Inadequacies of musculoskeletal medicine curriculum for undergraduate medical students: a cross-sectional study

ABSTRACT BACKGROUND: Musculoskeletal disorders account for up to one in four of general-practice consultations and almost one third of complaints in primary-care clinical practice. However, an insufficient amount of time and importance is given to their teaching in most medical schools. OBJECTIVE: To evaluate the acquisition of musculoskeletal competences in our institution, in order to identify flaws and propose changes to correct and improve the musculoskeletal curriculum. DESIGN AND SETTING: Cross-sectional study conducted in São Paulo, Brazil. METHODS: First to fifth-year medical students were enrolled in a survey using the Freedman and Bernstein musculoskeletal examination, in order to evaluate the acquisition of musculoskeletal competencies. Categorical data were analyzed using the chi-square test. Continuous data were analyzed using one-way analysis of variance (ANOVA). The level of significance was set as P < 0.05. RESULTS: A total of 545 students completed the questionnaire: from year 2, 115/167 (29.6%); from year 3, 118/138 (30.4%); from year 4, 98/130 (25.3%); and from year 5, 57/110 (14.7%). None of the students achieved the pass mark (established as 70%). The level of confidence in performing musculoskeletal examination was very low (3.7 ± 2.2; n = 386) and bore no relationship to the percentage of correct answers in the questionnaire (r = 0.331; 95% confidence interval, CI: 0.239-0.417; P < 0.001). CONCLUSION: Undergraduate teaching is the only exposure most general practitioners have to orthopedic problems. Universities are concerned about the adequacy of the musculoskeletal programs taught in their institutions. Student scores were found to be unsatisfactory in all the topics evaluated.

Evaluación de percepción de conocimientos y destrezas de alumnos de medicina en traumatología y ortopedia / Evaluation of students perception of knowledge and skills in orthopedics

Objectives: To evaluate student’s opinion about the knowledge and skills acquired during their graduate training. To evaluate the level of completion of the minimal required objectives assessed by the Medical National Exam (EUNACOM). Materials and Methods: Prospective research. descriptive and transversal. 152 final year medical students, from 3 different Universities (U1, U2 and U3), answered an anonymous and voluntary questionnaire. Inclusion criteria: Final year medical students who had completed their orthopedics rotation. The questionnaire evaluated 4 areas of knowledge and skills. General clinical conditions; emergency consultations; laboratory and radiologic exam interpretations; and clinical procedures. On each areas, the student, could consider themselves well prepared or unprepared. University programs were analyzed and evaluated, according to the completion of the objectives indicated by EUNACOM. Results: Percentage of students who considered themselves well prepared versus unprepared (WP vs UP): general clinical conditions: WP = 63.15 percent vs UP = 36.85 percent; emergency consultations: WP = 61.05 percent vs UP = 38.95 percent; interpretations of laboratory and radiologic exams: WP = 63.66 percent vs UP = 36.34percent; clinical procedures: WP = 21.50 percent vs UP = 78.05 percent. Regarding the University programs, a maximum potential score of 185 points was possible, U1 obtained 68 points; U2, 74 points and U3, 131 points. Conclusion: A high percentage of students feel they don’t have the knowledge and skills required in Orthopedics. Programs accomplish only partially the orthopaedic objectives assessed by EUNACOM.

Objetivos: Evaluar la opinión de los alumnos sobre los conocimientos y destrezas adquiridas en ortopedia y traumatología durante su formación de pregrado. Evaluar si los programas universitarios de pregrado cumplen con los perfiles del Examen Único Nacional de Conocimientos en Medicina (EUNACOM). Material y Métodos: Estudio prospectivo, descriptivo transversal. Se encuestaron en forma anónima y voluntaria a 152 internos de séptimo año de medicina de tres universidades de la Región Metropolitana (U1, U2 y U3). Criterios de inclusión: Internos de medicina de séptimo año con rotaciones completas en ortopedia y traumatología. La encuesta evalúa cuatro áreas de conocimientos y destrezas: patologías clínicas generales, patología de urgencia, interpretaciones de exámenes de laboratorio e imagenología y realización de procedimientos. En cada área el alumno puede considerarse bien preparado o mal preparado. Se realizó un análisis y revisión comparativa de los programas universitarios, asignándoles un puntaje de acuerdo a los perfiles descritos por el EUNACOM. Resultados: Porcentaje de alumnos que se consideraron bien preparados versus mal preparados (BP vs MP): patologías clínicas generales: BP 63,15 por ciento vs MP 36,85 por ciento; patología de urgencia: BP 61,05 por ciento vs MP 38,95 por ciento; interpretación de exámenes de laboratorio e imagenología: BP 63,66 por ciento vs MP 36,34 por ciento; realización de procedimientos: BP 21,50 por ciento vs MP 78,05 por ciento. Respecto a los programas universitarios de un total posible de 186puntos, U1 obtuvo 68, U2 74 y U3 131. Conclusiones: Un alto porcentaje de los alumnos de pregrado no se siente bien preparado en Ortopedia y Traumatología. Los programas sólo cumplen parcialmente con los perfiles EUNACOM.