Educating Medical Students in Musculoskeletal Surgery and Medicine—How to Get a Course Up and Running at Your Institution

Abstract

Approximately 15% to 30% of visits to primary care physicians in the United States and Canada1, 20% of emergency room visits in the U.S.2, and 20% of nonroutine pediatric visits to physicians in Europe3 are for the purpose of addressing musculoskeletal complaints and injuries. In 2004, the National Ambulatory Medical Care Survey indicated that musculoskeletal conditions composed the number-one reason for visits to physicians’ offices, with approximately 92.1 million visits reported annually4. Two years later, in 2006, the Centers for Disease Control and Prevention (CDC) reported that an estimated 7.9 million (15%) of the 53.3 million surgical and nonsurgical procedures performed during visits for ambulatory surgery in the U.S. were related to the musculoskeletal system, a percentage that is second only to that of procedures related to the digestive system (27%)5. With the current system of managed care and the prevalence of musculoskeletal disease, knowledge of musculoskeletal medicine must not only be mastered by specialists but should also be well understood by practitioners across a wide range of fields, including internal medicine, family practice, emergency medicine, pediatrics, and surgery. Nevertheless, relatively little attention is devoted to musculoskeletal medicine in most medical school curricula. Of the 122 medical schools in the U.S. in 2003, fewer than 50% required preclinical courses in musculoskeletal medicine, fewer than 25% required a clinical course in that subject area, and nearly 50% had no required course, preclinical or clinical6. In 2005, the Association of American Medical Colleges (AAMC) published a report highlighting this deficiency as part of its Medical School Objectives Project. In this report, entitled “Contemporary Issues in Medicine: Musculoskeletal Medicine Education,” the AAMC stated that “Medical schools may not be accomplishing this educational goal (i.e., preparing doctors to care for patients with musculoskeletal …