February 1999 Bulletin

Med students flunk musculoskeletal test

Eighty-two percent of graduates from 37 different medical schools failed a valid musculoskeletal competency examination, showing the inadequacy of preparation in musculosketelal medicine.

Kevin B. Freedman, MD, resident, orthopaedic surgery, University of Pennsylvania Health Systems, Philadelphia; and Joseph Bernstein, MD, assistant professor, orthopaedic surgery, University of Pennsylvania Health Systems, co-authors of a study presented at Academy's 1999 Annual Meeting, also found that increased instruction time in medical school on orthopaedic rotations was associated with better performance on the examination. The authors concluded that "medical school preparation in musculoskeletal medicine is inadequate, probably on the basis of inadequate instruction time and content."

A 25-question test, "Basic Competency Examination in Musculoskeletal Medicine," was developed. To establish content validity, the examination was sent to all orthopaedic residency program chairmen in the United States, who were asked to rate each question on the exam for importance on a visual analogue scale, and to suggest a "passing score." To assess criterion validity, the examination was administered to eight chief residents in orthopaedic surgery.

The study population comprised all PGY-1 residents at University of Pennsylvania, who were administered the examination on their first day of residency. These doctors were graduates of 37 different medical schools.

Eighty percent of the orthopaedic chairmen responded to the survey, and rated 24 of the 25 questions as 'important.' Their passing score for basic competence was 73.1 percent. The mean score on the examination of the eight orthopaedic chief residents was 98.5 percent. The mean score on the examination for the 85 PGY- 1 residents was 59.6 percent. Seventy of the PGY- 1 residents (82 percent) failed to demonstrate basic competency on the examination, by the chairmen's criteria.

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