The Inadequacy of Musculoskeletal Knowledge in Graduating Medical Students in the United Kingdom

Al-Nammari, Shafic Said; Pengas, I; Asopa, Vipin; Jawad, Ali S M; Rafferty, M; Ramachandran, Manoj

doi:10.2106/jbjs.n.00488

Cited by 39 publications

(44 citation statements)

References 23 publications

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“…A number of studies have found that inadequate clinical exposure to MSK medicine during medical school could result in residents and physicians across many specialties who feel underprepared to appropriately evaluate MSK conditions [1,5,6,11,12,15]. For the majority of physicians entering general practice, the primary instruction they receive in the diagnosis and initial management of MSK disorders is during their medical school education [18] because most residents in non-MSK specialties are provided little additional instruction in MSK medicine during their residency training [11,14,20].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies [1,5,9,12,13,17,21] and the American Association of Medical Colleges (AAMC) [3] have raised concern that medical schools may not give sufficient instruction on this topic. In 2003, DiCaprio et al [9] demonstrated the lack of required instruction in MSK medicine in both preclinical and clinical years of undergraduate medical education.…”

Section: Introductionmentioning

confidence: 99%

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Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

DiGiovanni

Sundem

Southgate

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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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

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

DiGiovanni

Sundem

Southgate

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Musculoskeletal pain ranks third as a reason for adolescent medical visits to the primary care physician [5]. In addition, musculoskeletal injuries are one of the most common reason for acute visits to the emergency department and primary care office [1][2][3][4]. Recognition of musculoskeletal diagnoses is very important in a pediatric clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 10% -30% of patients who are seen by a primary care physician are seeking care due to a musculoskeletal complaint [1][2][3][4]. De Inocencio reports that >6% or pediatric clinic visits are musculoskeletal pain with nearly 30% attributable to trauma or overuse 4 .…”

Section: Introductionmentioning

confidence: 99%

An orthopaedic elective for pediatric residents

Piazza¹,

Nilson²,

Wells³

et al. 2017

Rheumatol Orthop Med

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“…A recent study from the United Kingdom suggested that UK medical schools may be failing to ensure that medical students have acquired a basic competence in musculoskeletal medicine. 31 In fact only 21% of students passed the Freedman and Bernstein musculoskeletal cognitive examination. 32 The situation does not appear to be much better in South Africa, where a similar study (involving interns) found a 91% failure rate.…”

Section: Assessmentmentioning

confidence: 99%

Teaching and training in orthopaedics

Marais

Dunn

2017

SA orthop. j.

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This article aims to review the current trends in the pedagogy of orthopaedic surgery, with specific reference to teaching philosophies, training methods and assessments tools that may be used. Our expanding knowledge base and the complexity of skills required, combined with the pressure created by medical negligence litigation increases the emphasis on knowledge of disease in contrast to pure competency in practical procedures. At specialist level, the drive now appears stronger than ever to develop less-or non-invasive ways to treat musculoskeletal disease. As a disease specialist the trainee, therefore, needs to develop a wider vision than one held by a competent technician. A combination of educational philosophies can be employed to achieve these objectives. Cognitive task analysis (CTA) and constructivism may be useful strategies for skills acquisition. In terms of theoretical knowledge, the emphasis remains on an evidence-based approach, delivered in an active student-centred environment. Clinical teaching as a whole, however, demands the promotion of critical thinking and a problem-oriented approach in a situated learning setting. The pedagogy of skill and knowledge assessment in orthopaedics remains unresolved. However, the educational impact of assessment through its value as a driver for learning has been recognised.

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The Inadequacy of Musculoskeletal Knowledge in Graduating Medical Students in the United Kingdom

Cited by 39 publications

References 23 publications

Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

An orthopaedic elective for pediatric residents

Teaching and training in orthopaedics

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