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Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program.
Am J Phys Med Rehabil. 2020 Mar 18 [Online ahead of print]AJ

Abstract

Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in Physical Medicine and Rehabilitation (PM&R) residents in foot and ankle surface anatomy palpation and to determine if senior residents had higher examination performance compared to more junior residents. PM&R residents at different levels of training were tested cross-sectionally and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (p<0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%), and the second (13.3%) and fourth tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for PM&R resident training.

Authors+Show Affiliations

Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ Burke Rehabilitation Hospital, White Plains, NY, Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System1 Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA and University of Hawaii School of Medicine, Honolulu, Hawaii, USA. Department of Physical Medicine & Rehabilitation, VA New Jersey Health Care System, East Orange, NJ.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32195736

Citation

Bitterman, Jason, et al. "Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle With Diagnostic Ultrasound: Experience From a Physical Medicine and Rehabilitation Residency Training Program." American Journal of Physical Medicine & Rehabilitation, 2020.
Bitterman J, Oh-Park M, Lew HL, et al. Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program. Am J Phys Med Rehabil. 2020.
Bitterman, J., Oh-Park, M., Lew, H. L., & Ma, R. T. (2020). Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program. American Journal of Physical Medicine & Rehabilitation. https://doi.org/10.1097/PHM.0000000000001425
Bitterman J, et al. Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle With Diagnostic Ultrasound: Experience From a Physical Medicine and Rehabilitation Residency Training Program. Am J Phys Med Rehabil. 2020 Mar 18; PubMed PMID: 32195736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle with Diagnostic Ultrasound: Experience from a Physical Medicine and Rehabilitation Residency Training Program. AU - Bitterman,Jason, AU - Oh-Park,Mooyeon, AU - Lew,Henry L, AU - Ma,Rex T, Y1 - 2020/03/18/ PY - 2020/3/21/entrez JF - American journal of physical medicine & rehabilitation JO - Am J Phys Med Rehabil N2 - Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in Physical Medicine and Rehabilitation (PM&R) residents in foot and ankle surface anatomy palpation and to determine if senior residents had higher examination performance compared to more junior residents. PM&R residents at different levels of training were tested cross-sectionally and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (p<0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%), and the second (13.3%) and fourth tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for PM&R resident training. SN - 1537-7385 UR - https://www.unboundmedicine.com/medline/citation/32195736/Identifying_and_Monitoring_Deficiencies_in_Physical_Examination_of_the_Foot_and_Ankle_with_Diagnostic_Ultrasound:_Experience_from_a_Physical_Medicine_and_Rehabilitation_Residency_Training_Program L2 - https://doi.org/10.1097/PHM.0000000000001425 DB - PRIME DP - Unbound Medicine ER -
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