| Summary: | Injuries and diseases of the musculoskeletal system account for more than
20% of patient visits to, and comprise one of the greatest competency needs among
primary care medical practitioners. However, each phase of the medical
education process typically fails to provide student physicians and interns with
adequate knowledge and skill training in this area. Most primary care physicians
receive no clinical undergraduate or postgraduate training in musculoskeletal
disorders and, those that do, are commonly rated as possessing inadequate
cognitive and manual skills by their program supervisors. Available elective
training in musculoskeletal injuries and diseases is commonly taught by hospital-affiliated
physicians and surgeons, but this teaching case-load is typically skewed
toward 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 potential explanation for this is that the diagnostic coding systems
commonly used in primary care medical practice are incomplete and imprecise
with respect to musculoskeletal diagnoses. Morbidity statistics based on such
codes can not be relied upon for an accurate needs assessment of the common
disorders seen in clinical practice. As a result, data obtained using these codes
cannot be used to define the competencies required by primary care physicians.
To address this disparity, the purpose of this thesis was to develop a new
curriculum for musculoskeletal disorders. The curriculum's content was selected
using a competency based curriculum planning technique. Physicians from the
disciplines of sports medicine, family medicine, orthopedic surgery, physical
medicine and rheumatology (n=20 in each group) were surveyed with respect to
the most common musculoskeletal conditions they encountered in their clinical practice.
The 20 most common musculoskeletal problems selected by the five groups
of practitioners were used to develop two forms of learning objective curricula.
The first curriculum included terminal and enabling learning objectives grouped
around a particular clinical problem. The enabling objectives were subdivided
into knowledge, skill and attitude sections. The second curriculum involved a
more traditional content knowledge approach, with each disorder being
presented as a clinical scenario followed by detailed learning objectives
regarding essential anatomy of the region, regional physical examination,
specific physical findings, diagnosis, treatment, associated disorders and a brief
selection of references. Also, five musculoskeletal disorders which communicate
important principles in musculoskeletal medicine were presented in a similar
fashion.
The content of the curriculum was validated using an expert validity
survey, and consensus outcome measures. Both documented that the curriculum
content was valid, and a useful addition to the medical education process.
It is concluded that these curricula are a first step toward correcting the
disparity between the burden of musculoskeletal problems seen in primary care
medical practice, and the current competency requirements of the medical
education process. Mastery of these learning objectives will enable the physician
to competently deal with common musculoskeletal problems.
Key Words: Musculoskeletal disorders, medical education, curricula, competency === Education, Faculty of === Kinesiology, School of === Graduate
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