Training and clinical competency in musculoskeletal medicine. Identifying the problem.

Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care and emergency medical practitioners. However, less than 3% of the pre-clinical medical school curriculum is devoted to teaching all aspects of musculoskeletal disease, and only 12% of medical schools require mandatory training in musculoskeletal medicine during the clinical years of undergraduate medical education in Canada. Available elective training in musculoskeletal injuries and diseases is commonly taught by hospital-affiliated physicians and surgeons, with the result that this teaching case load is typically skewed towards serious and/or surgical problems. The disparity between the clinical competence required for musculoskeletal problems in clinical practice and the content and format of medical education has not yet been addressed by changes in medical school curricula. One of the reasons for this is that the available morbidity statistics, which provide data regarding the frequency of specific musculoskeletal diagnoses, are based on diagnostic codes which are imprecise and incomplete. This prohibits the accurate selection of course content in this area, which is among the first steps in the development of a curriculum.