Resolution 310, Musculoskeletal Care In Graduate Medical Education, introduced by the American Orthopaedic Foot and Ankle Society and the American Academy of Orthopaedic Surgeons, asks our AMA to 1) strongly urge medical schools to formally reevaluate the musculoskeletal curriculum; 2) strongly urge medical schools to ensure that medical students have the appropriate education and training in musculoskeletal care, making this competence a requirement for graduation; and 3) encourage its representatives to the Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education and the Residency Review Committees to promote higher standards in basic competence in musculoskeletal care in accreditation standards.
Resolution 310 is undoubtedly a reaction to a number of studies that have concluded: "Current medical school training in musculoskeletal medicine is inadequate"2-5 - something about which most doctors of chiropractic are well-aware. Apparently, this has now become obvious to the AMA leadership as well.
Although Resolution 310 was "recommended for non-adoption," it was passed by the AMA HOD after only "limited" testimony that "medical students and resident physicians are not well-trained in musculoskeletal care." It appears there was little dispute regarding the accuracy of the conclusions established by the previous studies.
Resolution 310 couldn't have come at a better time for ACA general counsel George McAndrews, Esq., who undoubtedly will use it to further demonstrate to the appeals court in the Trigon lawsuit that most medical doctors just don't have the necessary training to care for most spinal problems. We've always known this. They not only know it, but also are admitting it formally.
With admission comes the opportunity to rectify.
Medical students may currently be undertrained and less than competent in regard to the musculoskeletal system, but that may not be the case forever. Their embarrassment may become the driving force that changes medical school curriculum.
This leads to a number of interesting questions:
- If medical doctors really learn about the musculoskeletal system, will they also learn to appreciate chiropractic more?
- Will there ever come a day when the average MD will treat a spinal ailment with something more than a prescription pad?
- Will the current concern over this educational inadequacy cause permanent changes in medical school curriculum, or just cosmetic ones?
Chiropractic has expended enormous effort over the years to convince the world of the importance of musculoskeletal health. It is obvious that along with consumers, PTs, DOs and now MDs have heard us.
It seems realistic to surmise that maintaining our position as the top spine-oriented profession may boil down to effectiveness. In the past, doctors of chiropractic were the only nonsurgical providers interested in the spine. Now, we have plenty of other professions (as well as a host of drug companies) crowding onto the bandwagon.
Demonstrating that chiropractic is superior will be more of an issue in the near future - not just for the profession as a whole, but for individual DCs as well.
References
- www.ama-assn.org/ama/pub/category/10290.html.
- Med grads flunk musculoskeletal exam: 82% 'failed to demonstrate basic competency.' DC Jan. 12, 1999. www.chiroweb.com/archives/17/02/31.html.
- Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone and Joint Surg, October 1998;80A:1421-1427.
- Study follow-up confirms original conclusion: Musculoskeletal prep in med school inadequate. Dynamic Chiropractic, June 3, 2002. www.chiroweb.com/archives/20/12/17.html.
- Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. The Journal of Bone and Joint Surgery 2002;84-A(4): 604-608.
DMP Jr.
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