In 1998 Drs. Friedman and Bernstein, two professors from the University of Pennsylvania medical school, published about their efforts to evaluate musculoskeletal competency1. They constructed a 25-question quiz on musculoskeletal medicine to evaluate competency in this area. They sent the quiz to 128 medical schools in the USA where it was validated by chairpersons of Internal Medicine or Orthopedics. These chairpersons set a passing score of 73.1% saying new grads should be able to at least pass this quiz (get a low C or high D – typically the letter grade for a score of 73.1%). The two professors then administered the validated quiz to doctors in their first year of post graduate training – first year residents (in previous years known as interns). 82% of them failed.
The professors were dumbfounded and next looked at the curricula in these schools. They found that 48.6% of them didn’t even have one hour dedicated to musculoskeletal medicine in four years of medical school2.
Seven years later, Dr. Elizabeth Matzkin and three of her colleagues administered the same quiz – now called a “Cognitive Skills Exam” versus a “Competency Exam” – to 334 staff physicians, residents and recent medical school graduates3. 79% of them failed it. After seven years not much had changed for the better.
In a study conducted in Great Britain, physical therapists were pretty much equal to orthopedists in the evaluation and management of musculoskeletal issues but generated lower costs4. Same outcomes for less money! In the USA this is particularly problematic because it means less money for the healthcare systems and their bloated bureaucracy and over compensated administrators and managers.
When I asked a physician friend at dinner several years ago how much training in musculoskeletal medicine did, he get in medical school or as a resident, he replied “none”.
So, when you have a knee, shoulder or back pain, who do you want to see?
1 Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Joint Surg Am. 1998;80:1421-7.
2 Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg Am. 2002;84:604-8.
3 THE JOURNAL OF BONE & JOINT SURGERY · JBJS.ORG VOLUME 87-A · NUMBER 2 · FEBRUARY 2005
4 J Epidemiol Community Health 1999;53:643–650) ADEQUACY OF EDUCATION IN MUSCULOSKELETAL MEDICINE
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West Lafayette, Indiana 47906