Bayat M, Çatı K. The Effect of family medicine practice on the quality of services provided by doctors: Case of Düzce]. AIBU Journal of Social Sciences 2014; 14 (3): 23-50.
• 9. Resmi Gazete (25.1.2013, Sayı: 28539) Aile Hekimliği Uygulama Yönetmeliği; 2013. p.1.
• 10. Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am 2001 Sep;83-A(9):1317-20.
• 11. Ellis H. Medico-legal litigation and its links with surgical anatomy. Surgery 2002;20: 1-2. https://doi.org/10.1383/surg.20.8.0.14518.
• 12. Smith CF, Mathias HS. What impact does anatomy education have on clinical practice? Clin Anat 2011 Jan;24(1):113-9. doi: 10.1002/ca.21065.
• 13. Nabil NM, Al-Mously N, AlWathnani S, Abduldaiem A, Al-Issa H. Medical students' perception on anatomy knowledge relevance and retention during clerkship. J Contemp Med Edu 2014; 2(3): 147-51. doi: 10.5455/jcme.20140928035119.
• 14. DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am 2003;85:565-7.
• 15. Sbayeh A, Qaedi Choo MA, Quane KA, Finucane P, McGrath D, O'Flynn S, et al. Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators. Perspect Med Educ 2016 Dec;5(6):338-46.
• 16. Fowler PJ, Regan WD. The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med 1987;15:321-5.
• 17. Sneiderman C. Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners. J Fam Pract 1977;4:267-70.
• 18. Reznick RK, Brewer ML, Wesley RM, Stauffer ES. Orthopaedic teaching: the practicing family doctor’s perspective. Orthop Rev 1987;16:529-35.
• 19. Matheny JM, Brinker MR, Elliott MN, Blake R, Rowane MP. Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop 2000;29:945-52.
• 20. Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 2005 Feb;87(2):310-4.
• 21. Jurjus RA, Lee J, Ahle S, Brown KM, Butera G, Goldman EF, et al. Anatomical knowledge retention in third-year medical students prior to obstetrics and gynecology and surgery rotations. Anat Sci Educ 2014 Nov-Dec;7(6):461-8. doi: 10.1002/ase.1441.