Musculoskeletal medicine: An assessment of the attitudes and knowledge of medical students at Harvard Medical School

back.jpg   From the May 2007 issue of Academic Medicine:

Day CS, Yeh AC, Franko O, Ramirez M, Krupat E. Musculoskeletal medicine: An assessment of the attitudes and knowledge of medical students at Harvard Medical School. Acad Med 2007; 82(5):452-457.

PURPOSE: To assess medical students’ knowledge and clinical confidence in musculoskeletal medicine as well as their attitudes toward the education they receive in this specialty.
METHOD: A cross-sectional survey of students in all four years of Harvard Medical School was conducted during the 2005-2006 academic year. Participants were asked to fill out a 30-question survey and a nationally validated basic competency exam in musculoskeletal medicine.

RESULTS: The response rate was 74% (449/608). Medical students rated musculoskeletal education to be of major importance (3.8/5) but rated the amount of curriculum time spent on musculoskeletal medicine as poor (2.1/5). Third-year students felt a low to adequate level of confidence in performing a musculoskeletal physical examination (2.7/5) and failed to demonstrate cognitive mastery in musculoskeletal medicine (passing rate on competency exam: 7%), whereas fourth-year students reported a similar level of confidence (2.7/5) and exhibited a higher passing rate (26%). Increasing exposure to the subject by taking clinical electives resulted in greater clinical confidence and enhanced performance on the exam (P < .001). Students’ feedback suggested that musculoskeletal education can be better integrated into the preclinical curriculum, more time should be spent in the field, and more focus should be placed on common clinical conditions.

CONCLUSIONS: These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field. Implementing a four-year integrated musculoskeletal curriculum is one way that medical schools can address this concern.

Notes: Dr Day is assistant professor in orthopedic surgery and director, Musculoskeletal Curriculum, Harvard Medical School, and chief, Orthopedic Hand Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts Mr Yeh is a fourth-year undergraduate, Harvard College, Cambridge, Massachusetts Mr Franko is a second-year medical student, Harvard Medical School, Boston, Massachusetts Mr Ramirez is a third-year medical student, Harvard Medical School, Boston, Massachusetts Dr Krupat is director of evaluation and associate professor of psychology, Center for Evaluation, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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