E-Learning Module on Chronic Low Back Pain in Older Adults: Evidence of Effect on Medical Student Objective Structured Clinical Examination Performance

Authors

  • Debra K. Weiner MD,

    Corresponding author
    1. Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    2. Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
    3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
    4. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
    5. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
    • Address correspondence to Debra K. Weiner, Suite 500, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail: dweiner@pitt.edu

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  • Natalia E. Morone MD, MS,

    1. Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    2. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
    3. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Heiko Spallek DMD, PhD,

    1. Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Jordan F. Karp MD,

    1. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
    2. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
    3. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Michael Schneider PhD, DC,

    1. School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Carol Washburn EdD,

    1. Center for Instructional Development and Distance Education, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Michael P. Dziabiak MLIS,

    1. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • John G. Hennon MD,

    1. Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    2. University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • D. Michael Elnicki MD,

    1. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • and on behalf of the University of Pittsburgh Center of Excellence in Pain Education


Abstract

The Institute of Medicine has highlighted the urgent need to close undergraduate and graduate educational gaps in treating pain. Chronic low back pain (CLBP) is one of the most common pain conditions, and older adults are particularly vulnerable to potential morbidities associated with misinformed treatment. An e-learning case-based interactive module was developed at the University of Pittsburgh Center of Excellence in Pain Education, one of 12 National Institutes of Health–designated centers, to teach students important principles for evaluating and managing CLBP in older adults. A team of six experts in education, information technology, pain management, and geriatrics developed the module. Teaching focused on common errors, interactivity, and expert modeling and feedback. The module mimicked a patient encounter using a standardized patient (the older adult with CLBP) and a pain expert (the patient provider). Twenty-eight medical students were not exposed to the module (Group 1) and 27 were exposed (Group 2). Their clinical skills in evaluating CLBP were assessed using an objective structured clinical examination (OSCE). Mean scores were 62.0 ± 8.6 for Group 1 and 79.5 ± 10.4 for Group 2 (P < .001). Using an OSCE pass–fail cutoff score of 60%, 17 of 28 Group 1 students (60.7%) and 26 of 27 Group 2 students (96.3%) passed. The CLBP OSCE was one of 10 OSCE stations in which students were tested at the end of a Combined Ambulatory Medicine and Pediatrics Clerkship. There were no between-group differences in performance on eight of the other nine OSCE stations. This module significantly improved medical student clinical skills in evaluating CLBP. Additional research is needed to ascertain the effect of e-learning modules on more-advanced learners and on improving the care of older adults with CLBP.

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