MUSCULOSKELETAL MEDICINE EDUCATION: A SURVEY OF CANADIAN MEDICAL PROGRAMMES

Despite the large burden of disease associated with musculoskeletal (MSK) injuries & disorders, a considerable body of evidence suggests that physician training in the area of MSK medicine has historically been either absent or insufficient. In fact, North American data suggests that only a very small amount of curricular time (~3%) within medical schools is actually spent educating students on topics related to MSK medicine3–6. Not surprisingly, post-graduate investigations indicate that many physicians lack adequate confidence, knowledge, and clinical skills when practicing MSK medicine. The purpose of this investigation was to document the current state of musculoskeletal medicine education in Canadian undergraduate medical programs in order to identify variations in programming and potential shortcomings. All 14 English-speaking AFMC-accredited Canadian medical schools were surveyed using a questionnaire adopted from the work of Wang et al5, and Pinney & Reagan10. The questionnaire included 34 questions that were divided into three themes: 1). MSK anatomy teaching (twelve questions); 2). Preclinical MSK curriculum (sixteen questions); and 3). Clinical MSK education (six questions). The survey had a 100% response rate. Results indicated that the mean time spent educating medical students about MSK anatomy was 30.2 hours (SD ±14.2, range 12 – 60), with all but one program using some form of cadaveric-based instruction to support their anatomy curriculum. Thirteen programs reported teaching radiological correlates (x-ray, CT, MRI), and 11 programs included MSK surface land marking and/or palpation as part of program delivery. Preclinical students spent an average of 58.0 hours (SD ±53.4, range 6 – 204) learning about topics related to MSK medicine. Preclinical curricula were most commonly delivered by orthopaedic surgeons, rheumatologists, or physiatrists using case-based and small group learning sessions, didactic lectures and self-study activities. MSK courses included a diverse range of topics, but the extent to which each curriculum focused on “core” or “must know” MSK pathologies (eg. osteoarthritis) or injuries (eg. ankle sprain) varied widely across the 14 programs. The mean time spent teaching MSK clinical assessment skills during preclinical training was 12.6 hours (SD ±9.7, range: 3 – 40). Only 50% of medical programs required a clinical rotation in orthopaedic surgery as part of clerkship education, and this rotation was most commonly two weeks in duration. No schools required clinical rotations in either rheumatology or physical medicine & rehabilitation. This investigation quantifies the large variation in structure and content of MSK instruction among Canadian undergraduate medical programs, and highlights the need for expanded MSK learning opportunities during the clerkship portion of medical student training. Our results also highlight the need for enhanced interdisciplinary collaboration between MSK-focused physician groups when delivering the MSK curricula, as well as the identification and adoption of a standardized set of MSK course learning objectives or core topics that would be taught by all AFMC-accredited Canadian medical programs.