Most medical residents failed to demonstrate even basic competency in musculoskeletal medicine, according to a study published in the April 2002 Journal of Bone and Joint Surgery.

Kevin B. Freedman, M.D., MSCE, and Joseph Bernstein, M.D., MS, gave a basic competency test to 85 residents on their first day of residency at the University of Pennsylvania School of Medicine.

The investigators had validated the examination by surveying 124 orthopaedic program directors who reviewed the test, rated the importance of individual questions, and established a minimum passing score.

Before drawing a final conclusion, however, the researchers recognized that orthopaedic surgeons may not be the best group to validate such an examination because (1) orthopaedic surgeons provide only a small proportion of musculoskeletal care and thus may not perceive what is important to the non-orthopaedic practitioner, and (2) orthopaedic surgeons may overemphasize conditions requiring surgery.

Therefore, the investigators sent the competency examination to all 417 program directors of internal medicine departments in the United States. Using instructions identical to those given to the orthopaedic program directors, the 240 internal medicine directors who responded were asked to rate the importance of each question and to suggest a passing score.

The investigators then compared the responses of the orthopaedic directors to those of the internal medicine directors. The orthopaedic program directors suggested a minimum passing score of 73.1 percent; the internal medicine program directors proposed 70.0 percent as the passing score. Interestingly, the comparison of the ratings of the questions revealed that the weights assigned by the two groups were similar.

Based on the criteria established by the orthopaedic program directors, 82 percent of the test group failed to demonstrate basic competency in musculoskeletal medicine. According to the standards set by the internal medicine program directors, 78 percent failed to exhibit basic competency in this field.

The researchers concluded that medical school preparation in musculoskeletal medicine is inadequate and that using a second set of criteria from internal medicine directors further validated the findings of the initial studies with orthopaedic program directors.

The average amount of time spent in courses or programs in medical schools dedicated to orthopaedics was only 2.1 weeks for all the residents taking the examination. Freedman and Bernstein suggest that the two weeks of instruction is probably inadequate and that the time may not be spent in an efficient way. They noted that many orthopaedic directors place too much emphasis on surgical therapies for more complex disorders.