Med Grads Flunk Musculoskeletal Exam

A recent study in the Journal of Bone and Joint Surgery¹ concluded what many doctors of chiropractic have long suspected: "Current medical school training in musculoskeletal medicine is inadequate."

About 23% of patient visits to the family physician and 20% of visits to emergency rooms are for musculoskeletal complaints.

To test the level of musculoskeletal competency among recent medical school graduates, researchers developed a 25-question test. The test was reviewed and validated by 124 orthopedic chairpersons from residency programs across the United States. Further validation was made by having eight chief residents in orthopedic surgery take the test. The eight surgeons passed the test with a mean score of 98.5%. Basic competency was judged to be a score of 73%.

Eighty-five first-year medical and surgical residents at the University of Pennsylvania School of Medicine were administered the test on their first day of residency: 61 were medical residents, 17 were surgical residents and seven were orthopedic residents. The 85 residents were graduates of 37 medical schools.

In their medical school training:

• 44 (52%) of the residents had taken the required course in orthopedic surgery (average duration 1.3 weeks);


• 20 (24%) had taken an elective course in orthopedic surgery (average duration of 5.6 weeks);


• 7 (8%) had taken both courses;


• 28 (33%) took neither course.

The average score of the 85 residents was 59.6% (73% was considered passing); the highest score was 86%; the lowest 35%. Only 19 residents earned a passing grade; 70 (82%) "failed to demonstrate basic competency."

The orthopaedic residents performed the best with an average score of 74.1% (only one percent over passing). The medical and surgical residents did about the same with average scores of 58.4% and 58.1% respectively. The failure rates broke down as follows:

Orthopedic Residents: 3 of 7 (43%) failed

Medical Residents: 53 of 61 (87%) failed

Surgical Residents: 14 of 17 (82%) failed

The authors concluded

"The current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine. The duration of the residents' preparation in this area was inadequate. For the study population as a whole, the mean duration of instruction in orthopaedics was only 2.1 weeks. In addition, 28 residents (33%) had graduated from medical school with no rotation, required or elective, in orthopedic surgery; these residents had the lowest mean score (55.9%) on the examination and the highest rate of failure (93%).

"However, those who had taken a course in orthopedic surgery in medical school were not found to have a significantly higher mean score than those who had not, perhaps because the standard required course was too brief for the essential information to be conveyed."

While this discovery supports what DCs have suspected all along, it may be a key factor in why MDs don't cooperate with and refer well to doctors of chiropractic. Their lack of understanding also makes them a poor choice to act as gatekeepers for musculoskeletal problems in managed care environments.

One can't help but wonder how this shortcoming can be overcome. Perhaps it will be DCs that teach MDs what they didn't learn in medical school.

Reference

1. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone and Joint Surg, 80A:1421-1427. Oct. 1998.