Changes needed to reduce risk of musculoskeletal disorders.

Musculoskeletal disorders (MSDs) are the main contributor to disability levels, which are rising as populations age. Workplace hazard exposures are a major source of this problem, and current workplace risk management practices require substantial changes to tackle it more effectively. Most importantly, the current focus of risk management on "manual handling" tasks must broaden to encompass the whole job. This is necessary because a wide range of psychosocial hazards, most of which operate across the whole job rather than particular tasks, are significant contributors to risk. To ensure that risk-control actions are effective, a recurring risk management cycle that includes worker participation and addresses risk from both biomechanical and psychosocial hazards will be essential. Legislation that mandates workplace management of psychosocial hazards would be helpful. Amendment by regulatory bodies of MSD-related guidance and codes of practice so that they reflect current research evidence would also be helpful in communicating the need for change to workplace stakeholders.

Psychosocial hazards play a key role in differentiating MSD risk levels of workers in high-risk occupations.

OBJECTIVES: Workplace management practices targeting risk of musculoskeletal disorders (MSDs) fail to reflect evidence that risk is affected by psychosocial as well as physical hazards. To promote improved practices in occupations where MSD risk is highest, better information is needed on how psychosocial hazards, combined with physical hazards, affect risk of workers in these occupations. METHODS: Survey ratings of physical and psychosocial hazards by 2329 Australian workers in occupations with high MSD risk were subjected to Principal Components Analysis. Latent Profile Analysis of hazard factor scores identified different combinations of hazards to which latent subgroups of workers were typically exposed. Survey ratings of frequency and severity of musculoskeletal discomfort or pain (MSP) generated a pre-validated MSP score and its relationship with subgroup membership was analysed. Demographic variables associated with group membership were investigated using regression modelling and descriptive statistics. RESULTS: Analyses identified three physical and seven psychosocial hazard factors and three participant subgroups with differing hazard profiles. Profile group differences were greater for psychosocial than physical hazards, and MSP scores out of 60 ranged from 6.7 for the low hazard profile (29% of participants) to 17.5 for the high hazard profile (21%). Differences between occupations in hazard profiles were not large. CONCLUSIONS: Both physical and psychosocial hazards affect MSD risk of workers in high-risk occupations. In workplaces such as this large Australian sample where risk management has focused on physical hazards, actions targeting psychosocial hazards may now be the most effective way to reduce risk further.

Reinforcing outpatient medical student learning using brief computer tutorials: the Patient-Teacher-Tutorial sequence.

BACKGROUND: At present, what students read after an outpatient encounter is largely left up to them. Our objective was to evaluate the education efficacy of a clinical education model in which the student moves through a sequence that includes immediately reinforcing their learning using a specifically designed computer tutorial. METHODS: Prior to a 14-day Pediatric Emergency rotation, medical students completed pre-tests for two common pediatric topics: Oral Rehydration Solutions (ORS) and Fever Without Source (FWS). After encountering a patient with either FWS or a patient needing ORS, the student logged into a computer that randomly assigned them to either a) completing a relevant computer tutorial (e.g. FWS patient + FWS tutorial = "in sequence") or b) completing the non-relevant tutorial (e.g. FWS patient + ORS tutorial = "out of sequence"). At the end of their rotation, they were tested again on both topics. Our main outcome was post-test scores on a given tutorial topic, contrasted by whether done in- or out-of-sequence. RESULTS: Ninety-two students completed the study protocol with 41 in the 'in sequence' group. Pre-test scores did not differ significantly. Overall, doing a computer tutorial in sequence resulted in significantly greater post-test scores (z-score 1.1 (SD 0.70) in sequence vs. 0.52 (1.1) out-of-sequence; 95% CI for difference +0.16, +0.93). Students spent longer on the tutorials when they were done in sequence (12.1 min (SD 7.3) vs. 10.5 (6.5)) though the difference was not statistically significant (95% CI diff: -1.2 min, +4.5). CONCLUSIONS: Outpatient learning frameworks could be structured to take best advantage of the heightened learning potential created by patient encounters. We propose the Patient-Teacher-Tutorial sequence as a framework for organizing learning in outpatient clinical settings.

Embedding medical student computer tutorials into a busy emergency department.

OBJECTIVES: To explore medical students' use of computer tutorials embedded in a busy clinical setting; to demonstrate that such tutorials can increase knowledge gain over and above that attributable to the clinical rotation itself. METHODS: Six tutorials were installed on a computer placed in a central area in an emergency department. Each tutorial was made up of between 33 and 85 screens of information that include text, graphics, animations, and questions. They were designed to be brief (10 minutes), focused, interactive, and immediately relevant. The authors evaluated the intervention using quantitative research methods, including usage tracking, surveys of faculty and students, and a randomized pretest-posttest study. RESULTS: Over 46 weeks, 95 medical students used the tutorials 544 times, for an overall average of 1.7 times a day. The median time spent on completed tutorials was 11 minutes (average [SD], 14 [+/-12] minutes). Seventy-four students completed the randomized study. They completed 65% of the assigned tutorials, resulting in improved examination scores compared with the control (effect size, 0.39; 95% confidence interval = 0.15 to 0.62). Students were positively disposed to the tutorials, ranking them as "valuable." Fifty-four percent preferred the tutorials to small group teaching sessions with a preceptor. The faculty was also positive about the tutorials, although they did not appear to integrate the tutorials directly into their teaching. CONCLUSIONS: Medical students on rotation in a busy clinical setting can and will use appropriately presented computer tutorials. The tutorials are effective in raising examination scores.