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Adequacy of Education in Musculoskeletal Medicine
Elizabeth Matzkin, MD1; Major Eric L. Smith, MD2; Captain David Freccero, MD3; Allen B. Richardson, MD4
1 Duke University Medical Center, Box 3615, Durham, NC 27710. E-mail address: ematzki@aol.com
2 Orthopaedic Department, Naval Hospital, 100 Brewster Boulevard, Camp Lejeune, NC 28547
3 Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859
4 Deceased
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive 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. The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.
Investigation performed at the University of Hawaii and Tripler Army Medical Center, Honolulu, Hawaii

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Feb 01;87(2):310-314. doi: 10.2106/JBJS.D.01779
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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 medicine training.

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.

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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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    Elizabeth G. Matzkin
    Posted on October 05, 2005
    Dr. Matzkin and Colleagues respond to Dr. Peck
    Foundry Sports Medicine and Fitness, 285 Promenade St., Providence, RI 02908

    We would like to thank Dr. Peck for his interest in our article. We administered the basic musculoskeletal competency exam to credentialed physicians at two medical centers and thus we are unable to comment about the level of understanding of musculoskeletal medicine amongst alternative providers.

    We agree that some health care providers are competent in their level of understanding of musculoskeletal medicine and these providers can be an asset in the “team” approach to treating patients with musculoskeletal injuries. Overall, however, the level of musculoskeletal understanding of non-orthopaedic providers was poor. Our study did show a significantly higher score on the musculoskeletal competency exam for those providers who had additional training in orthopaedics.

    We are not familiar with the specific musculoskeletal training nor the abilities of chiropractors and thus cannot endorse the comments made by Dr. Peck.

    Perhaps in the future, a similar peer reviewed study evaluating the level of musculoskeletal understanding of additional providers such as physician assistants, nurses and chiropractors should be performed to answer this question.


    Elizabeth Matzkin, Major Eric L. Smith, Captain David Freccero

    The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.

    Timothy A. Peck
    Posted on August 01, 2005
    D.C's Are Here To Help

    To The Editor:

    As a chiropractic doctor, I evaluate and treat non surgical orthopedic conditions on a daily basis. I have strong referrals from internal medicine and family physicians. If the case is surgical, I refer to the surgeon. It appears that the orthopaedic surgeon's evaluation and the Chiropractor's nearly mirror one another.

    The message of this letter is that a reputable chiropractor is well versed in the evaluation and rehabilitation of musculoskeletal conditions and can be a great team member to primary care and ortho surgeons. I know that the stigma towards chiropractors is still alive and well in many medical circles. I have found that many medical doctors simply were not aware or have been mislead about the training and abilities of a good chiropractor.


    Timothy A. Peck, DC

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