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The Inadequacy of Musculoskeletal Knowledge in Graduating Medical Students in the United Kingdom

Al-Nammari, Shafic Said MBChB, MSc(Oxon), FRCS(Tr&Orth)1; Pengas, Ioannis MBChB, MPhil, MD, FRCS(Tr&Orth)2; Asopa, Vipin MBBS, PhD, FRCS(Tr&Orth)3; Jawad, Ali4; Rafferty, Michael MBBS, MRCS5; Ramachandran, Manoj BSc(Hons), MBBS(Hons), FRCS(Tr&Orth)1

doi: 10.2106/JBJS.N.00488
Topics in Training

Background: Musculoskeletal symptoms are common reasons for patients seeking medical attention. Basic competency in musculoskeletal medicine is therefore essential for all clinicians. To our knowledge, this is the first assessment of the competency in musculoskeletal medicine of medical students in the United Kingdom.

Methods: Medical students were enrolled after passing final university examinations and being awarded degrees of Bachelor of Medicine, Bachelor of Surgery (MBBS) or Medicinae Baccalaureus, Baccalaureus Chirurgiae (MBChB) in 2013 and were assessed with use of the Freedman and Bernstein musculoskeletal cognitive examination tool.

Results: Two hundred and thirty students were recruited, of whom 210 were suitable for inclusion. Only 21% (forty-four students) passed the assessment. Mandatory exposure to musculoskeletal medicine during medical school consisted of orthopaedics for 100% of participants for a mean duration of 2.65 weeks, rheumatology for 96% of participants for a mean duration of 2.5 weeks, and sports medicine for 1% of participants for a mean duration of two weeks. There was a significant difference (p = 0.002) in scores between those with career interests in musculoskeletal specialties (69.3%) and the rest of the cohort (54.9%). There was also a significant difference (p = 0.001) in scores between participants with career interests in general practice (42%) and the rest of the cohort (56%). Only 40% of participants considered themselves competent in musculoskeletal medicine. Fifty-five percent thought that musculoskeletal conditions would be an important component of their future practice.

Conclusions: Our findings suggest that medical schools may be currently failing to ensure that medical students have a basic competence in musculoskeletal medicine. Further investigation is warranted to fully assess the current training provided by U.K. medical schools in musculoskeletal medicine, and appropriate steps must be taken to improve the quantity and quality of training in musculoskeletal medicine in the United Kingdom.

1Centre for Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1BB, United Kingdom. E-mail address for S.S. Al-Nammari:

2The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, United Kingdom

3St. Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom

4Barts and The London School of Medicine and Dentistry, Turner Street, London E1 2AD, United Kingdom

5University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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