BACKGROUND AND PURPOSEDespite higher costs compared with dedicated primary care practice settings, the emergency department (ED) is used as a primary care site and serves as a point of entry into the health care system.1 Patients with musculoskeletal complaints comprise 15%-20% of ED visits per year.2 The National Hospital Ambulatory Medical Care Survey (NHAMCS) data show that 7,400 individuals are diagnosed annually in the ED with acute musculoskeletal injuries.1 More specifically, the NHAMCS found that musculoskeletal injuries categorized as acute sprains and strains ranked as the fourth most-common diagnosis among patients treated and discharged from the ED.1 Thus, it is imperative that physicians practicing in the ED setting are competent in the assessment and initial management of musculoskeletal injuries.Data suggest that musculoskeletal training of graduating medical students is not sufficient to prepare them for practice in an emergency practice setting,3-5 so it could be questioned whether students entering emergency medicine (EM) residencies are prepared for this component of practice. Numerous studies support the need for enhanced musculoskeletal education and training in medical school curricula.3-5 Based on a 2007 study at Harvard Medical School, medical students typically leave medical school with a poor musculoskeletal skill set, as only 7% of students were able to pass a musculoskeletal competency examination.4 A subsequent elective in musculoskeletal medicine resulted in greater confidence and enhanced their performance on the competency examination.4 A review of medical school curricula in the United States showed that approximately 50% of medical schools did not require a musculoskeletal clinical rotation, and fewer than 50% had a formal didactic course dedicated to musculoskeletal medicine. Furthermore, 82% of recent medical school graduates did not pass a musculoskeletal competency examination.3 Similarly, in a study assessing 29,442 medical students' performance on the United States Medical Licensing Examination Step 2 CS (clinical skills test), the physical examination scores for the musculoskeletal and neurological systems were lower than other clinical examinations involving the gastrointestinal, cardiovascular/pulmonary, andintegumentary systems.6Other health care providers have identified deficiencies in students' performance on a clinical musculoskeletal examination. A survey of Doctor of Osteopathy students entering a residency program indicated they were adequately trained to assess patients with musculoskeletal conditions.7 When 1,920 osteopathic medical students were surveyed to assess their perception of formalized training in diagnosing and treating patients with musculoskeletal pain, 26% indicated they were poorly prepared to perform a musculoskeletal physical examination on a patient with low back pain, and 60% indicated they were poorly prepared to assess foot pain.7 Pediatric residency graduates have noted that musculoskeletal injuries and their management are areas where they felt the most uncomfortable.8-12 A subsequent paper in the pediatric literature corroborated the poor musculoskeletal baseline skills.8 At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. Nine months following a teaching intervention, their clinical examinations skills improved: residents performed 67% of the ankle and 47% of the knee physical examination techniques correctly.8 Based on these studies and the lack of EM literature on the topic, EM residents may face similar challenges with musculoskeletal examination.One approach to expanding musculoskeletal examination and procedural skills in the medical school curriculum is through the expanded role of the physiatrist. Newcomer et al13 discussed the development of the physiatrists' role in the implementation of musculoskeletal physical examination in medical schools through teaching inspection, palpation, range of motion, and application of special tests. …