The Current State of Musculoskeletal Education and Orthopaedic Surgery Exposure in US Allopathic Medical Schools

Background: Musculoskeletal (MSK) disorders are among the most prevalent conditions affecting adults aged 18 years or older, with growing healthcare impact as populations' age. Ensuring adequate medical student training in MSK diagnosis and management is critical. Previous studies indicate deficits in MSK education by allopathic medical schools, with Association of American Medical College and American Orthopaedic Association outlining needs for drastic improvement. Despite these calls, major gaps persist in MSK curricula compared with non-MSK fields. This study cross-sectionally evaluated all US allopathic medical school curricula, quantifying preclinical MSK education and orthopaedic clinical clerkship opportunities. Methods: Using a novel applied AI workflow protocol with structured outputs for unbiased analysis, websites of all 158 accredited US allopathic medical schools were analyzed for 2023 to 2024 clinical curricula content. One school was excluded for lacking an inaugural class. Complete preclinical curricula information was examined for all 158 schools. Required rotation data were obtained for 153 of 157 schools (96.8%). All websites underwent manual auditing for accuracy confirmation. Results: Among analyzed schools, 80.89% (127/157) referenced MSK curricula. The mean preclinical MSK education duration was 6.14 ± 3.25 weeks (range: 1-15 weeks). Only 14.01% (22/157) referenced isolated MSK curricula averaging 4.25 ± 1.69 weeks (range: 1-6 weeks). Strong primary care emphasis was found in 67 of 157 schools (42.67%). Family medicine was required in 151 of 152 schools (99.32%). Other noncore specialties showed higher core curricula involvement: geriatrics/ambulatory care in 46 of 152 (30%), critical care in 34 of 152 (22.36%), and anesthesiology in 24 of 152 (15.79%). Orthopaedics appeared in only 7/ of 152 curricula (4.6%). Conclusion: Despite high MSK disorder frequency, disease burden, and national recommendations for improved education, clinical experiences in MSK specialties such as orthopaedics remain underrepresented. Current “big eight” core clerkships include 5 traditional rotations of internal medicine, surgery, pediatrics, obstetrics and gynecology, and psychiatry plus family medicine, neurology, and emergency medicine. National dialog and refocus of US allopathic medical schools is warranted to address MSK education challenges and establish appropriate MSK education and orthopaedic exposure levels.