Musculoskeletal education in undergraduate medical curricula–A systematic review

Abstract

Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results.Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required.

Inadequacies in Undergraduate Musculoskeletal Education - A Survey of Nationally Accredited Allopathic Medical Programs in Canada

“…Data illustrated that only four topics-carpal tunnel syndrome, septic joint, osteoarthritis, and rheumatoid arthritis-were "covered" or "covered in detail" by all accredited programs, while common MSK injuries and diseases such as fractures of child abuse, hip dysplasia, hip fractures, and osteoporosis were "not addressed" within the MSK curricula of some programs. These findings illustrate the inadequacies in MSK education that have been previously reported 20,25 and are in agreement with data recently published for California medical schools, which indicated that large variations exist in the detail with which MSK "core or must-know topics" were covered. These results have important implications for national accrediting bodies such as the AAMC (American Association of Medical Colleges) and AFMC, as well as the preclinical curriculum leaders and MSK course directors at individual institutions.…”

“…26 Despite the fact that MSK injuries and diseases are among the most common conditions that physicians encounter during their daily practice, 1,2 as well as research that clearly documents that medical residents and practicing physicians lack adequate knowledge, confidence, and clinical skills when practicing MSK medicine, [10][11][12] our results highlight the educational inadequacies and inconsistencies that exist across nationally accredited medical programs. 25 These findings amplify the results of earlier investigations, which reported that despite the increased presence of MSK coursework in preclinical training, only a very small percentage of preclinical curricular time is specifically dedicated to topics related to MSK medicine. 5,6,9,20 Thus, it would appear that Bernstein et al,'s (2011) statement, "now that musculoskeletal medicine is taught explicitly at most (US) schools, the enduring challenge is to ensure that it always is taught well," is still applicable to many medical programs.…”

“…Again, these findings are consistent with a previous study of California medical schools that showed significant variation in the time each program allotted for MSK preclinical learning (mean = 58.7 hrs, range = 6–150) 26 . Despite the fact that MSK injuries and diseases are among the most common conditions that physicians encounter during their daily practice, 1,2 as well as research that clearly documents that medical residents and practicing physicians lack adequate knowledge, confidence, and clinical skills when practicing MSK medicine, 10–12 our results highlight the educational inadequacies and inconsistencies that exist across nationally accredited medical programs 25 . These findings amplify the results of earlier investigations, which reported that despite the increased presence of MSK coursework in preclinical training, only a very small percentage of preclinical curricular time is specifically dedicated to topics related to MSK medicine 5,6,9,20 .…”

“…4,5,9,10,24 Although the curricula of North American medical programs are regularly scrutinized through stringent national accreditation processes, a recent systematic review of 1128 articles published on topics related to MSK education in medical schools between 2012 and 2021 found that only 44 articles met the Mixed Methods Appraisal Tool criteria used within the systematic review. 25 In fact, the vast majority of publications on the topic of MSK education simply provide institution-specific data, and over the last decade, only three publications have detailed and compared the MSK curricular data across a large number of nationally accredited medical programs. 9,20,26 Consequently, there is currently a lack of data available to help address curricular inadequacies and guide the development and adoption of curricular standards in the area of MSK medicine within nationally accredited medical programs.…”

“…Despite increased awareness and ongoing initiatives designed to improve physician training in the area of MSK medicine, 5,8,21–23 there remain many barriers for learning and knowledge retention in the discipline 4,5,9,10,24 . Although the curricula of North American medical programs are regularly scrutinized through stringent national accreditation processes, a recent systematic review of 1128 articles published on topics related to MSK education in medical schools between 2012 and 2021 found that only 44 articles met the Mixed Methods Appraisal Tool criteria used within the systematic review 25 . In fact, the vast majority of publications on the topic of MSK education simply provide institution-specific data, and over the last decade, only three publications have detailed and compared the MSK curricular data across a large number of nationally accredited medical programs 9,20,26 .…”