Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice

Abstract

Background Musculoskeletal Women's Health (MSK WH) is a niche subspecialty within physical medicine & rehabilitation (PM&R). Women make up 50.7% of the population of the United States but are burdened with higher rates of musculoskeletal disease compared to men. MSK WH topics are not included in PM&R or Primary Care Accreditation Council for Graduate Medical Education (ACGME) program requirements. Given the comprehensive training provided in PM&R, physiatrists are ideal candidates to diagnose, treat, and provide education on MSK WH conditions. Objective To identify the prevalence of formalized MSK WH education and of WH physiatrists at ACGME‐accredited PM&R residency programs. Design Cross‐sectional survey design. Setting Computer‐based survey. Participants ACGME‐accredited residency programs (N = 86; as of February 2017). Methods A single, multiple choice, computer‐generated Research Electronic Data Capture (REDCap) survey with branching logic was sent to all ACGME‐accredited PM&R residency programs (N = 86). Outcomes The primary outcome was to assess the prevalence of women's health curricula at ACGME‐accredited PM&R residency programs in the United States. The secondary outcome was to assess the prevalence of WH physiatrists at these programs. Results Eighty‐six ACGME‐accredited PM&R residency programs were contacted with 55 completed responses (64% response rate). Only six programs (11%) reported the presence of a formal WH curriculum at their residency program. In contrast, 25 programs (45%) reported having WH physiatrists at their institutions, and 36 programs (65%) reported that general physiatrists were providing WH‐related care. Conclusions The study findings identify a mismatch between the prevalence of MSK WH residency education (11% of programs) and the prevalence of physiatrists providing MSK WH care (66% of programs). Physiatrists are ideally suited to manage MSK WH care. Based on the findings of this cross‐sectional study, residency programs and governing bodies should evaluate these trends and consider the addition of topics pertinent to women's musculoskeletal health into PM&R graduate medical education. Level of Evidence III.

Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health

“…More than 60% of PM&R programs already have at least one physiatrist on staff providing women's musculoskeletal health care, although only 38% of PM&R residents reported being able to identify a local provider. 16 If these women's musculoskeletal health physiatrists were more closely allied with resident education, they could provide high-quality teaching on women's musculoskeletal health topics and provide supervised clinical experiences. For programs that do not have these subspecialized physiatrists on staff or in the local community, they may face additional challenges that are likely best addressed through national support, such as through professional continuing education endeavors.…”

“…The study topics were chosen based on anecdotal practice patterns by women's musculoskeletal health practitioners that were consistent with recent national committee consensus on overall sports medicine guidelines for PM&R residents 16,17 . These topics were used in the prior survey previously mentioned 16 .…”

“…Four demographic questions included postgraduate year (PGY), sex assigned at birth, gender identity, and location of program coded based on Doximity Residency Navigator assigned regions (Midwest, Northeast, South, and West) 20 . Eight women's musculoskeletal health questions included six questions on PM&R residents' perspectives and two questions on field‐specific curricular topics and learning formats (Appendix A) 16 . The questions on residents' perspectives were developed through research team discussion and asked about comfort with patient care, importance of field, desire for formal curriculum, desire for more exposure, awareness of local provider, and interest in future practice involving women's musculoskeletal health.…”

“…A prior survey of PM&R program directors revealed that very few programs formally teach women's musculoskeletal health and it remains unknown whether or not PM&R residents feel adequately prepared for caring for this patient population. 16 To better understand the experiences of PM&R residents and to address this knowledge gap, we surveyed residents for their perspectives of the field, their exposure to formal education on women's musculoskeletal health, and their interest in a future practice that includes women's musculoskeletal health.…”

“…Women's musculoskeletal health is an emerging subspeciality within physiatry that considers female sex‐ and gender‐based differences in musculoskeletal injury and treatment approaches. Although there are no published clinical guidelines on what constitute women's musculoskeletal health, based on sports medicine training guidelines and the authors' experiences, women's musculoskeletal health encompasses three major unique clinical categories: (1) care that accounts for female biochemical and neuromuscular sexual dimorphism in musculoskeletal injury, (2) complex pelvic girdle and pelvic floor concerns, and (3) pregnancy and postpartum‐related musculoskeletal issues 16,17 . Given the prevalence of the conditions that fall under these categories, many providers would benefit from the opportunity to refer their patients to women's rehabilitation–focused physiatrists.…”