Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

Abstract

Background Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend. Questions/purposes The purposes of this study were: (1) to assess the presence and duration of required or selective instruction in a MSK medicine specialty within the clinical years of undergraduate medical education; and (2) to assess the current state of requirements of clinical clerkships or rotations in other surgical and nonsurgical fields for comparison with the initial findings.Methods The web sites of all 141 US medical schools were assessed to determine the content of their clinical curricula for the 2014-2015 academic year; five were excluded because they had not yet had a graduating class by the conclusion of the 2014-2015 academic year. Complete information on required rotations was obtained through the schools' web sites for all 136 (100%) medical schools. For selective experience during the surgery clerkships, complete information was available for 130 of the remaining 136 (96%) web sites. Results Mean (in weeks, ± SD) duration of core clerkships were as follows: internal medicine (10 ± 2), surgery (8 ± 2), pediatrics (7 ± 1), obstetrics/gynecology (6 ± 1), and psychiatry (5 ± 1). Other common required clerkships were: family medicine (required in 96% [131 of 136] of schools, mean duration of 6 ± 2 weeks), neurology (81% [110], 4 ± 1), and emergency medicine (55% [75], 3 ± 1). Required MSK instruction, at a mean of 2 ± 1 weeks, was only present in 15% (20 of 136) of medical schools. In addition, clinical MSK instruction was offered as a selective (eg, students pick from a selection of subspecialties such as orthopaedics, plastics, or urology during a general surgery clerkship) in 34% (44 of 130) of all medical schools. This is less than other non-core specialties: geriatrics/ambulatory care (required in 40% [54 of 136] of schools, mean duration of 3 ± 1 weeks), critical care (30% [41], mean of 3 ± 1 weeks), radiology (26% [35], mean of 3 ± 1 weeks), anesthesiology (23% [31], mean of 2 ± 1 weeks), and other surgical subspecialties (19% [26

Discordance Between Population Impact of Musculoskeletal Disorders and Scientific Representation: A Bibliometric Study

“…These include, but are not limited to, funds allocated to MSD research, MSD-related training in medical schools, and attention directed toward MSDs in the dissemination of research results. Our findings that MSDs rank from moderate to low in the published health literature are consistent with reports that MSDs are underrepresented in clinical trials relative to the burden they represent (8), and that they appear underrepresented in medical schools, where few clerkships specific to MSDs are offered (9).…”

A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education

“…This work led to the development of recommendations for core RMD curricula and some curricular reform [30][31][32][33][34]. Nevertheless, worldwide deficiencies in RMD knowledge and skills among medical school graduates and PCPs persist [27,35,36]. Surveys of students, graduates, PCPs and even young rheumatologists consistently reveal low confidence in MSK competencies [16,[37][38][39][40].…”

“…USA Medical schools across the USA have consistently reported poor student performance in the Freedman and Bernstein examination (pass rate < 50%), despite an appreciation of the importance of RMDs [37,[47][48][49]. MSK clinical instruction continues to be underrepresented in undergraduate curricula: MSK clerkships were found to only feature in 15% of medical schools (mean of 2 ± 1 weeks) and clinical MSK medicine selectives were only offered in 34% of medical schools [36]. [34].…”

Comparison of physical examination performance of medical students trained by musculoskeletal versus non‐musculoskeletal specialists

“…Most often the medical school was identified as the only source of formal MSK training for students who felt that the level of training, time allocated to MSK and the non-mandatory nature were inadequate. [4][5][6] In addition, students have reported lack of confidence and the feeling of being unprepared, or not competent, to perform an MSK assessment. [7][8][9][10] A possible contributing factor to those areas of concern in regard to lack of confidence and skill level in the area of MSK, is the type of training received, with an apparent lack of training under MSK specialists.…”