To the Editor:

I read with great interest the article “Musculoskeletal Preclinical Medical School Education: Meeting an Underserved Need” (1). As a recent osteopathic medical school graduate and current orthopaedic surgery intern, I contemplated whether or not osteopathic medical students received more musculoskeletal preclinical education when compared to their allopathic colleagues. After a brief literature search, I came across an article by Alan R. Stockard, DO, and Thomas Wesley Allen, DO, in the June 2006 issue of The Journal of the American Osteopathic Association(JOAO) entitled, “Competence Levels in Musculoskeletal Medicine: Comparison of Osteopathic and Allopathic Medical Graduates” (2).

Given the osteopathic medical profession's emphasis on the musculoskeletal system, one might assume that osteopathic graduates would have more knowledge of musculoskeletal medicine upon graduation. However, Stockard’s comparison demonstrated that graduating osteopathic students fared only slightly better than their allopathic counterparts. In fact, basic competence in musculoskeletal medicine was not demonstrated by either group(3).

I applaud Dr. Day and his colleagues at Harvard for their effort to expose the current shortcomings in musculoskeletal training. The integrated musculoskeletal curriculum should serve as a model for both osteopathic and allopathic medical educators.

The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of her immediate family, is affiliated or associated.

References

1. Day CS, Yu YR, Yeh AC, Newman LR, Arky R, Roberts DH. Musculoskeletal preclinical medical school education: meeting an underserved need. J Bone Joint Surg Am. 2009;91:733-39.

2. Stockard AR, Allen TW. Competence levels in musculoskeletal medicine: comparison of osteopathic and allopathic medical graduates. J Am Osteopath Assoc. 2006;106:350-5.

3. Ruane JJ. Competence levels in musculoskeletal medicine: a call to action. J Am Osteopath Assoc. 2007;107:197-8.

It is surprising to learn that a one-year Physician Assistants (PA) didactic program is dedicating more time to musculoskeletal (MSK) topics than two years of a Medical School's pre-clinical program. At our institution, we had allocated only 40 hours to MSK topics before our curriculum change, but even after a change in curriculum, our MSK pre-clinical curriculum time is only 52 hours,still well below the 80 hours at this PA program.

Perhaps the substantial emphasis on MSK teaching in the PA curriculum is a reflection of the percentage of MSK questions on the Physician Assistant National Certifying Examination - coming in just behind cardiovascular and pulmonary questions.

Hopefully, some of the data from our institution and recommendations from national organizations such as the AAMC will be taken into consideration in increasing the percentage of MSK questions on the United States Medical Licensing Examination (USMLE). An increased emphasis on MSK related topics by the USMLE may be the necessary catalyst to increase the time devoted to teaching an MSK curriculum at all medical schools.

To the Editor:

In the article, “Musculoskeletal Preclinical Medical School Education: Meeting an Underserved Need”(1),the authors quote figures from The Association of American Medical Colleges (AAMC) which state that the average time spent on musculoskeletal (MS) education in the pre-clinical years of in medical school is 65 hours(2). This led me to calculate the time we spend teaching topics related to the musculoskeletal system at our PA program at DeSales University (Center Valley, PA).

Over the course of our 12 month didactic phase, we we devote 80 hours to the musculoskeletal system. The subject matter is comprised of anatomy (36 hours), physical examination (12 hours), clinical skills (casting, diabetic foot examination, etc.) (8 hours), an orthopaedics section (12 hours), and a rheumatology section (12 hours). Therefore, we spend roughly 20% more time teaching MS topics in our single year pre-clinical phase than in the two years of medical school.

The importance of musculoskeletal education for PA's is also evidenced by the emphasis given it by the Physician Assistant National Certifying Examination (PANCE, the PA USMLE equivalent). Musculoskeletal topics constitute fully 10% of the examination, more than any other topic other than cardiovascular (16%) and pulmonary (12%) (3).

I thought this information would be of interest to your readers as we move forward to improve the education of our future health care providers.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

References

1. Day CS, Yu YR, Yeh AC, Newman LR, Arky R, Roberts DH. Musculoskeletal preclinical medical school education: meeting an underserved need. J Bone Joint Surg Am. 2009;91;733-9.

2. Association of American Medical Colleges. Curriculum directory course details: musculoskeletal. http://services.aams.org/currdir/section4/start.cfm. Accessed June 8, 2008.

3. National Commission of Certification of Physician Assistants. Exams: Content Blueprint. http://www.nccpa.net/EX_samplediseases.aspx?r=pance. Accessed March 11, 2009.