Curricular Requirements for Musculoskeletal Medicine in American Medical Schools

A fundamental knowledge of the musculoskeletal system and its disorders is necessary for most practicing physicians, regardless of their specialty. Disorders of the musculoskeletal system are the primary reason that individuals seek medical attention in the United States 1,2. Nonetheless, there is evidence that medical students are not well prepared in this area. Freedman and Bernstein 3 administered a basic-competency examination comprising twenty-five questions on musculoskeletal medicine to a group of eighty-five recent medical school graduates. The examination was validated by 124 chairmen of orthopaedic departments, and a passing grade of 73.1% was set. With use of this criterion, 82% were found to have failed the examination. The examination was further validated by the directors of medical residency programs, and a comparable passing score was set 4. Moreover, Clawson et al. 5 surveyed 5487 second-year residents in United States allopathic and osteopathic residency programs and found that many considered themselves ill-prepared in the area of musculoskeletal medicine. On the basis of these reports, it is reasonable to believe that medical students in the United States are not receiving the instruction in musculoskeletal medicine that they need. We hypothesized that if preparation in musculoskeletal medicine is indeed inadequate, a lack of required curricular time devoted to these subjects may be the cause. Therefore, we assessed the extent to which American medical schools require either a preclinical course in musculoskeletal medicine or a clinical clerkship in a related field, namely, orthopaedic surgery, rheumatology, or physiatry (physical medicine and rehabilitation). Curriculum data were obtained from the 122 medical schools in the continental United States and Hawaii. The American Association of Medical Colleges web site, www.aamc.org, provided links to the web sites of all medical schools in the United States. Data were obtained directly from curriculum information published on the …