ORIGINAL REPORTS Undergraduate Clinical Teaching in Orthopedic Surgery: A Randomized Control Trial Comparing the Effect of Case-Based Teaching and Bedside Teaching on Musculoskeletal OSCE Performance Martin Kelly, MCh, MRCSI,* Iain Feeley, MCh, MRCSI,* Fiona Boland, PhD, † and John M. O’Byrne, MCh, FRCSI, FRCS(Tr. & Orth), FFSEM, FFSEM(UK)* * Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; and † Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland INTRODUCTION: Musculoskeletal (MSK) complaints are the second most common reason for a hospital outpatient appointment in the US, and account for 19.5% of general practice consultations. Previous studies have shown that passive teaching in medical school does not imbue students with an adequate degree of confidence in MSK evaluation. The aim of this study was to conduct a randomized control trial to compare the effect of the gold standard small group tutorial of bedside teaching against case-based teaching (CBT) in relation to orthopedic surgery in medical students. METHODS: All third-year medical students at our institu- tion were invited to participate in a randomized control trial comparing CBT and bedside tutorials in relation to MSK. The primary outcome was student performance in an Objective Structured Clinical Examination (OSCE). Partic- ipants were randomized into 2 groups, receiving either a bedside tutorial or a case-based tutorial. Participants were then assigned self-directed learning before undergoing a final OSCE assessment. Student feedback was attained through a poststudy questionnaire. RESULTS: Complete data was acquired for 96 study participants (n ¼ 45 CBT; n ¼ 51 bedside tutorial). The results of a linear regression model used to assess differences in the final OSCE scores, adjusting for the baseline OSCE score, gender, age, previous problem-based learning expo- sure and whether English was their first language or not showed no evidence of a difference between the bedside teaching group and the CBT group (mean difference: 0.34; 95% confidence interval: 3.79 to 4.47; p ¼ 0.872). Almost all (95%) of the study participants felt that CBT was an important component in their learning. CONCLUSION: There was no difference in OSCE per- formance between groups. The introduction of CBT before clinical placement in medical school could accentuate the clinical skills of students before transition into the appren- ticeship model of clinical attachment. ( J Surg Ed ]:]]]-]]]. J C 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: case-based, bedside, musculoskeletal, skills, student COMPETENCIES: Medical Knowledge, Practice-Based Learning and Improvement, Professionalism INTRODUCTION Musculoskeletal (MSK) diseases represent a varied group of pathologies that affect a diverse population demographic, the spectrum of conditions ranges from the acute trauma to biomechanical degenerative disease such as osteoarthritis and rheumatic inflammatory conditions. 1 These pathologies are a major cause of disability around the world, 2 and indeed have huge economic repercussions, with an estimated cost in the US of 7.4% of GDP secondary to both direct health care costs and lost wages and decreased productivity. 3 Priorities for health care have long focused on communi- cable diseases. 4 Improvements in this regard have led to a Correspondence: Inquires to Martin Kelly, Department of Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland; e-mail: martinkelly@rcsi.ie Journal of Surgical Education  & 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. 1931-7204/$30.00 http://dx.doi.org/10.1016/j.jsurg.2017.06.024 1