A.A. Marino, K. Bilderback, J. Eggerstedt, and R. McCall reply:
We did not study the musculoskeletal knowledge base of primary care practitioners but, rather, accepted that deficiencies existed, as has been documented by others1-3. Our goal was to develop a comprehensive course in musculoskeletal medicine for medical students to help to address the problem. In 2009, we expect to post course materials including Microsoft PowerPoint presentations and audio files of the lectures, small-group cases, criteria documents for evaluating student proficiency in performing the musculoskeletal physical examination, and video files of actual student examinations ().
We agree there does not seem to have been much progress regarding the education of primary care physicians in musculoskeletal medicine during The Bone and Joint Decade. In our view, a major reason is that too few deans of medical schools are aware of the deficiencies in the musculoskeletal knowledge of their graduates and consequently have not been motivated to change the traditional undergraduate curriculum. Unfortunately, evidence of the deficiencies (as opposed to the deficiencies themselves) may soon become difficult to produce because an important tool for documenting the problem, the Freedman and Bernstein test2,3, is likely to become a victim of its popularity. We reported that 55% of students in 2007 passed the examination. The passing rate for the 2008 freshmen was 58%. However, we can no longer use the test because, unlike the situation in 2007 and 2008, the existence of the test is now more or less common knowledge among the medical students. We anticipate that the same thing will happen elsewhere, with the result that efforts to demonstrate the need for a course in musculoskeletal medicine in the undergraduate curriculum, or the effectiveness of specific courses, will be seriously hampered, at least until another authoritative, validated test is developed.
Now is the time to do more than simply develop exemplary teaching materials, an effective assessment tool, and a course based on them. The professional academies and societies devoted to the study and treatment of musculoskeletal disease need to make the case directly to the deans of the medical schools that musculoskeletal medicine should be presented as an independent academic subject in the undergraduate curriculum.
These letters originally appeared, in slightly different form, on . They are still available on the web site in conjunction with the article to which they refer.