Evidence of educational inadequacies in region-specific musculoskeletal medicine

Abstract

Recent studies suggest US medical schools are not effectively addressing musculoskeletal medicine in their curricula. We examined if there were specific areas of weakness by analyzing students' knowledge of and confidence in examining specific anatomic regions. A cross-sectional survey study of third- and fourth-year students at Harvard Medical School was conducted during the 2005 to 2006 academic year. One hundred sixty-two third-year students (88% response) and 87 fourth-year students (57% response) completed the Freedman and Bernstein cognitive mastery examination in musculoskeletal medicine and a survey eliciting their clinical confidence in examining the shoulder, elbow, hand, back, hip, knee, and foot on a one to five Likert scale. We specifically analyzed examination questions dealing with the upper extremity, lower extremity, back, and others, which included more systemic conditions such as arthritis, metabolic bone diseases, and cancer. Students failed to meet the established passing benchmark of 70% in all subgroups except for the others category. Confidence scores in performing a physical examination and in generating a differential diagnosis indicated students felt below adequate confidence (3.0 of 5) in five of the seven anatomic regions. Our study provides evidence that region-specific musculoskeletal medicine is a potential learning gap that may need to be addressed in the undergraduate musculoskeletal curriculum.

Figures

Fig. 1A–B

(A) Competency examination scores of third-year students divided by categories (N = 128) are shown: examination scores (mean ± 95% CI of mean): overall (54.8 ± 2.59); back (29.2 ± 3.50); lower extremity (45.4 ± 4.24); upper extremity (48.2 ± 3.79); others (76.9 ± 3.52). (B) The competency examination scores of fourth-year students divided by categories (N = 84) are shown: examination scores (mean ± 95% CI of mean): overall (62.1 ± 2.88); back (43.2 ± 4.83); lower extremity (55.7 ± 5.28); upper extremity (54.9 ± 4.73); others (80.1 ± 3.22). CI = confidence interval.

Fig. 2A–B

(A) The clinical confidence scores in performing a physical examination for third- and fourth-year students (N = 161) are shown. Numeric scales were categorized as: 1 = no confidence; 2 = low confidence; 3 = adequate confidence; 4 = high confidence; 5 = complete confidence. Scores (mean ± 95% CI of mean): overall pulmonary system: third year (4.00 ± 0.13), fourth year (4.00 ± 0.18); overall musculoskeletal system: third year (2.60 ± 0.11), fourth year (2.65 ± 0.15); shoulder: third year (2.60 ± 0.12), fourth year (2.62 ± 0.15); elbow: third year (2.52 ± 0.13), fourth year (2.49 ± 0.17); hand/wrist: third year (2.71 ± 0.14), fourth year (2.53 ± 0.18); back: third year (2.44 ± 0.14), fourth year (2.90 ± 0.19); knee: third year (3.14 ± 0.15), fourth year (3.23 ± 0.20); hip: third year (2.64 ± 0.13), fourth year (2.64 ± 0.19); foot/ankle: third year (2.46 ± 0.14), fourth year (2.51 ± 0.16). (B) Clinical confidence scores in generating a differential diagnosis for third- and fourth-year students (N = 86) are shown. Numeric scales were categorized as: 1 = no confidence; 2 = low confidence; 3 = adequate confidence; 4 = high confidence; 5 = complete confidence. Scores (mean ± 95% CI of mean): overall pulmonary system: third year (3.71 ± 0.13), fourth year (3.84 ± 0.19); overall musculoskeletal system: third year (2.35 ± 0.11), fourth year (2.57 ± 0.14); shoulder: third year (2.35 ± 0.12), fourth year (2.51 ± 0.15); elbow: third year (2.27 ± 0.12), fourth year (2.39 ± 0.15); hand/wrist: third year (2.47 ± 0.14), fourth year (2.46 ± 0.15); back: third year (2.52 ± 0.14), fourth year (3.06 ± 0.19); knee: third year (2.67 ± 0.13), fourth year (3.01 ± 0.19); hip: third year (2.35 ± 0.12), fourth year (2.94 ± 0.16); foot/ankle: third year (2.32 ± 0.12), fourth year (2.37 ± 0.14). CI = confidence interval.