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BIMM Modular Course in Musculoskeletal Medicine

Enrollment now open for January 2012

Introduction

Do take a moment to look at our videos showing some of the new skills you can learn on the BIMM Modular Course

The course will introduce you to the best evidence based approach to musculoskeletal problems:

The tutors are experts with many years experience in their field and will be available to respond to your learning needs throughout the course.

The benefits of this training:

 

The Diploma
On completion of each module a certificate of attendance will be issued.

In addition, students will be encouraged to sit an examination for The Diploma in Musculoskeletal Medicine. Further details are available here.

The Curriculum
The course is targeted at GPs who wish to develop a special interest in musculoskeletal problems, SpR’s in rheumatology, orthopaedics and pain medicine, occupational physicians and sports medicine practitioners.

It consists of eight distance based learning packages and eight practical and skills based modules of 21 hours each, totalling 168 hours of attendance, with access to a e learning website throughout the duration of the course. The course is normally designed to run over a two and a half year period but participants can opt to spread the course over a longer period or in certain circumstances select only those modules most appropriate to their needs. Intake numbers may be variable but the ratio of students to tutors will remain at an optimum of 8:1.
Entry requirements - Doctors registered with the GMC.

Academic level
By the end of the course participants will have covered the ground to achieve a basic level of clinical competence in Musculoskeletal Medicine and, subject to a certificate of completion, be eligible to sit the Diploma in Musculoskeletal Medicine.

Aims

  1. To acquire the core knowledge of musculoskeletal science, to be able to orchestrate a comprehensive approach to the diagnosis and management of patients with musculoskeletal disorders within a biopsychosocial context.
  2. Develop the necessary perceptual and psychomotor skills, which are essential for the processes of patient assessment and management in this field.
  3. To be aware of the skills that other health professionals have to offer and to work with them in a team for the benefit of the patient.
  4. To recognise the roles and value of research and audit in this field of medicine.

Objectives
At the end of the course the participant should:

  1. Be competent in history taking and clinical examination of the musculoskeletal system.
  2. Be aware of the indications for appropriate investigations.
  3. Be aware of the ‘red flag’ and "yellow flag" signs in relation to presenting symptoms and signs of low back pain or other musculoskeletal conditions and know how to manage such patients.
  4. Be competent to perform some types of manipulative and injection treatments (see Appendix) and to be aware of their indications and contraindications.
  5. Be aware of when, and to whom, to refer appropriate patients.

Accreditation and assessment of learning needs
It is recognised that applicants may come to the course with varied experience and prior clinical training. Each individual will be assessed at the outset and may be awarded credits or be exempted certain modules or parts thereof according to their prior training.

Individuals wishing to acquire competencies within a limited field may restrict their training to specific modules; but it is recommended that all those wishing to practice musculoskeletal medicine should take the introductory module.

The Learning  Process
Students will be involved in the ongoing development of their course, so that they may take some responsibility for the choice of activities within each module that best serve their learning needs, in order to achieve the overall aims and objectives of the course.

Students will be given access to the BIMM Educational Website to complete the necessary knowledge base components for each module prior to attendance on the practical and skills based modules. Prior to admission for each module students will be required to participate in an online assessment

There is a required minimum passmark for eligibility for the practical modules. In this way much of the essential basic sciences (anatomy, physiology) and factual knowledge base can be gained without the need for didactic teaching.

After the introductory module students will be asked to select specific topics, which form part of the next module, which they can prepare, and present to their group. One or both clinical tutors may be present for each of these ‘small group’ teaching sessions (6-10 people) as a facilitator.

The use of outside lecturers and formal presentations will be limited although it is accepted that there is value in drawing from the experience of ‘experts’ in certain situations, e.g., the indications for surgery.

Assessment Handbook
This will be given to each student at the first module containing full guidelines for producing a professional development portfolio. This will encourage the student to be reflective about their practice and professional development. Each student will be asked to produce a reflective essay towards the end of the course and have access to a tutor for appraisal and formative feedback.

Casebooks
Each student will be asked to log a number of cases from their own practice, preferably related to subjects recently covered, to bring to the tutorials on the next module for discussion.

Professional Development Portfolio
This is regarded as an integral part of practice and maximises the benefit of the course. It can be used to demonstrate specific achievements, to identify and collate learning obtained elsewhere as well as within the course, to develop and define learning objectives and to help the student integrate this process into their personal, professional life. The student’s portfolio should be maintained within the intermodular periods, focusing on the application of learning gained whilst attending the course, that when they return to the next module, students can discuss with peers and tutors any problems and successes that have occurred.

Teaching Methods
These include some formal lectures, demonstrations of practical technique, practical sessions (in twos or threes) and clinic-based teaching on patients.

Much of the learning will take place in small group teaching sessions where the emphasis will be on a learner-centred approach, with the tutor(s) acting as group facilitator(s).

