Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum.
BACKGROUND
Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend.


OBJECTIVE
The purposes of this study were: (1) to assess the presence and duration of required or selective instruction in a MSK medicine specialty within the clinical years of undergraduate medical education; and (2) to assess the current state of requirements of clinical clerkships or rotations in other surgical and nonsurgical fields for comparison with the initial findings.


METHODS
The web sites of all 141 US medical schools were assessed to determine the content of their clinical curricula for the 2014-2015 academic year; five were excluded because they had not yet had a graduating class by the conclusion of the 2014-2015 academic year. Complete information on required rotations was obtained through the schools' web sites for all 136 (100%) medical schools. For selective experience during the surgery clerkships, complete information was available for 130 of the remaining 136 (96%) web sites.


RESULTS
Mean (in weeks, ± SD) duration of core clerkships were as follows: internal medicine (10 ± 2), surgery (8 ± 2), pediatrics (7 ± 1), obstetrics/gynecology (6 ± 1), and psychiatry (5 ± 1). Other common required clerkships were: family medicine (required in 96% [131 of 136] of schools, mean duration of 6 ± 2 weeks), neurology (81% [110], 4 ± 1), and emergency medicine (55% [75], 3 ± 1). Required MSK instruction, at a mean of 2 ± 1 weeks, was only present in 15% (20 of 136) of medical schools. In addition, clinical MSK instruction was offered as a selective (eg, students pick from a selection of subspecialties such as orthopaedics, plastics, or urology during a general surgery clerkship) in 34% (44 of 130) of all medical schools. This is less than other non-core specialties: geriatrics/ambulatory care (required in 40% [54 of 136] of schools, mean duration of 3 ± 1 weeks), critical care (30% [41], mean of 3 ± 1 weeks), radiology (26% [35], mean of 3 ± 1 weeks), anesthesiology (23% [31], mean of 2 ± 1 weeks), and other surgical subspecialties (19% [26], mean of 3 ± 1weeks).


CONCLUSIONS
Traditional core clerkships continue to be well represented in the clinical years, whereas three newer specialties have gained a larger presence: family medicine, neurology, and emergency medicine; these comprise the "big eight" of clinical clerkships. Given the high prevalence and burden of MSK disorders, required experience in MSK medicine continues to be underrepresented. Further discussion at a national level is needed to determine appropriate representation of MSK medicine specialties during the clinical years.
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA. Benedict_DiGiovanni@urmc.rochester.edu.
Benedict F
BF
DiGiovanni
Office of Medical Student Education, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
Leigh T
LT
Sundem
Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
Richard D
RD
Southgate
Office of Medical Student Education, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
David R
DR
Lambert
D002982:Clinical Clerkship; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D019637:Orthopedic Procedures / Q000193:education*; D009985:Orthopedics / Q000193:education*; D012577:Schools, Medical; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods*; D013997:Time Factors; D014481:United States