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Medical Student Musculoskeletal EducationAn Institutional Survey
Nathan W. Skelley, MD1; Miho J. Tanaka, MD1; Logan M. Skelley, BS1; Dawn M. LaPorte, MD1
1 Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue #A665, Baltimore, MD 21224-2780. E-mail address for D.M. LaPorte: ehenze1@jhmi.edu
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Investigation performed at the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Oct 03;94(19):e146 1-7. doi: 10.2106/JBJS.K.01286
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Since the 1910 Flexner Report, medical education continues to undergo curriculum and graduation guideline reform to meet the needs of physicians and patients. Our aims were to (1) assess the quality of musculoskeletal education at our institution’s School of Medicine by reporting the results of the Freedman and Bernstein examination among our medical students across all four years of training, and (2) stratify results according to medical school year, educational module, and intended career.


We surveyed the 460 2009-2010 School of Medicine students via e-mail. The survey contained a validated orthopaedic examination of musculoskeletal competency (passing grade, 70%), demographic questions (e.g., year in training, clinical area of interest, and time dedicated to musculoskeletal topics in medical school education), and a 10-point tool for determining confidence in assessing musculoskeletal disorders. There were 354 responses (77.0%); six were excluded for incompleteness, leaving 348 for analysis. Linear regression analysis was used to determine the association between test scores and days spent studying musculoskeletal material. The unpaired Student t test was used to compare performance among areas of interest and training years, with p < 0.05 being considered significant.


The mean score was 51.1%; only sixty-seven (19.3%) of the students passed. Fourth-year students scored significantly higher (59.0%) compared with first-year students (37.3%), but >65% of students in both groups failed. Only 34.2% of the graduating students had completed a musculoskeletal elective. Students who participated in elective musculoskeletal education had a higher pass rate (67.5%) than those who did not (43.9%, p < 0.001). A minimum of fifteen days dedicated to elective study of musculoskeletal medicine significantly increased the chance of passing this examination. First-year through fourth-year students ranked their level of confidence in dealing with musculoskeletal issues as 3.18, 3.82, 3.57, and 4.77, respectively.


To our knowledge, this is the first study to test this examination with medical school class years and have quantifiable results that advocate for incorporation of a dedicated musculoskeletal block in medical student education.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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