To The Editor:
I applaud the efforts of Lynch and colleagues to further enlighten us on
the crisis in musculoskeletal education in the United States. Their article
"Important Demographic Variables Impact the Musculoskeletal Knowledge
and Confidence of Academic Primary Care Physicians" (2006;88:1589-95)
indicates that our medical providers lack a consistent basic fund of
musculoskeletal knowledge, which our medical schools should be providing to
every graduate. I do have several comments.
As a rheumatologist who has spent his entire career educating internal
medicine residents in the area of musculoskeletal medicine, I do not think the
Freedman and Bernstein twenty-five-item assessment test1 accurately
reflects the issues most primary care internists face in practice. It is a
one-size-fits-all test and is really an orthopaedic assessment that is heavily
weighted toward orthopaedic trauma (nine of the twenty-five items). While this
may be more relevant to certain primary care providers (family practice
physicians or rural internists), it does not reflect the musculoskeletal
problems seen on a daily or weekly basis by most primary care internists. I
know that chairs of medical departments have endorsed the test, but I am not
sure that in most cases they would be the best group to evaluate orthopaedic
issues. I understand a more directed assessment is under study currently.
My second comment is more general. A previous paper on this topic by Lynch
et al.2 delineated what a rural internist was actually seeing in
clinic with regard to musculoskeletal problems. I think this type of
information should be our starting point for teaching future generations of
primary care providers. Teaching should address their future needs rather than
be based on a hypothetical curriculum generated by expert opinion and panels.
While a good place to start, this cannot substitute for evidencebased
curriculum development. Knowing what they need to know will help us know what
to teach and allow us to develop more useful assessment tools.