The fact that allopathic physicians and medical students lack adequate knowledge of the musculoskeletal system is not news to chiropractors.1,2
The most recent study to examine this educational gap shows that, while medical students continue to feel unprepared to deal with musculoskeletal complaints, they rate learning about such conditions to be of high importance.3 Charles S.
The medical students rated musculoskeletal education to be of major importance (3.8 on a five-point scale) but rated the amount of curriculum time spent on the subject as poor (2.1/5).3 They also estimated that musculoskeletal problems comprise somewhere between 40 percent and 45 percent of all primary care visits. This is somewhat higher than the actual estimate of between 10 percent and 37 percent of office visits.2
Overall, students did not feel adequately informed to either examine the musculoskeletal system or generate a differential diagnosis.3 Second-year students scored the lowest, as expected (2.3/5 and 2/1/5 for physical exam and differential diagnosis, respectively). Fourth-year students felt equally comfortable with both the physical exam and the differential diagnosis (2.6/5 for each), although this still was considered below-adequate.
In looking at the exam scores, students throughout years two through four had an overall average score below the 70-percent passing mark.3 Only 7 percent of third-year students passed the exam, whereas 26 percent of fourth-year students did so. However, third-and fourth-year students who took musculoskeletal elective classes did significantly better than those who only took the required classes.
As earlier studies have demonstrated, this lack of fundamental knowledge carries over after graduation from medical school.1 In the most recent example, Lynch and colleagues at the University of Washington examined the scores of 92 physicians who took a text of musculoskeletal knowledge.2 More than half of the participating doctors (59) received a score of less than 70 percent. As expected, those physicians who had taken musculoskeletal elective courses in medical school scored higher than those who only took required courses.
The conclusion reached by both studies is very similar - a greater emphasis is needed on training in musculoskeletal conditions over all four years of medical school. As Day and colleagues concluded, "One way to guarantee greater exposure would be for medical institutions to increase the amount of mandatory musculoskeletal education in their curricula. Although every academic department could benefit from more curricular time, our study adds to the literature that provides direct evidence that such a need exists for musculoskeletal medicine.3"
References
- Vasquez A. Chiropractic musculoskeletal competence: is being "best" good enough? Dynamic Chiropractic. March 12, 2007;25(6). Available at: www.chiroweb.com/archives/25/06/03.html.
- Lynch JR, Schmale GA, Schaad DC, Leopold SS. Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians. J Bone Joint Surg Am, July 2006;88(7):1589-95.
- Day CS, Yeh AC, Franko O, et al. Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School. Acad Med, May 2007;82(5):452-7.