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Musculoskeletal education in US medical schools: lessons from the past and suggestions for the future

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Abstract

Despite the prevalence of musculoskeletal disorders in the United States, physicians have received inadequate training during medical school on how to examine, diagnose, and manage these conditions. This article provides an overview of the existing literature on undergraduate medical musculoskeletal education, including learning objectives, researched methodology, and currently utilized assessment tools. A discussion of challenges to and suggested approaches for the implementation of medical school musculoskeletal curricula is presented.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. The bone and joint decade 2010–2020. Available at http://www.boneandjointdecade.org/. Accessed May 2011

  2. Musculoskeletal diseases: leading cause of disability and health care cost. Available at http://www.usbjd.org/about/index.cfm?pg=fast.cfm. Accessed February 2011

  3. Bush GW. National bone and joint decade: 2002–2011. A proclamation by the President of the United States of America. J Bone Joint Surg Am. 2002;84-A:1297. discussion 1298.

    PubMed  Google Scholar 

  4. Project 100. Available at http://www.usbjd.org/projects/project_op.cfm?dirID=127. Accessed April 2011

  5. Bernstein J, King T, Lawry GV. Musculoskeletal medicine educational reform in the bone and joint decade. Arthritis Rheum. 2007;57:1109–11.

    Article  PubMed  Google Scholar 

  6. Contemporary issues in medicine report VII: musculoskeletal medicine education medical school objectives project. Available at www.aamc.org/meded/msop

  7. Musculoskeletal subject examination. Available at http://www.nbme.org/Schools/SubjectExams/Subjects/musculo.html. Accessed April 2011

  8. Bernstein J, Garcia GH, Guevara JL, Mitchell GW. Progress report: the prevalence of required medical school instruction in musculoskeletal medicine at decade’s end. Clin Orthop Relat Res. 2011;469:895–7.

    Article  PubMed  Google Scholar 

  9. • Curriculum development for medical education. 2nd ed. DE Kern, PA Thomas, and MT Hughes. 2009, Baltimore: The Johns Hopkins University Press. This is the 2nd edition of the classic textbook of curriculum development for medical educators.

  10. Bloom BS, Englehart MB, Furst EJ, et al. Taxonomy of educational objectives: the classification of educational goals. Handbook I: the cognitive domain. New York: Longman; 1956.

    Google Scholar 

  11. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:S63–7.

    Article  PubMed  CAS  Google Scholar 

  12. Prevalence and most common causes of disability among adults—United States, 2005. Morbidity and Mortal Weekly Report 58: 421–26

  13. Schappert S, Rechtsteiner E. Ambulatory medical care utilization estimates for 2007. in Vital Health Statistics, National Center for Health Statistics. 2011

  14. Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001;83-A:1317–20.

    PubMed  CAS  Google Scholar 

  15. National Health Interview Survey. Available at http://www.cdc.gov/nchs/nhis.htm. Accessed April 2011

  16. Curtiss Jr PH. Undergraduate education in the musculo-skeletal system. Clin Orthop Relat Res. 1971;75:140–5.

    Article  PubMed  Google Scholar 

  17. Goldenberg DL, Mason JH, De Horatius R, et al. Rheumatology education in United States medical school. Arthritis Rheum. 1981;24:1561–6.

    Article  PubMed  CAS  Google Scholar 

  18. DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003;85-A:565–7.

    PubMed  Google Scholar 

  19. Clawson DK, Jackson DW, Ostergaard DJ. It’s past time to reform the musculoskeletal curriculum. Acad Med. 2001;76:709–10.

    Article  PubMed  CAS  Google Scholar 

  20. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am. 1998;80:1421–7.

    PubMed  CAS  Google Scholar 

  21. Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am. 2002;84-A:604–8.

    PubMed  Google Scholar 

  22. 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. 2007;82:452–7.

    Article  PubMed  Google Scholar 

  23. Lynch JR, Gardner GC, Parsons RR. Musculoskeletal workload versus musculoskeletal clinical confidence among primary care physicians in rural practice. Am J Orthop (Belle Mead NJ). 2005;34:487–91. discussion 491–482.

    Google Scholar 

  24. Schmale GA. More evidence of educational inadequacies in musculoskeletal medicine. Clin Orthop Relat Res. 2005; 251–59

  25. 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. 2006;88:1589–95.

    Article  PubMed  Google Scholar 

  26. Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005;87:310–4.

    Article  PubMed  Google Scholar 

  27. Simpson EJ. The classification of educational objectives in the psychomotor domain. Washington: Gryphon House; 1972.

    Google Scholar 

  28. Woolf AD, Walsh NE, Akesson K. Global core recommendations for a musculoskeletal undergraduate curriculum. Ann Rheum Dis. 2004;63:517–24.