Seminars will provide opportunity for students to make contributions from their intermodular prepared work and present case studies. Small group teaching sessions provide the space for students to flag up any clinical problems or personal/professional problems encountered in their clinical work.

Each module will have at least one session, increasing to one day as the need accumulates, for revision of newly acquired skills (manual and injection techniques). Participants will be asked to log in their casebook at least ten relevant case histories to bring to the ensuing module tutorial and to flag up any personal or clinical problems they have encountered.

For each anatomical region tutors should normally cover: Functional anatomy and biomechanics, standard orthopaedic, neurologic examination plus manual diagnosis, differential diagnosis (including investigations required), manual and injection treatments, other approaches (e.g., indications for surgery or other specialist consultation), exercise advice, self-care and patient management. The evidence, for clinical tests and treatments, if available should be provided. The lack of such evidence or need for future research can provide fertile ground for tutorial discussion.

Evaluation of teaching
A system of evaluating the teaching using standard rating scales and tools to assess interest; relevance, presentation and group process will be used.

Assessment of learning
This will take place both through the online assessments prior to each module and on a continuous basis during the small group teaching sessions and tutorials. Towards the end of module four and eight, each student will receive formative assessment. This will take place as constructive feedback about logbooks, development of manual skills and the professional development portfolio at these two points in the course.  Students will be given guidance and support in achieving what they want and need to learn.

Support
This will be made available by allocating each student to a specific clinical tutor for guidance and feedback throughout the course. Clinical attachments are available with accredited trainers in hospital medicine, general practice and independent clinics during and after the course. It is hoped that the enthusiastic student will be interested in continuing their learning after completing the course by taking up this opportunity.

Mentoring
A system of mentoring will be made available to those students who express a need and who cannot obtain access to a mentor in their own locality.

Continuing Professional Development
By continuing to develop their portfolio the student will identify their learning needs and make a checklist. From this an action plan can be made to attend meetings, private learning, courses or conduct literature searches, whatever is most appropriate, and record such activities and the learning gained in their portfolio.

People who have successfully completed the course might be invited to participate in future courses presenting results of basic science and evidence reviews, audits and evaluations for discussion by those taking modules for the first time. Such attendance could then be integrated with parallel activities such as advanced technique sessions and contact with mentors.

Study of musculoskeletal medicine is a lifelong process and the student will be invited to attend their appointed tutor for an annual review. A system of re-accreditation every four years will be provided by BIMM tutors on a more formal basis.

Course Index

The modules:

  1. Introductory Course
    • Basic concepts and techniques of examination.
    • Learning methods.
  2. Biostatistics and low back pain
  3. Systemic disorders, the use of imaging. Cervical spine.
  4. The thoracic spine, chest wall and mid course appraisal
  5. Ergonomics. The upper limb.
  6. Sports and exercise medicine. The lower limb.
  7. Chronic pain, pain management, interventions, medications, TENS, acupuncture.
  8. Cognitive behavioural therapy.
    • Occupational aspects.
    • Role of complementary therapies.
    • Integrated approaches.

Clinical Tutors
Dr. John Tanner
Course organiser and Clinical Tutor BIMM modular course,
Oving Clinic, West Sussex, and BUPA Wellness, Barbican, London.

Dr. Rod MacDonald
Clinical Tutor BIMM modular course and LCOM,
London College of Osteopathic Medicine, London.

Dr. Ian Bernstein
GP and Musculoskeletal Physician
Advisor to PCG and Health Authority of Ealing, Hammersmith and
Hounslow on musculoskeletal services, and BIMM modular course.

Dr. Grahame Brown
Consultant Musculoskeletal Medicine,
Course organiser (Birmingham), Clinical Tutor BIMM modular course
Royal Orthopaedic Hospital, Birmingham.

Dr. Chris Parsons
Osteopathic Physician
Clinical Tutor BIMM modular course, Gloucester

Dr. Martyn Speight
Osteopathic & Sports Physician
Clinical Tutor BIMM modular course, Harrogate.

Dr. Steven Brennan
Orthopaedic physician Leeds
Clinical Tutor BIMM modular course, Leeds

Guest Lecturers

Dr. Richard Ellis
Senior Lecturer Rheumatology and Rehabilitation,
University of Southampton.

Dr. Brian Marien
Clinical Psychologist
King Edward V11 Hospital, Sussex.

Educational Advisor

Dr. Adrian Dunbar
GP with Special Interest in Musculoskeletal Medicine and
Associate Director of Postgraduate Medical Education (University of Leeds)

Module Outlines

MODULE 1 - PRINCIPALS OF MUSCULOSKELETAL MEDICINE
This module will cover the essentials of history taking and systematic physical examination of the musculoskeletal system. You will be introduced to the neurophysiology of pain and the relevance of the biopsychosocial model to understanding the modern epidemic of backpain. You will learn how to assess posture, gait and function and develop your manual skills in diagnosis of soft tissue dysfunction. Through understanding of joint mechanics and physiology you will learn the principles of mobilisation and manipulation. Demonstration of diagnostic technique on clinic patients together with small group sessions will help you integrate this new knowledge and skills into your own practice.

