title: Impact of clinical electives and residency interest on medical students' education in musculoskeletal medicine.
abstract: BACKGROUND
  Despite the frequency of musculoskeletal conditions seen in a broad spectrum of medical practice, there is compelling evidence that medical schools are inadequately preparing students in this field. We compared medical students across all residency interests with respect to their clinical confidence, cognitive mastery, and perception of education in musculoskeletal medicine.
  
  
  METHODS
  A cross-sectional survey study of third and fourth-year students at Harvard Medical School was conducted during the 2005-2006 academic year. Two hundred and forty-nine of 337 students completed the survey, yielding an overall response rate of 74%. All participants were asked to complete a nationally validated objective examination in musculoskeletal medicine and a thirty-question survey soliciting their top residency choice, all of the musculoskeletal electives that they had taken, their clinical confidence, and their attitudes toward musculoskeletal education.
  
  
  RESULTS
  Residency interest significantly affected the third-year students' performance on the cognitive mastery examination (p = 0.018) and also significantly affected both the third and the fourth-year students' clinical confidence in their ability to perform an examination of the musculoskeletal system (p = 0.023 and p = 0.015, respectively). The students' perception of the importance of musculoskeletal medicine, regardless of their residency interest, correlated with their decision to take musculoskeletal clinical electives (p = 0.009 and p < 0.001 for third and fourth-year students, respectively). Perceived importance was also correlated with higher clinical confidence for third-year students (p = 0.043) and increased examination scores for fourth-year students (p < 0.001). However, only students who listed orthopaedic surgery as their top residency choice demonstrated cognitive mastery in musculoskeletal medicine and reported above-average clinical confidence in their ability to conduct an examination of the musculoskeletal system.
  
  
  CONCLUSIONS
  Students' residency interest and their perception of the importance of musculoskeletal medicine to their future career influence the education that they receive in this field. In particular, students interested in non-orthopaedic residencies failed to demonstrate cognitive mastery and lacked clinical confidence. Possible approaches for medical schools to tackle this important issue that merit further exploration include requiring additional time for education in musculoskeletal medicine and providing a more structured musculoskeletal curriculum.
authors.affiliation: Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Orthopedic Surgery, 330 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Yeh
authors.forename: Orrin
authors.initials: O
authors.lastname: Franko
authors.forename: Charles S
authors.initials: CS
authors.lastname: Day
mesh_terms: D002321:Career Choice; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D006801:Humans; D007396:Internship and Residency; D009985:Orthopedics