Deficiencies in the education of musculoskeletal medicine in Ireland

  • J. M. QueallyEmail author
  • P. D. Kiely
  • M. J. Shelly
  • B. J. O’Daly
  • J. M. O’Byrne
  • E. L. Masterson
Original Article



Basic competency in musculoskeletal medicine is essential for many specialties being particularly relevant to primary care.


The purpose of this study was to objectively assess the adequacy of musculoskeletal education at multiple levels of medical training from undergraduate level to primary care.


A previously validated musculoskeletal examination was administered to 303 volunteers consisting of medical students, orthopaedic specialist registrars, general practice trainees and general practitioners.


Forty (71%) general practitioners and 74 (71.8%) general practice trainees failed to obtain the passing score of 70. Sixty-three (87.5%) medical students who had completed an intensive 1-week long course in musculoskeletal medicine failed the examination. The pass rate improved significantly for general practitioners who had completed a postgraduate rotation in musculoskeletal medicine (47.8 vs 18.1%, P < 0.01).


These findings suggest that training in musculoskeletal medicine is inadequate at multiple levels of medical education with reform urgently required.


Musculoskeletal education Primary care Undergraduate level 


Conflict of interest

No financial support was sought for this study.


  1. 1.
    Weinstein SL (2000) 2000–2010: the bone and joint decade. J Bone Joint Surg Am 82(1):1–3PubMedCrossRefGoogle Scholar
  2. 2.
    Woolf AD, Akesson K (2001) Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ 322(7294):1079–1080PubMedCrossRefGoogle Scholar
  3. 3.
    Simon LS (1999) Osteoarthritis: a review. Clin Cornerstone 2(2):26–37PubMedCrossRefGoogle Scholar
  4. 4.
    Geyman JP, Gordon MJ (1979) Orthopedic problems in family practice: incidence, distribution, and curricular implications. J Fam Pract 8(4):759–765PubMedGoogle Scholar
  5. 5.
    Kahl LE (1987) Musculoskeletal problems in the family practice setting: guidelines for curriculum design. J Rheumatol 14(4):811–814PubMedGoogle Scholar
  6. 6.
    Marsland DW, Wood M, Mayo F (1976) Content of family practice. Part I. Rank order of diagnoses by frequency. Part II. Diagnoses by disease category and age/sex distribution. J Fam Pract 3(1):37–68PubMedGoogle Scholar
  7. 7.
    Mulhall KJ, Masterson E (2005) Relating undergraduate musculoskeletal medicine curricula to the needs of modern practice. Ir J Med Sci 174(2):46–51PubMedCrossRefGoogle Scholar
  8. 8.
    Lynch JR, Gardner GC, Parsons RR (2005) Musculoskeletal workload versus musculoskeletal clinical confidence among primary care physicians in rural practice. Am J Orthop 34(10):487–491 (discussion)PubMedGoogle Scholar
  9. 9.
    Matzkin E, Smith EL, Freccero D, Richardson AB (2005) Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am 87(2):310–314PubMedCrossRefGoogle Scholar
  10. 10.
    Matheny JM, Brinker MR, Elliott MN, Blake R, Rowane MP (2000) Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop 29(12):945–952PubMedGoogle Scholar
  11. 11.
    Sneiderman C (1977) Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners. J Fam Pract 4(2):267–50PubMedGoogle Scholar
  12. 12.
    Clawson DK, Jackson DW, Ostergaard DJ (2001) It’s past time to reform the musculoskeletal curriculum. Acad Med 76(7):709–710PubMedCrossRefGoogle Scholar
  13. 13.
    Freedman KB, Bernstein J (1998) The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am 80(10):1421–1427PubMedGoogle Scholar
  14. 14.
    Freedman KB, Bernstein J (2002) Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am 84-A(4):604–608PubMedGoogle Scholar
  15. 15.
    Lynch JR, Schmale GA, Schaad DC, Leopold SS (2006) Important demographic variables impact the musculoskeletal knowledge and confidence of academic primary care physicians. J Bone Joint Surg Am 88(7):1589–1595PubMedCrossRefGoogle Scholar
  16. 16.
    Fowler PJ, Regan WD (1987) The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med 15(4):321–325PubMedCrossRefGoogle Scholar
  17. 17.
    Booth A, Wise DI (1990) General practice training in musculoskeletal disorders. Br J Gen Pract 40(338):390PubMedGoogle Scholar
  18. 18.
    Pinney SJ, Regan WD (2001) Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am 83-A(9):1317–1320PubMedGoogle Scholar
  19. 19.
    DiCaprio MR, Covey A, Bernstein J (2003) Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am 85-A(3):565–567PubMedGoogle Scholar
  20. 20.
    Williams JR (2000) The teaching of trauma and orthopaedic surgery to the undergraduate in the United Kingdom. J Bone Joint Surg Br 82(5):627–628PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2008

Authors and Affiliations

  • J. M. Queally
    • 1
    Email author
  • P. D. Kiely
    • 2
  • M. J. Shelly
    • 1
  • B. J. O’Daly
    • 1
  • J. M. O’Byrne
    • 1
  • E. L. Masterson
    • 2
  1. 1.Department of Trauma and Orthopaedic SurgeryRoyal College of Surgeons in Ireland, Cappagh National Orthopaedic HospitalDublin 11Ireland
  2. 2.Mid-Western Regional Hospital Orthopaedic Hospital CroomLimerickIreland

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