Medical training Related to Musculoskeletal Treatment Inadequate

Posted on 2010-01-24 08:16:49

Medical Training Related to Musculoskeletal Conditions is Inadequate

ChiroACCESS Editorial Staff

The article was written by the combined efforts of the ChiroACCESS editorial staff.
Published on January 6, 2010

Low Back Pain
From Harvard Medical School in the U.S. to medical schools in Europe, medical education related to musculoskeletal conditions is inadequate. A 2009 survey tested physician’s knowledge related to simple low back pain management. The average survey score of family practitioners was 69.7 and the average score of orthopedists was far less at 44.3. Orthopedists were less likely to make the proper radiological referral and appropriate pharmacological prescription based upon the literature.

Another 2009 study from the U.K. found that only 13% of the junior doctors felt they had adequate musculoskeletal medical training. Research from the University of Washington found that less than 50% for the fourth-year student interns were competent in the area of musculoskeletal medicine. A 2007 study of Harvard medical students found that they were not confident in management of musculoskeletal cases and failed to demonstrate cognitive mastery. The study concluded that “These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field.”

The current failure of modern medicine worldwide to adequately train physicians and the continually growing problems like low back pain creates a window of opportunity for the chiropractic profession.

Orthopaedists' and family practitioners' knowledge of simple low back pain management.
Spine (Phila Pa 1976). 2009 Jul 1;34(15):1600-3.

Finestone AS, Raveh A, Mirovsky Y, Lahad A, Milgrom C.
Department of Orthopaedics, Assaf HaRofeh Medical Center, Zeriffin, Israel. asff@inter.net.il

STUDY DESIGN: Comparative knowledge survey.
OBJECTIVE: This study compared the knowledge of orthopaedic surgeons and family practitioners in managing simple low back pain (LBP) with reference to currently published guidelines.

SUMMARY OF BACKGROUND DATA: LBP is the most prevalent of musculoskeletal conditions. It affects nearly everyone at some point in time and about 4% to 33% of the population at any given point. Treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians' knowledge of the guidelines.

METHODS: Orthopedic surgeons and family practitioners participating in their annual professional meetings were requested to answer a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain.

RESULTS: One hundred forty family practitioners and 253 orthopaedists responded to the questionnaire. The mean family practitioners' score (69.7) was significantly higher than the orthopaedists' score (44.3) (P < 0.0001). No relation was found between the results and physician demographic factors, including seniority. Most orthopaedists incorrectly responded that they would send their patients for radiologic evaluations. They would also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs, despite the guidelines recommendations to use paracetamol or nonspecific nonsteroidal anti-inflammatory drugs. Significantly less importance was attributed to patient encouragement and reassurance by the orthopaedists as compared with family physicians.

CONCLUSION: Both orthopaedic surgeons' and family physicians' knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.

The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.

J Bone Joint Surg Br. 2009 Nov;91(11):1413-8.

Al-Nammari SS, James BK, Ramachandran M.
Department of Trauma & Orthopaedics, 2nd Floor, John Harrison House, The Royal London Hospital, Whitechapel Road, London E1 1BB, UK.

The aim of this study was to determine whether the foundation programme for junior doctors, implemented across the United Kingdom in 2005, provides adequate training in musculoskeletal medicine. We recruited 112 doctors on completion of their foundation programme and assessed them using the Freedman and Bernstein musculoskeletal examination tool. Only 8.9% passed the assessment. Those with exposure to orthopaedics, with a career interest in orthopaedics, and who felt that they had gained adequate exposure to musculoskeletal medicine obtained significantly higher scores. Those interested in general practice as a career obtained significantly lower scores. Only 15% had any exposure to orthopaedics during the foundation programme and only 13% felt they had adequate exposure to musculoskeletal medicine. The foundation programme currently provides inadequate training in musculoskeletal medicine. The quality and quantity of exposure to musculoskeletal medicine during the foundation programme must be improved.

Competence in evidence-based medicine of senior medical students following a clinically integrated training programme.

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