Improving musculoskeletal clinical skills teaching. A regionwide audit and intervention study

Objective-To identify factors that influence medical students' perceptions of the quality of a clinical skills course; to apply these factors to the course at one hospital; to measure the effect of this change. Design-Cross sectional questionnaire survey; application of identified factors; repeat questionnaire survey. Setting-Three teaching hospitals and five district general hospitals in north east England. Subjects-Third year medical students attending locomotor clinical skills courses in two consecutive years. Main outcome measures-Score awarded by students in five categories; numbers of patients seen by each student; comparisons with other clinical skills weeks. Results-Response rates were 71 of 150 and 89 of 161. Factors associated with a high awarded score were: organisation of the course by a rheumatologist (p<0.01); teaching from a rheumatologist (p<0.01); higher number of patients seen (r=0.76). Mean number of patients seen varied widely, from 7 per student at one hospital to 20.4 at another. Teaching hospitals scored poorly. In the second year, after making changes at one teaching hospital the mean total score improved (p<0.01), and students saw more patients (p<0.01). The ranking of this hospital rose from 6 to 1. The additional cost of the modified course was pound 640 per student. Conclusions-The standard of teaching of locomotor clinical skills varies widely and can be improved by application of factors identified in this survey, although additional costs are incurred.