Background: Basic musculoskeletal knowledge is essential to the
practice of medicine. A validated musculoskeletal cognitive examination was
given to medical students, residents, and staff physicians in multiple
disciplines of medicine to assess the adequacy of their musculoskeletal
Methods: The examination was given to 334 volunteers consisting of
medical students, residents, and staff physicians. Analysis of the data
collected and comparisons across disciplines were performed.
Results: The average cognitive examination score was 57%. Sixty-nine
participants (21%) obtained a score of =73.1%, the recommended mean passing
score. Of the sixty-nine with a passing score, forty (58%) were orthopaedic
residents and staff physicians with an overall average score of 94%.
Differences in the average scores for the orthopaedic residents compared with
all other specialties were significant (p < 0.001). The average score was
69% for the 124 participants who stated that they had taken a required or an
elective course in orthopaedics during their training compared with an average
score of 50% for the 210 who had not taken an orthopaedic course (p <
0.001). When the scores of those in orthopaedics were excluded, the average
score for the participants who had taken an orthopaedic course was 59%; this
difference remained significant (p < 0.001).
Conclusions: Seventy-nine percent of the participants failed the
basic musculoskeletal cognitive examination. This suggests that training in
musculoskeletal medicine is inadequate in both medical school and
nonorthopaedic residency training programs. Among the nonorthopaedists, scores
were significantly better if they had taken a medical school course or
residency rotation in orthopaedics, suggesting that a rotation in orthopaedics
would improve the general level of musculoskeletal knowledge.