Freedman K B, Bernstein J
University of Pennsylvania School of Medicine, Philadelphia, USA.
J Bone Joint Surg Am. 1998 Oct;80(10):1421-7. doi: 10.2106/00004623-199810000-00003.
A basic familiarity with musculoskeletal disorders is essential for all medical school graduates. The purpose of the current study was to test a group of recent medical school graduates on basic topics in musculoskeletal medicine in order to assess the adequacy of their preparation in this area. A basic-competency examination in musculoskeletal medicine was developed and validated. The examination was sent to all 157 chairpersons of orthopaedic residency programs in the United States, who were asked to rate each question for importance and to suggest a passing score. To assess the criterion validity, the examination was administered to eight chief residents in orthopaedic surgery. The study population comprised all eighty-five residents who were in their first postgraduate year at our institution; the examination was administered on their first day of residency. One hundred and twenty-four (81 per cent) of the 154 orthopaedic residency-program chairpersons who received the survey responded to it. The chairpersons rated twenty-four of the twenty-five questions as at least important. The mean passing score (and standard deviation) that they recommended for the assessment of basic competency was 73.1 +/- 6.8 per cent. The mean score for the eight orthopaedic chief residents was 98.5 +/- 1.07 per cent, and that for the eighty-five residents in their first postgraduate year was 59.6 +/- 12 per cent. Seventy (82 per cent) of the eighty-five residents failed to demonstrate basic competency on the examination according to the chairpersons' criterion. The residents who had taken an elective course in orthopaedic surgery in medical school scored higher on the examination (mean score, 68.4 per cent) than did those who had taken only a required course in orthopaedic surgery (mean score, 57.9 per cent) and those who had taken no rotation in orthopaedic surgery (mean score, 55.9 per cent) (p = 0.005 and p = 0.001, respectively). In summary, seventy (82 per cent) of eighty-five medical school graduates failed a valid musculoskeletal competency examination. We therefore believe that medical school preparation in musculoskeletal medicine is inadequate.
所有医学院毕业生都必须对肌肉骨骼疾病有基本的了解。本研究的目的是对一组近期医学院毕业生进行肌肉骨骼医学基础主题的测试，以评估他们在该领域的准备是否充分。开发并验证了一项肌肉骨骼医学基础能力考试。该考试被发送给美国所有157名骨科住院医师培训项目的主任，要求他们对每个问题的重要性进行评分，并建议一个及格分数。为了评估标准效度，该考试对八名骨科外科总住院医师进行了测试。研究人群包括在我们机构完成第一年研究生学业的所有八十五名住院医师；考试在他们住院的第一天进行。收到调查的154名骨科住院医师培训项目主任中有124名（81%）回复了调查。主任们将25个问题中的24个评为至少重要。他们推荐用于评估基本能力的平均及格分数（及标准差）为73.1±6.8%。八名骨科总住院医师的平均分数为98.5±1.07%，而八十五名第一年研究生住院医师的平均分数为59.6±12%。根据主任们的标准，八十五名住院医师中有七十名（82%）在考试中未能证明具备基本能力。在医学院选修过骨科手术课程的住院医师在考试中的得分（平均分数为68.4%）高于仅上过骨科手术必修课的住院医师（平均分数为57.9%）和未参加过骨科手术轮转的住院医师（平均分数为55.9%）（p值分别为0.005和0.001）。总之，八十五名医学院毕业生中有七十名（82%）未能通过有效的肌肉骨骼能力考试。因此，我们认为医学院在肌肉骨骼医学方面的准备不足。