    Article  PubMed  CAS  Google Scholar 

  29. Boyer MI. Objectives of undergraduate medical education in musculoskeletal surgery and medicine. J Bone Joint Surg Am. 2005;87:684–5.

    Article  PubMed  Google Scholar 

  30. Coady D, Walker D, Kay L. Regional Examination of the Musculoskeletal System (REMS): a core set of clinical skills for medical students. Rheumatology (Oxford). 2004;43:633–9.

    Article  CAS  Google Scholar 

  31. Doherty M, Dacre J, Dieppe P, Snaith M. The ‘GALS’ locomotor screen. Ann Rheum Dis. 1992;51:1165–9.

    Article  PubMed  CAS  Google Scholar 

  32. Samuelson Jr CO, Cockayne TW, Williams HJ. Rheumatology. What should students know? Arthritis Rheum. 1979;22:290–3.

    Article  PubMed  Google Scholar 

  33. • Woolf AD, Akesson K. Primer. history and examination in the assessment of musculoskeletal problems. Nat Clin Pract Rheumatol. 2008; 4: 26–33. This recent review summarizes a number of recommendations for history and clinical examination skills suggested as basic competencies for physicians.

    Article  PubMed  Google Scholar 

  34. Wilson FC. Development of a musculoskeletal organ system curriculum. J Med Educ. 1973;48:928–33.

    PubMed  CAS  Google Scholar 

  35. Wilson FC, Esther RJ. Development and use of a second-year musculoskeletal organ-system curriculum: a 40-year experience. J Bone Joint Surg Am. 2010;92:e14.

    Article  PubMed  Google Scholar 

  36. Bilderback K, Eggerstedt J, Sadasivan KK, et al. Design and implementation of a system-based course in musculoskeletal medicine for medical students. J Bone Joint Surg Am. 2008;90:2292–300.

    Article  PubMed  Google Scholar 

  37. Day CS, Yu YR, Yeh AC, et al. Musculoskeletal preclinical medical school education: meeting an underserved need. J Bone Joint Surg Am. 2009;91:733–9.

    Article  PubMed  Google Scholar 

  38. Laskowski ER, Moutvic M, Smith J, et al. Integration of physical medicine and rehabilitation into a medical school curriculum: musculoskeletal evaluation and rehabilitation. Am J Phys Med Rehabil. 2000;79:551–7.

    Article  PubMed  CAS  Google Scholar 

  39. Saleh K, Messner R, Axtell S, et al. Development and evaluation of an integrated musculoskeletal disease course for medical students. J Bone Joint Surg Am. 2004;86-A:1653–8.

    PubMed  Google Scholar 

  40. de Jong Z, van Nies JA, Peters SW, et al. Interactive seminars or small group tutorials in preclinical medical education: results of a randomized controlled trial. BMC Med Educ. 2010;10:79.

    Article  PubMed  Google Scholar 

  41. Modica RF, Thundiyil JG, Chou C, et al. Teaching musculoskeletal physical diagnosis using a web-based tutorial and pathophysiology-focused cases. Med Educ Online. 2009;14:13.

    PubMed  Google Scholar 

  42. Vivekananda-Schmidt P, Lewis M, Hassell AB. Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students. Arthritis Rheum. 2005;53:764–71.

    Article  PubMed  Google Scholar 

  43. • Hull P, Chaudry A, Prasthofer A, Pattison G. Optimal sequencing of bedside teaching and computer-based learning: a randomised trial. Med Educ. 2009; 43: 108–12. This is a good example of well-designed study for comparing different educational methodologies.

    Article  PubMed  Google Scholar 

  44. Cook DA. The research we still are not doing: an agenda for the study of computer-based learning. Acad Med. 2005;80:541–8.

    Article  PubMed  Google Scholar 

  45. Connell KJ, Sinacore JM, Schmid FR, et al. Assessment of clinical competence of medical students by using standardized patients with musculoskeletal problems. Arthritis Rheum. 1993;36:394–400.

    Article  PubMed  CAS  Google Scholar 

  46. Gruppen LD, Branch VK, Laing TJ. The use of trained patient educators with rheumatoid arthritis to teach medical students. Arthritis Care Res. 1996;9:302–8.

    Article  PubMed  CAS  Google Scholar 

  47. Smith MD, Henry-Edwards S, Shanahan EM, Ahern MJ. Evaluation of patient partners in the teaching of the musculoskeletal examination. J Rheumatol. 2000;27:1533–7.

    PubMed  CAS  Google Scholar 

  48. Schrieber L, Hendry GD, Hunter D. Musculoskeletal examination teaching in rheumatoid arthritis education: trained patient educators compared to nonspecialist doctors. J Rheumatol. 2000;27:1531–2.

