Background: Although most musculoskeletal illness is managed by
primary care providers, and not by surgeons, evidence suggests that primary
care physicians may receive inadequate training in musculoskeletal medicine.
We evaluated the musculoskeletal knowledge and self-perceived confidence of
fully trained, practicing academic primary care physicians and tested the
following hypotheses: (1) a relationship exists between a provider's
musculoskeletal knowledge and self-perceived confidence, (2) demographic
variables are associated with differences in the knowledge-confidence
relationship, and (3) specific education or training affects a provider's
musculoskeletal knowledge and clinical confidence.
Methods: An examination of basic musculoskeletal knowledge and a
10-point Likert scale assessing self-perceived confidence were administered to
family practice, internal medicine, and pediatric faculty at a large,
regional, academic primary care institution serving both rural and urban
populations across a five-state region. Subspecialty physicians were excluded.
Individual examination scores and self-reported confidence scores were
correlated and compared with demographic variables.
Results: One hundred and five physicians participated. Ninety-two
physicians adequately completed the musculo-skeletal knowledge examination.
Fifty-nine (64%) of the ninety-two physicians scored <70%. Higher
examination scores were associated with male gender (p = 0.01) and
participation in a musculoskeletal course (p = 0.009). Practitioners who took
elective courses demonstrated higher scores compared with those who took
required courses (p = 0.014). Greater musculoskeletal confidence was
associated with the number of years in clinical practice (p = 0.045), male
gender (p = 0.01), residency training in family practice (p < 0.00001), and
prior participation in a musculoskeletal course (p = 0.0004). Physicians
demonstrated greater confidence with medical issues than with musculoskeletal
issues (mean confidence scores, 8.3 and 5.1, respectively; p < 0.00001).
Higher scores for musculoskeletal knowledge correlated significantly with
increasing levels of musculoskeletal confidence (r = 0.416, p <
Conclusions: Although a large proportion of primary care visits are
for musculoskeletal symptoms, the majority of primary care providers tested at
a large, regional, academic primary care institution failed to demonstrate
adequate musculoskeletal knowledge and confidence. Further characterization of
the relationship between knowledge and confidence and its association with
demographic variables might benefit the education of musculoskeletal providers
in the future.