Educational Deficiencies in Musculoskeletal Medicine

[drfunction]

Educational Deficiencies in Musculoskeletal Medicine

The Journal of Bone and Joint Surgery (Am) 84:604-608 (April 2002)
Kevin B. Freedman, MD, and Joseph Bernstein, MD

Investigation performed at the University of Pennsylvania School of Medicines
　
This post is not meant to pick on any profession. This was published in a Medical Journal in 2002. Hopefully things are better now. This post is meant to educate and to consider getting 2nd and 3rd opinions (on your particular conditions) with whatever type health care provider you may be consulting.

KEY POINTS

(1) On this musculoskeletal medicine test, orthopedic residency directors considered a passing score to be 73.1%, and 82% of the examines residents failed to demonstrate basic competency.

(2) On this musculoskeletal medicine test, internal medicine residency directors lowered the passing score to 70%, and 78% of the examines residents still failed to demonstrate basic competency.

(3) The lowest percent of correct answers pertained to questions relating to the spine, indicating that these residents are lease competent in musculoskeletal spine issues.

(4) These experts in both orthopedics and internal medicine consider new-onset of low back pain in a pediatric population to be an indicator for exposing radiographs.

(5) The average amount of time spent in medical education on orthopedics was only 2.1 weeks.

(6) 33% of medical school graduates no exposure orthopedics.

(7) The orthopedics emphasized in medical school emphasizes surgery, and not common daily clinical problems.

(8) Musculoskeletal problems will increase in the future because of the aging population.

(9) Medical school preparation in musculoskeletal problems is inadequate.
　
　
FROM ABSTRACT

Background:
We previously reported the results of a study in which a basic competency examination in musculoskeletal medicine was administered to a group of recent medical school graduates.

This examination was validated by 124 orthopedic program directors, and a passing grade of 73.1% was established.

According to that criterion, 82% of the examines failed to demonstrate basic competency in musculoskeletal medicine.

It was suggested that perhaps a different passing grade would have been set by program directors of internal medicine departments.

To test that hypothesis, and to determine whether the importance of the individual questions would be rated similarly, the validation process was repeated with program directors of internal medicine residency departments as subjects.

Conclusions:

According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examines once again failed to demonstrate basic competency in musculoskeletal medicine on the examination.

It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.

THESE AUTHORS ALSO NOTE:

“Musculoskeletal care is provided by a variety of practitioners, including internists, family practitioners, rheumatologists, emergency physicians, pediatricians, and orthopedic surgeons.”

“Mastery of the basics of musculoskeletal medicine is therefore essential for many, if not all, medical students.”

“Ideally, a solid knowledge base would be acquired in medical school and refined during postgraduate training.”

The authors previously evaluated the quality of musculoskeletal knowledge among a cohort of 85 recent medical school graduates in residency, and found that 82% “failed to demonstrate basic competency in musculoskeletal medicine.”
[Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am, 1998;80: 1421-7.]

“On the basis of these data, we suggested that medical school training in musculoskeletal medicine is inadequate.”

DISCUSSION

“According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examines once again failed to demonstrate basic competency in musculoskeletal medicine.”
　
“It is reasonable, therefore, to conclude that medical school preparation in musculoskeletal medicine is inadequate.”

“The average amount of time spent in courses or rotations dedicated to orthopedics was only 2.1 weeks for all examines, and 33% of them graduated from medical school with no such exposure.” (Yikes!)

This represents <2% of the entire typical medical school curriculum.
(Yikes!)

The authors suggest that the standard rotation in orthopedic surgery probably emphasizes too many particulars of surgical practice, and does not emphasize conditions that are more clinically important.

“The ideal course in musculoskeletal medicine should concentrate on common outpatient orthopedic problems, orthopedic emergencies, and the musculoskeletal physical examination.”

“Medical school curricula must place a greater emphasis on musculoskeletal medicine.
Because of the aging of the population, the prevalence of bone and joint diseases in the United States is already the primary reason that people seek medical care -- is sure to rise.
Thus, the demands will soon be even greater. Students must master the topic of musculoskeletal medicine. The results of these studies suggest that they have not.”

[TPT]

some of the data were intriguing. e.g., 78% failure.

they suggest that consumers should be somewhat skeptical when being serviced by practioners including physicians. more specifically, we should be careful when looking for help by professionals for impairments that may not be relevant to those professionals. e.g., listening to someone with a history of internal medicine for musculoskeletal problems.

good find, drfunction.