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Musculoskeletal Education: MDs Still Fail the Test

By Michael Devitt

In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."

Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

Musculoskeletal Education Exam Results, 1998 vs. 2005
Category 1998 Exam 2005 Exam
# of participants 85 residents (7 orthopedic, 61 medical, 17 surgical) 113 medical students, 167 residents, 54 staff physicians
Average score 59.6% (overall)
74.1% (orthopedic residents)
58.4% (medical residents)
58.1% (surgical residents)
56.9% (overall)
48.8% (medical students)
58.1% (residents)
70.4% (staff physicians)
% earning at least a passing grade 17.6% 20.7%

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.


  1. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.
  2. Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.

Written by Michael Devitt, senior associate editor of MPA Media.

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