    PubMed  CAS  Google Scholar 

  49. Raj N, Badcock LJ, Brown GA, et al. Undergraduate musculoskeletal examination teaching by trained patient educators—a comparison with doctor-led teaching. Rheumatology (Oxford). 2006;45:1404–8.

    Article  CAS  Google Scholar 

  50. Kogan JR, Holmboe ES, Hauer KE. Tools for direct observation and assessment of clinical skills of medical trainees: a systematic review. JAMA. 2009;302:1316–26.

    Article  PubMed  CAS  Google Scholar 

  51. Mini-CEX direct observation assessment tool. Available at http://www.abim.org/pdf/paper-tools/mini-cex.pdf. Accessed May 2011

  52. Basu S, Roberts C, Newble DI, Snaith M. Competence in the musculoskeletal system: assessing the progression of knowledge through an undergraduate medical course. Med Educ. 2004;38:1253–60.

    Article  PubMed  Google Scholar 

  53. Constructing written test questions for the basic and clinical sciences. 2002, National Board of Medical Examiners: Philadelphia

  54. Fournier JP, Demeester A, Charlin B. Script concordance tests: guidelines for construction. BMC Med Inform Decis Mak. 2008;8:18.

    Article  PubMed  Google Scholar 

  55. Raj N, Badcock LJ, Brown GA, et al. Design and validation of 2 objective structured clinical examination stations to assess core undergraduate examination skills of the hand and knee. J Rheumatol. 2007;34:421–4.

    PubMed  Google Scholar 

  56. • Yudkowsky R, Otaki J, Lowenstein T, et al. A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Med Educ. 2009; 43: 729–40. This study presents a method for teaching and assessing higher-level diagnostic examination skills.

    Article  PubMed  Google Scholar 

  57. Day CS, Ahn CS, Yeh AC, Tabrizi S. Early assessment of a new integrated preclinical musculoskeletal curriculum at a medical school. Am J Orthop (Belle Mead NJ). 2011;40:14–8.

    Google Scholar 

  58. Coady DA, Walker DJ, Kay LJ. Teaching medical students musculoskeletal examination skills: identifying barriers to learning and ways of overcoming them. Scand J Rheumatol. 2004;33:47–51.

    Article  PubMed  CAS  Google Scholar 

  59. Day CS, Ahn CS. Commentary: the importance of musculoskeletal medicine and anatomy in medical education. Acad Med. 85: 401–02

  60. Day CS, Ahn CS. Commentary: the importance of musculoskeletal medicine and anatomy in medical education. Acad Med. 2010;85:401–2.

    Article  PubMed  Google Scholar 

  61. Bernstein J, Alonso DR, DiCaprio M, et al. Curricular reform in musculoskeletal medicine: needs, opportunities, and solutions. Clin Orthop Relat Res. 2003; 302–08

  62. Mayer RS, Baima J, Bloch R, et al. Musculoskeletal education for medical students. Am J Phys Med Rehabil. 2009;88:791–7.

    Article  PubMed  Google Scholar 

  63. Lee FJ, Anderson JR. Does learning a complex task have to be complex? A study in learning decomposition. Cogn Psychol. 2001;42:267–316.

    Article  PubMed  CAS  Google Scholar 

  64. Rosen J, Chang L, Brown JD, et al. Minimally invasive surgery task decomposition–etymology of endoscopic suturing. Stud Health Technol Inform. 2003;94:295–301.

    PubMed  Google Scholar 

  65. Reid M, Whiteside D, Elliott B. Effect of skill decomposition on racket and ball kinematics of the elite junior tennis serve. Sports Biomech. 2010;9:296–303.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to gratefully acknowledge the Medical Education Scholars Program from the Department of Medical Education at the University of Michigan Medical School, in which all four authors have participated. SUM would also like to acknowledge the American College of Rheumatology Research and Education Clinician Scholar Educator Award, which provides funding for her educational research.

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No conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Taubman Center SPC 5358, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA

    Seetha U. Monrad

  2. Departments of Orthopaedic Surgery, Emergency Medicine, and Medical Education, University of Michigan Medical School, Ann Arbor, MI, USA

    John L. Zeller

  3. Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI, USA

    Clifford L. Craig

  4. Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA

    Lisa A. DiPonio

Authors
  1. Seetha U. Monrad
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  2. John L. Zeller
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  3. Clifford L. Craig
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  4. Lisa A. DiPonio
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Correspondence to Seetha U. Monrad.

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Monrad, S.U., Zeller, J.L., Craig, C.L. et al. Musculoskeletal education in US medical schools: lessons from the past and suggestions for the future. Curr Rev Musculoskelet Med 4, 91–98 (2011). https://doi.org/10.1007/s12178-011-9083-x

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