Two patients present to the sports medicine clinic with shoulder pain and limited range of motion. A 51-year-old healthy female rower presents 5 months after developing left shoulder pain. She had no specific inciting injury, although she increased overhead workouts with dumbbells prior to the onset of pain. She describes soreness that started in the left biceps and then shifted to the lateral shoulder. The other patient, a 61-year-old male golfer with a history of hyperlipidemia and hypertension, developed right shoulder pain also after increasing overhead exercises with weights 3 months prior to presentation. His pain is most significant with sleeping on the right side, abducting the right arm, and lifting heavy objects. Both patients have limited shoulder flexion, abduction, and internal rotation despite 8 weeks of physical therapy.

Background and Objectives: Musculoskeletal (MSK) concerns constitute up to 40% of primary care outpatient visits. Despite Accreditation Council for Graduate Medical Education (ACGME) family medicine program requirements for musculoskeletal medicine and sports medicine training, previous studies have shown that family medicine residency graduates do not have adequate training to manage common musculoskeletal conditions. Factors for this may include deficiencies in education at both the undergraduate and graduate medical education training levels. Methods: A Council of Academic Family Medicine Educational Research Alliance survey of 287 family medicine program directors assessed the current state of the delivery of musculoskeletal medicine education. Opinions were gathered on the scope and delivery of training requirements as well as potential areas for further curricular attention. Results: Two hundred eighty-seven program directors responded to the survey (response rate 41.53%). Most (72.60%) were in university based or affiliated programs and had a fellowship-trained primary care sports medicine physician (59.85%) curricular lead. A majority (77.4%) did not feel that PGY-1 residents enter residency with the physical exam skills needed to evaluate common musculoskeletal (MSK) conditions , and most (81.15%) did not feel that there should be changes to the current ACGME requirements. An area highlighted for further investment is faculty development in point-of-care ultrasound (39.85%). Conclusions: Although program directors believe that current ACGME MSK curricular requirements are likely appropriate, they do not feel residents arrive with the examination skills needed to evaluate common MSK conditions.Therefore, further attention can be given to medical student education in musculoskeletal exam skills prior to residency. Future research should develop objective measures using multiple assessors—students, residents, teaching faculty, and patients—to assess both the baseline and graduating competency in MSK medicine of our residents.