Advanced NMSK Clinical Reasoning

If you work in neuromusculoskeletal healthcare:

• How effective are your clinical reasoning skills?
• Do you recognise when you are using pattern recognition or hypotheticodeductive reasoning when formulating a neuromusculoskeletal diagnosis?
• Do you know the limitations of these frameworks?
• Are you aware of the varied clinical reasoning strategies you employ, like narrative reasoning or ethical reasoning, when making clinical decisions?
• Are you able to reflect in action and modify your reasoning approach?
• Are you aware of your biases and how they impact your clinical reasoning?
• Can you use these skills to confidently differentiate between neuromusculoskeletal presentations, and other medical causes of pain and dysfunction?

The Neuromusculoskeletal Triage module uses a mixed teaching approach that will involve face-to-face teaching, asynchronous learning, and work-based learning at your place of employment through watched/joint sessions with Advanced/Consultant level MSK Practitioners.

Students will gain a critical overview of the evidence base underpinning clinical decisions including professional, ethical and medico-legal issues, and will employ these advanced clinical reasoning skills to recognise medical masquerader presentations in musculoskeletal practice settings such as FCP or Advanced MSK Clinics.

This module is suitable for those working towards enhanced or advanced musculoskeletal practice, and can be put towards one of our Advanced Practice Masters awards.

Who is it for?

This course is for registered healthcare professionals working in any area of musculoskeletal clinical practice.

Timetable

Face-to-face training will be on the following days:

• 16 January 2027
• 26 February 2027
• 13 March 2027
• 15 April 2027

Additional teaching will take place in the student's workplace.

Benefits

Much of the teaching for this module is facilitated in the students workplace, tailoring the level of learning to the student. This makes the module suitable for those working towards both enhanced or advanced levels of practice. This is an ideal module for new MSK specialist clinicians to start their MSc level journey, and for established clinicians to fine tune their clinical justification skills.

This module is aligned with the relevant capabilities outlined in the NHS England Advanced Practice MSK Curriculum and Capabilities Framework (2023) and Multiprofessional Framework for Advanced Practice (2017). Completion of this module can therefore be used as evidence of Enhanced and Advanced Practice capability and may be used to contribute to an overall Advanced Practice MSc or as part of a portfolio route to achieve the NHS Advanced Practice digital badge.

This module will focus on gathering the most relevant information from the subjective and objective elements of the patient examination and assessment and interpreting the findings in order to make triage decisions.

Significant emphasis will be placed on the development of clinical reasoning skills underpinned by the best evidence available. This will enable clinicians to recognise the differences between medical and NMSK presentations that often arise in practice, as well as facilitate development of more targeted questioning and physical examination techniques to improve quality and timeliness of consultations. This will also enable clinicians to develop into specific job roles such as FCP, ACP and Advanced MSK Practitioner positions.

By the end of the course, you will be able to:

• Understand and be able to explain the concept and importance of neuromusculoskeletal triage informed with a critical interpretation of evidence-based research.
• Critically discuss the ethical responsibilities of the clinician within the triage process and be able to describe the medico-legal responsibilities.
  Identify key signs and symptoms of presenting pathologies and recognise those which require further investigation.
• Demonstrate effective interpretation of subjective information to justify the most appropriate physical examination techniques and interpret this accurately to determine the most appropriate management including an initial treatment plan and prognosis, all within a timely manner.
• Demonstrate reflexivity in adapting examination skills, including experimentation with combined examination techniques, to maximise efficiency of time whilst preserving patient safety and the necessary level of depth required for the clinical setting.
• Critically analyse the effectiveness of your examination and accurately identify possible risks or errors of judgement.

Teaching

Teaching will provide access to and discussion of the knowledge base and skills required to perform accurate clinical triage of patients presenting with neuromusculoskeletal symptoms in primary or secondary care services. Students will learn to recognise the differences between medical and neuromusculoskeletal presentations. Students will gain a critical overview of the evidence base underpinning triage decisions including professional, ethical and medico-legal issues.

The course will be taught in a blended fashion of online access to Canvas content and three face to face taught days, each one month apart the fourth assessment day will be approx. 6 weeks after last teaching day. Much of the module hours will be made up from self-directed learning and watched/joint sessions in the students clinical practice with their clinical mentor, recorded in their log-book.

Assessment

Log-book: throughout the module, students will keep a portfolio of their work-based learning and critical reflective practice. This does not carry a numerical mark and is pass/fail.

Observed patient consultation and viva: a watched clinical consultation with the student seeing a real patient in their own area of practice followed by a viva. This carries a numerical mark and accounts for 100% of the overall grade from the module.

Award

This module may be used toward an Advanced Practice MSc award.

Credits

This course is worth 15 credits toward eligible programmes.

To apply for this course, please follow these steps:

1. Check Eligibility: Ensure you meet any prerequisites or eligibility criteria mentioned.
2. Fill in the Application Form: Complete the online application form with your details, including name, contact information, and any required professional information.
3. Payment: Once your application has been approved, you will be contacted with payment instructions.
4. Confirmation: After submitting your application and payment, you should receive a confirmation email. If you do not receive this, please check your spam/junk folder. Keep this for your records.
5. Prepare for the Course: Review any pre-course materials or requirements provided in the confirmation email.

If applying for this module, you MUST state the Module Title and Course Code in the personal statement tab. Without this we will be unaware of what module you are applying for and will delay your application decision.

If you encounter any issues or have questions, consider contacting the course provider directly through the contact information available on the website.

Participants will need to be suitably experienced with neuromusculoskeletal practice in outpatient or primary care settings to be able to take on enhanced or advanced level clinical capabilities and development at Masters level (i.e., whilst there is no formal amount of experience required, this module is unlikely to be suitable for someone with less than approximately 1 year of full-time practice experience performing NMSK triage in outpatient or primary care settings.)

They will need to identify of a clinical mentor who is working at Advanced Practice level. Additionally, they will require workplace support for at least one watched/joint patient consultation per month throughout the duration of the module.

Please note this is the bare minimum requirement. The amount of support provided should be negotiated between the student and mentor in order to best achieve the learning outcome.

Undergraduate degree or equivalent

You should have all of the following:

• Honours degree (2:2 or above) from the UK or Republic of Ireland
• recognised healthcare/health-related professional qualification and current professional registration
• at least one year's full-time clinical experience (or the equivalent in part-time hours) in health or social care employment (for example nursing, paramedics, physiotherapy, occupational therapy, pharmacy, radiology, etc).

International qualifications

We accept equivalent qualifications gained in other countries. Please see our Entry Requirements page. For countries not on this list, we use UK ENIC to assess. Please see our International Student Support pages for more information.

If you have any questions, you can contact us at pec@sgul.ac.uk

English requirements

If your first language is not English, one of the following is required:

• A first degree from a UK university
• A first degree from an overseas institution recognised by City St George's, University of London as providing adequate evidence of proficiency in the English language, for example, from institutions from Australia, Canada or the United States of America
• International English Language Test Service (IELTS) a score of 7.0 is required with no subtest below 7.0
• Pearson Test of English (Academic) score 72 required
• TOEFL 100 overall with 24 in Writing, 20 in Listening, 19 Reading and 20 Speaking
• Other evidence of proficiency in the English language, which satisfies the board of studies concerned, including registration with your professional regulator.

Full details can be found on our English Language requirements webpage.