1. Musculoskeletal complaints are some of the most common reasons for primary care and specialty visits.
2. Little time is dedicated to diagnosis of musculoskeletal problems in undergraduate and graduate training curricula.
3. To address this critical need, we developed an inter-disciplinary and inter-professional program involving primary care, rheumatology, orthopaedic surgery, endocrinology, and physical medicine specialists to train physicians and associated health professionals in musculoskeletal care. 
4. Through funding from the Office of Academic Affiliations (OAA) of the Department of Veterans Affairs (VA), we developed a Center of Excellence (COE) for patient-centered musculoskeletal (MSK) care.   This interdisciplinary and interprofessional program includes an intensive week of training that combines didactics, simulations, and clinical experiences as well as longitudinal interdisciplinary clinics that evaluate patients with complex MSK disorders.

EDUCATIONAL MODEL

OVERVIEW OF INTENSIVE TRAINING WEEK.

TRAINEES.  Over the last two years, 62 physician trainees (42 internal medicine, 5 medical students, 5 physical medicine and rehabilitation, 5 rheumatology, 3 orthopaedic surgery, 1 occupational medicine, and 1 endocrinology) and 23 associated health trainees (10 nurse practitioner, 10 physician assistants, 2 physical therapy, 1 pharmacy) have experienced COE training.

INTER-DISCIPLINARY AND INTER-PROFESSIONAL DIDACTIC AND SIMULATION TRAINING

INTER-DISCIPLINARY AND INTER-PROFESSIONAL CLINICAL TRAINING

A review of the first 149 patients seen in the COE MSK interdisciplinary clinic documents a rich clinical training opportunity with an average of 2.4 ± 1.5 complaints per visit, and patients being seen by 2.8 ± 1.2 disciplines

CHEIF COMPLAINTS

Trainees reported high satisfaction with the intensive training and COE MSK experiences. The percent of students reporting competency in MSK-related physical examination increased from 16.7% to 100% and clinical management skills from 22.7% to 94.4% with self-assessment confirmed with Objective Structures Clinical Exam (OSCE).

CURRENT USE OF THE INTER-DISCIPLINARY AND INTER-PROFESSIONAL CLINICAL TRAINING CLINICS

1.The Center of Excellence in Musculoskeletal diseases provides a comprehensive training program in musculoskeletal disease.

2.The employment of an inter-disciplinary and inter-professional training model gives trainees the unique opportunity to learn to manage patients with musculoskeletal diseases in a rich collaborative setting. 

3.Trainees experience and demonstrate increased competence in addressing musculoskeletal diseases.

The COE in MSK care provides an innovative and comprehensive training program in MSK care that can be implemented to fulfill a need not achieved by the traditional training experiences.

Thanks to the Staff, Trainees, and Patients at the Salt City VA Medical Center for their participation in this program.   This project has been supported by the Department of Veteran Affairs, Veterans Health Administration, Office of Academic Affilliations and the Office of Specialty Care Transformation which is a part of the T-21 New Models of Care Initiative, VA Central Office, Washington DC.