Inadequacies in Undergraduate Musculoskeletal Education - A Survey of Nationally Accredited Allopathic Medical Programs in Canada

Abstract

Objective To document the current state of MSK medicine education across nationally accredited undergraduate medical programs. Design A cross-sectional survey design was used to gather curricular data on three MSK themes: 1) anatomy education; 2) preclinical education; and 3) clerkship education. Results The survey had a 100% response rate with all 14 english language medical schools in Canada responding. The mean time spent teaching MSK anatomy was 29.8 hours (SD ± 13.7, range 12 – 60), with all but one program using some form of cadaveric-based instruction. MSK preclinical curricula averaged 58.0 hours (SD ± 53.4, range 6 - 204), with didactic lectures, case-based learning, and small group tutorials being the most common modes of instruction. Curricular content varied greatly, with only 25% of “core or must-know” MSK topics being covered in detail by all programs. MSK training in clerkship was required by only 50% of programs, most commonly being two-weeks in duration. Conclusion Results document the large variability and curricular inadequacies that exist in MSK education across nationally accredited allopathic programs and highlight the need for the identification and implementation of more consistent MSK curricular content and educational standards by all nationally accredited medical programs.

Addressing Musculoskeletal Curricular Inadequacies within Undergraduate Medical Education

“…The same MSK medicine textbook (Essentials of Musculoskeletal Care − 5th ed., Sarwark JF, American Academy of Orthopaedic Surgeons, 2010, ISBN: 978-0781175004-2), course notes package, and standards for academic advancement (a minimum nal grade of 60%) were used over the 5-year period. Learning outcomes focused on "core or must know" topics in MSK medicine (3,13,14), providing detailed instruction about the clinical presentation, diagnosis, and non-surgical/surgical management of common MSK injuries and conditions. Beyond this, each year of the course also utilized the same modes of delivery for the sixty-eight hours of instruction: 1).…”

“…Despite this signi cant burden of disease and large socioeconomic cost, previous research indicates that some medical schools provide no MSK training what-so-ever as part of their medical curriculum (9,10). Additionally, among the programs that do provide instruction on topics related to MSK medicine, many dedicate only a very small fraction of the program's total curricular time (≥ 3.0%) (11)(12)(13)(14). Not surprisingly, research illustrates that a majority of medical students feel their training in MSK medicine is inadequate (15), and post-graduate data demonstrates that many physicians lack adequate con dence, knowledge, and clinical skills when practicing MSK medicine (16-18), with greater than 50% of practicing physicians failing to obtain a passing score when completing a standardized basic competency MSK examination after graduation (19)(20)(21)(22).…”

“…Not surprisingly, research illustrates that a majority of medical students feel their training in MSK medicine is inadequate (15), and post-graduate data demonstrates that many physicians lack adequate con dence, knowledge, and clinical skills when practicing MSK medicine (16-18), with greater than 50% of practicing physicians failing to obtain a passing score when completing a standardized basic competency MSK examination after graduation (19)(20)(21)(22). Despite ongoing initiatives designed to improve physician training in the area of MSK medicine (23)(24)(25)(26)(27), recent evidence con rms that a high degree of variability and large inadequacies still exist in the preclinical MSK curricula of both AFMC (Association of Facilities of Medicine of Canada) (14) and AAMC (American Association of Medical Colleges) accredited medical programs (13). The literature also indicates that there is a need for the identi cation and adoption of more consistent MSK content within the preclinical curricular of allopathic medical programs.…”

“…The instructional time, organization, curricular content and modes of delivery implemented with this new course were adopted from published reports on previous MSK curricular initiatives, as well as expert-group recommendations for improving physician training in the area of MSK medicine (20,(23)(24)(25)(26)(27)(28)(29). Interestingly, critical elements of this program's new preclinical MSK curriculum were re ective of curricular averages recently published for both AFMC (14) and AAMC (13) accredited programs (Table 1). The program's new MSK curriculum also "covered" or "covered in detail" fteen of sixteen topics in MSK medicine that had been previously identi ed as "core or must know" content for physicians to know (3) (Figure 1).…”

“…The program's new MSK curriculum also "covered" or "covered in detail" fteen of sixteen topics in MSK medicine that had been previously identi ed as "core or must know" content for physicians to know (3) (Figure 1). When compared to other AFMC accredited medical programs, only the topics of "fractures of child abuse" and "physeal fractures" were covered in more detail by the MSK curriculums of other AFMC accredited medical programs (14).…”