MODULE 2 - BIOSTATISTICS AND LOW BACK PAIN
This module introduces you to current methods of research in musculoskeletal problems. Epidemiological, clinical and reliability studies will be used to illustrate the current state of the evidence base with the problems and pitfalls of such research. You will learn how to conduct simple scientific enquiries, such as reliability and validity studies, and critical appraisal of published studies. Low back pain will be covered comprehensively, from pathology to diagnosis and treatment in small groups, demonstrations and practical sessions. Clinic attachments will aid the student to focus their newly acquired abilities and integrate them into practice, if the student takes up this option.

MODULE 3 - SYSTEMIC DISORDERS, USE OF IMAGING, CERVICAL SPINE.
Cervicoscapular pain, radiculopathy, cervicogenic headache and whiplash syndrome are but a few of the cervical spine disorders clarified in this module. Systematic examination with detailed palpatory diagnosis of segmental dysfunction leads to the application of specific manual technique. Ample opportunity is given to the acquisition of these skills through supervised practice on 'normal' subjects. Emphasis is placed throughout this module on the importance of postural training in recovery and prevention of recurrence. The module starts with revision of structure and function of soft tissues, injury and repair mechanisms. Common pathologies of the musculoskeletal system, recognition, management, use of imaging and other investigations will be covered in detail. Osteoporosis and its prevention, practical management of arthritis including exercise and joint injections will be given in depth treatment.

MODULE 4 - THORACIC SPINE, TREATMENT OF PELVIS, MID COURSE ASSESSMENT
This module will enable the student to treat thoracic spine and ribcage pain and dysfunction. Recognition of benign anterior chest wall pain and differentiation from 'red flags' is emphasised. The conditions of fibromyalgia and chronic fatigue syndrome will be reviewed in depth. The difficult diagnoses of sacroiliac dysfunction, osteitis pubis and other pelvic syndromes with their management will be covered. A large part of this mid- course module will focus on revision of treatment techniques for the spine followed by an assessment of manual skills gained.

MODULE 5 - ERGONOMICS AND THE UPPER LIMB
This module will cover the relevance of ergonomics to musculoskeletal medicine with particular reference to the neck, shoulder and upper limb. Recognition of WRLD/ RSI syndrome and differentiation from discrete conditions will enable the student to make confident diagnoses. Detailed examination, differential diagnosis and treatment techniques (including indications for surgery) of shoulder, elbow, wrist and hand will be covered. This is an important module to gain confidence in injection techniques in the clinic sessions.

MODULE 6 - SPORTS MEDICINE AND THE LOWER LIMB
This module is a general introduction to sports medicine and exercise physiology. With reference to lower limb injury and overuse syndromes the student will learn about the wider range of diagnostic possibilities encountered in the sports medicine clinic and their management. The hip, knee, ankle and foot will be covered comprehensively in terms of anatomy, function, clinical presentations, medical and surgical management. The role of gait analysis particularly in runners' lower limb symptoms, and the use of podiatric analysis will be included.

MODULE 7 - PAIN MANAGEMENT AND COGNITIVE BEHAVIOURAL THERAPY
This module is designed to deepen students’ understanding of the processes by which patients slide into chronicity and disability. Students will learn practical skills in interviewing and initiating change. This will include basic CBT and other ingredients of the pain management approach, namely graded exposure, pacing, coping strategies, and problem solving. The armamentarium of the Pain Clinic approach will be explored and explained, ranging from pharmacotherapy to invasive techniques. Particular attention will be paid to the use of acupuncture, intramuscular stimulation and TENS. Further time will be allocated for revision of manual and injection techniques, case history presentations and discussion of problem patients.

MODULE 8 - OCCUPATIONAL ASPECTS, EXERCISE AND REHABILITATION METHODS, AN INTEGRATED APPROACH.
The last module focuses on two important issues; the obstacles to patients returning to work and the various methods of rehabilitation. Psychosocial and other factors influencing sickness absence (the ‘black flags’) will be explored with occupational health experts. The role of vocational counselling, functional rehabilitation and the clinician’s role in liaison with all the relevant members of the team will be emphasised. The various types of exercise rehabilitation including cardiovascular conditioning, core stability, Mackenzie’s, Pilates will be demonstrated and taught to give students a thorough understanding of the most efficacious aspects of physiotherapy and their application. This final module will concentrate on integrating all the facets of the course so that the doctor can apply a multimodal approach in management of his/her patients.

Module Information

Booking Form

Cost



Further Information From:
BRITISH INSTITUTE OF MUSCULOSKELETAL MEDICINE
PO Box 1116, Bushey, WD23 9BY
Tel: 0208 421 9910, Fax: 0208 386 4183
www.bimm.org.uk, Email: deena@bimm.org.uk

British Institute of Musculoskeletal Medicine
BIMM