AAOS Bulletin - August, 2006

Project 100 and musculoskeletal education: An update

By Carolyn Rogers

Musculoskeletal conditions and injuries currently account for more than 100 million visits to physicians each year, according to Musculoskeletal Conditions in the United States. As the U.S. population ages, the prevalence of musculoskeletal conditions is increasing and will continue to increase over time. In light of this, there is a growing concern that U.S. physicians are ill-equipped to properly diagnose and treat the many millions of patients afflicted with musculoskeletal problems.

In fact, a recent series of studies found that four out of five first-year medical residents fail to demonstrate a basic competency in musculoskeletal medicine.

To ensure that U.S. medical students receive the education and training they need, the AAOS, the U.S. Bone and Joint Decade (USBJD) and other musculoskeletal health organizations have undertaken a number of projects, such as Project 100.

Project 100

Project 100 is a USBJD-sponsored initiative to improve medical school education in musculoskeletal medicine and develop a mandate for a required curriculum. The project is a collaborative effort among organizations participating in the Decade. The goal is to have 100 percent of American medical schools offering a required course in musculoskeletal medicine by 2012.

According to Joseph Bernstein, MD, director of Project 100, fewer than half of the country’s medical schools currently have any required musculoskeletal coursework.

“If the care of musculoskeletal disease is to improve, as we hope, improving medical school education will be a necessary milestone,” says Dr. Bernstein. “With the growing burden of musculoskeletal disease in an aging population, it is essential that we raise the profile of medical school education in this discipline.”

100 percent endorse the Decade

To serve as the foundation of Project 100, the USBJD asked that all U.S. medical schools sign a declaration of support, stating, “This Medical School recognizes the importance of musculoskeletal diseases and the disability caused by these conditions in our society. We support the goals and objectives of the U.S. Bone and Joint Decade, and declare our commitment to advance education, research and patient care for bone and joint diseases.”

As of March 2, 2006, the deans (or vice deans for education) of all 125 U.S. medical schools have signed the declaration of support. Visit online for the list of participating schools.

AAMC report

The past fall, the Association of American Medical Colleges (AAMC) released recommendations to all medical schools on the attitudes, knowledge and skills that all graduating medical students should possess in musculoskeletal medicine.

The report supports the efforts of Project 100. The expert panel that authored this report strongly recommends the integration of musculoskeletal medicine throughout the medical school curriculum.

Following are the leading recommendations for learning objectives to instill the appropriate attitudes, knowledge and skills related to musculoskeletal medicine. The full report contains specific learning objectives in each category.

Attitudes: First and foremost, medical schools most foster an appreciation for the complex effects musculoskeletal conditions have on patients.

Knowledge: Students should be knowledgeable about the clinical manifestations, pathology and pathophysiology of the common musculoskeletal conditions.

Skills: Medical students must be able to conduct a musculoskeletal physical exam, be capable of identifying common musculoskeletal diseases and conditions and be able to initiate appropriate treatment for these patients.

“We are delighted with these new recommendations,” says Nancy E. Lane, MD, president of the USBJD.

“The ultimate goal of Project 100 is to improve the care of patients with musculoskeletal conditions,” says Dr. Bernstein. “The objectives and education strategies articulated by the AAMC report will help make certain that students will be prepared for that important work.”

The challenge now is for medical schools to adopt the AAMC guidelines. To view the full report online

National Board of Examiners

The USBJD has worked with the National Board of Medical Examiners (NBME) to update the data bank of musculoskeletal questions for the Step 2 exams.

The NBME has also agreed to issue a Musculoskeletal Subject Test, underwritten by the USBJD. A multidisciplinary panel, working with the USBJD, selected the questions in April; the test will be released this fall. The test writers expect the test to drive curriculum content in musculoskeletal medicine for all four years of medical school. The goal is to achieve an annual number of 1,000 tests taken per year, within three years.

Musculoskeletal Medicine

In collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians, the AAOS has published Musculoskeletal Medicine— the first-ever musculoskeletal textbook designed specifically for medical schools and residency programs. More than 15 medical schools are now using the book as part of their curriculum.

For more information on the book, visit online; the AAOS is offering volume discounts for classroom adoption.

Musculoskeletal Educators Group

The USBJD’s Project 100 committee is now turning its attention to the development of a Musculoskeletal Educators Group. A program of workshops with a faculty of experienced musculoskeletal educators will teach best practices to professors providing or planning to teach courses in musculoskeletal medicine.


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