Educational Deficiencies in Musculoskeletal Medicine

 

Jou Bone and Joint Surgery (Amer) 2002;   84–A (4) Apr:   604–608

Kevin B. Freedman, MD, MSCE and Joseph Bernstein, MD, MS Investigation performed at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Kevin B. Freedman, MD, MSCE 1725 West Harrison Street, Suite 1063, Chicago, IL 60612

Joseph Bernstein, MD, MS Department of Orthopaedic Surgery and Leonard Davis Institute of Health Economics, 424 Stemmler Hall, University of Pennsylvania, Philadelphia, PA 19104-6081. E-mail address: orthodoc@uphs.upenn.edu


In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Office of the Dean for Health Services Research, University of Pennsylvania. None of the authors received 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.

Background:   We previously (Journal of Bone and Joint Surgery 1998;   80-A (10) Oct:   1421–1427) reported the results of a study in which a basic competency examination in musculoskeletal medicine was administered to a group of recent medical school graduates. This examination was validated by 124 orthopaedic program directors, and a passing grade of 73.1% was established. According to that criterion, 82% of the examinees failed to demonstrate basic competency in musculoskeletal medicine. It was suggested that perhaps a different passing grade would have been set by program directors of internal medicine departments. To test that hypothesis, and to determine whether the importance of the individual questions would be rated similarly, the validation process was repeated with program directors of internal medicine residency departments as subjects.

Methods:   Our basic competency examination was sent to all 417 program directors of internal medicine departments in the United States. Each recipient was mailed a letter of introduction explaining the purpose of the study, a copy of the examination, and our answer key and scoring guide. There was no mention of the results of the first study. The subjects were requested to rate the importance of each question on the same visual analog scale, ranging from "not important" to "very important," as had been used by the orthopaedic program directors. These ratings were converted into numerical scores. The program directors were also asked to suggest a passing score for the examination, and this score was used to assess the examinees' performance on the examination. The results on the basis of the internal medicine program directors' responses and those according to the orthopaedic program directors' reponses were compared.

Results:   Two hundred and forty (58%) of the 417 program directors of internal medicine residency departments responded. They suggested a mean passing score (and standard deviation) of 70.0% ±; 9.9%. As reported previously, the mean test score of the eighty-five examinees was 59.6%. Sixty-six (78%) of them failed to demonstrate basic competency on the examination according to the criterion set by the internal medicine program directors. The internal medicine program directors assigned a mean importance score of 7.4 (of 10) to the questions on the examination compared with a mean score of 7.0 assigned by the orthopaedic program directors. The internal medicine program directors gave twenty-four of the twenty-five questions an importance score of at least 5 and seventeen of the twenty-five questions an importance score of at least 6.6.

Conclusions:   According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.

 

A Comparison of Chiropractic Student Knowledge Versus Medical Residents

Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255

Tuchin, P.J. , Bonello, R.

Objective:   To assess the knowledge of Chiropractic students in orthopedics and neurology.

Design:   A previously published knowledge questionnaire designed by chief orthopedic residents was given to a Chiropractic student group for comparison to the results of the medical resident group.

Setting:   Chiropractic Research Center of Macquarie University.

Participants:   51 volunteers, between the ages of 20 to 47 were given the questionnaire in their first week of their final semester of the Master of Chiropractic degree.

Main Outcome Measures:   Students were asked to complete the entire questionnaire to the best of their ability within a 30 minute time period. The questionnaires were then independently marked by lecturer/practitioners utilizing the grading system published by the Journal of Bone and Joint Surgery.

Results:   Based on the marking scale determined by the chief residents, the Chiropractic group (n = 51) showed statistically significant higher average grade than the orthopedic residents. Expressed in other terms, 70% of chiropractic students passed the knowledge questionnaire, compared to an 80% failure rate for the medical residents.

Conclusion:   The results of this study suggest that chiropractic student neuromusculoskeletal knowledge is as good as or better than medical residents.

 

Musculoskeletal Knowledge: How Do You Stack Up?

                             Physician and Sportsmedicine 2002 Aug; 30 (8)

One of every 4 or 5 primary care visits is for a musculoskeletal problem. Yet undergraduate and graduate (medical) training for this burden of illness continues to constitute typically less than 5% of the medical curriculum. This is an area of clear concern, but also one in which sports medicine practitioners can assume leadership.

In a 1998 study by Freedman and Bernstein,1 82% of recent medical school graduates failed a basic competency exam in musculoskeletal medicine. One of the criticisms of the study was that the pass rate (73.1%), set by 124 orthopedic surgeons, was too high. In a new study by Freedman and Bernstein,2 though, the same exam was validated by 240 (58%) of the 417 program directors of internal medicine departments in the United States. The pass score, set by the program directors themselves, was 70% (not much different than the pass score set by orthopedic surgeons). Using this new criterion, 78% of the previously tested examinees would still have failed the exam. The authors' conclusion is that medical school preparation in musculoskeletal medicine is inadequate.