Early musculoskeletal classroom education confers little advantage to medical student knowledge and competency in the absence of clinical experiences: a retrospective comparison study

Derek Khorsand,Gregory A Schmale,Ansab Khwaja

doi:10.1186/s12909-018-1157-7

Abstract

BackgroundDeficiencies in medical student knowledge in musculoskeletal medicine have been well documented. To address these deficiencies, numerous curricular changes at our institution were instituted. The objective of this study was to determine whether medical students in their preclinical years benefit from early exposure to musculoskeletal medicine when compared to students exposed to musculoskeletal medicine just prior to completion of their preclinical curriculum.MethodsUnited States Medical Licensing Examination (USMLE) Step 1 and 2 scores were compared for periods of time before and after institution of the new curriculum. Scores on the previously validated 24-question short answer survey from Freedman and Bernstein were also compared over these same periods of time between these two groups and to established standards for competency, using a student’s two-tailed unpaired t-test for significance. Entering Medical College Admission Test (MCAT) scores were used to compare baseline preparation of students.ResultsOverall USMLE scores as well as scores on the USMLE subtest on Musculoskeletal, Skin and Connective Tissue Disease showed no improvement when scores were compared between the two groups of students. There was a statistically significant lower performance on the Freedman and Bernstein knowledge assessment exam for students in the new pre-clinical curriculum as compared to those introduced under the old model, considering both musculoskeletal knowledge (p < 0.001) and proficiency (p < 0.01), though the response rate on the recent survey was low (112/986 or 11%). Spine remained the least understood sub-topic, while a dedicated course in rheumatology likely contributed to increased student knowledge in that area. Additional exposure to musculoskeletal topics during the clinical years increased student knowledge. There was no difference between groups when comparing entering MCAT scores.ConclusionsClassroom curricular changes, including moving the introductory musculoskeletal course to the first year, intended to optimize musculoskeletal medicine education in the pre-clinical years of medical school did not appear to improve student musculoskeletal knowledge at any year of training. Further efforts to improve the education of medical students in musculoskeletal medicine should be directed towards providing more clinical experiences with patients having musculoskeletal concerns. This was a retrospective comparative study, level III evidence.

Highlights

Deficiencies in medical student knowledge in musculoskeletal medicine have been well documented
We examined the results of curricular changes instituted between 2005 and 2010 on student musculoskeletal knowledge and subject proficiency, with the hope and expectation that these changes would result in an improvement in student understanding in musculoskeletal medicine
0.2 standard deviations above to 0.2 standard deviations below the national average. These recent scores were perhaps slightly lower than scores ten years earlier (2001-2003), when our mean scores were greater than the national averages on five of six Step 1 and Step 2 United States Medical Licensing Examination (USMLE) subtests, including the Musculoskeletal, Skin, and Connective Tissue Diseases subtest of the Step 2 USMLE, where scores were above the national average by 0.1 – 0.3 standard deviations

Summary

Introduction

Deficiencies in medical student knowledge in musculoskeletal medicine have been well documented. Successful musculoskeletal medicine pre-clinical courses have typically included a mix of two or more instructional formats, with frequent framing of common problems using clinical scenarios, in small group settings led by clinicians, typically preceded by an anatomy course studying the spine and extremities [27, 28], or have included musculoskeletal anatomy instruction reinforced by review of common and pertinent clinical correlations [18, 20, 29,30,31] This latter description best matches our curriculum. USMLE Board exams were taken at the end of the second year (Step 1) and after completion of required clerkships - during the fourth year (Step 2)

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