Effect of Shortened Preclinical Curriculum on Medical Student Musculoskeletal Knowledge and Confidence: An Institutional Survey

Abstract

Musculoskeletal education is underrepresented in American medical school curricula, and many medical schools have recently shifted toward a condensed preclinical period. Given that musculoskeletal diseases represent a large and growing social and economic burden, it is imperative that medical students be properly prepared to care for patients with musculoskeletal disorders, regardless of intended specialty. A survey was sent to all medical students enrolled full-time at our institution during the 2018 to 2019 academic year. First year students had not yet received musculoskeletal instruction, second-year students had completed a shortened musculoskeletal curriculum of 49 total hours, and third- and fourth-year respondents had completed a longer 78 hour musculoskeletal curriculum. Respondents were asked to rank their confidence in their musculoskeletal knowledge, their interest in orthopaedics, followed by the well-validated Freedman and Bernstein musculoskeletal knowledge assessment and a demographics section asking had respondents completed an orthopaedic surgery clinical rotation, if they had other clinical orthopaedic experience, class year, intended clinical specialty, and gender. There were 179 responses to the survey, comprising 53 first-year, 54 second-year, and 72 third- and fourth-year students. The longer musculoskeletal curriculum was associated with significantly improved performance compared to the shorter musculoskeletal curriculum (p < 0.0001). Completion of a clinical orthopedics rotation was associated with significantly improved performance than not completing a rotation (p < 0.001), regardless of if non-rotators had other orthopedic experience (p = 0.001) or if they did not (p < 0.001). There was no difference in score (p = 0.94) or musculoskeletal knowledge confidence (p = 0.09) between males and females. Intending to pursue orthopedics was associated with significantly higher scores (p < 0.001) and significantly higher confidence (p = 0.02). As shortening preclinical musculoskeletal curricula worsens musculoskeletal performance, medical schools should consider requiring orthopedic clinical rotations to maintain musculoskeletal competency of graduates.