Scientific Article   |    
Educational Deficiencies in Musculoskeletal Medicine
Kevin B. Freedman, MD, MSCE; Joseph Bernstein, MD, MS
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Investigation performed at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Kevin B. Freedman, MD, MSCE
1725 West Harrison Street, Suite 1063, Chicago, IL 60612

Joseph Bernstein, MD, MS
Department of Orthopaedic Surgery and Leonard Davis Institute of Health Economics, 424 Stemmler Hall, University of Pennsylvania, Philadelphia, PA 19104-6081. E-mail address: orthodoc@uphs.upenn.edu

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Office of the Dean for Health Services Research, University of Pennsylvania. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 Apr 01;84(4):604-608
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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 orthopaedic program directors, and a passing grade of 73.1% was established. According to that criterion, 82% of the examinees 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.

Methods: Our basic competency examination was sent to all 417 program directors of internal medicine departments in the United States. Each recipient was mailed a letter of introduction explaining the purpose of the study, a copy of the examination, and our answer key and scoring guide. There was no mention of the results of the first study. The subjects were requested to rate the importance of each question on the same visual analog scale, ranging from "not important" to "very important," as had been used by the orthopaedic program directors. These ratings were converted into numerical scores. The program directors were also asked to suggest a passing score for the examination, and this score was used to assess the examinees' performance on the examination. The results on the basis of the internal medicine program directors' responses and those according to the orthopaedic program directors' reponses were compared.

Results: Two hundred and forty (58%) of the 417 program directors of internal medicine residency departments responded. They suggested a mean passing score (and standard deviation) of 70.0% ±; 9.9%. As reported previously, the mean test score of the eighty-five examinees was 59.6%. Sixty-six (78%) of them failed to demonstrate basic competency on the examination according to the criterion set by the internal medicine program directors. The internal medicine program directors assigned a mean importance score of 7.4 (of 10) to the questions on the examination compared with a mean score of 7.0 assigned by the orthopaedic program directors. The internal medicine program directors gave twenty-four of the twenty-five questions an importance score of at least 5 and seventeen of the twenty-five questions an importance score of at least 6.6.

Conclusions: According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees 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.

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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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    Hans Friedrich Baer
    Posted on May 18, 2002
    Educational Deficiencies in Musculoskeletal Education
    Orthopädische Universitätsklinik Bochum

    I would like to express my gratitude to the authors for addressing this difficult subject with methodological skill, and appropriate self criticism.

    It is difficult to comprehend that current medical curricula are so deficient in teaching the basic sciences of the musculo-skeletal system and the clinically necessary knowledge about common musculoskeletal diseases that affect such a large majority of the adult population.

    It is my impression that in the German speaking orthopaedic community, as in the rest of the medical world, there is a special lack of education in musculoskeletal basic sciences such as functional anatomy, and an inability for our younger medical colleagues to apply orthopedic science to clinical situations.

    Clear thinking and decision making in orthopaedics is hard enough to teach to students, but it is impossible to teach these skills without first teaching the basic knowledge in this specialty.

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