The Current State of Musculoskeletal Clinical Skills Teaching for Preclerkship Medical Students

Objective. Musculoskeletal (MSK) complaints have high prevalence in primary care practice (12%-20% of visits), yet many trainees and physicians identify themselves as weak in MSK physical examination (PE) skills. As recruitment to MSK specialties lags behind retirement rates, there is a shortage of physicians able to effectively teach this subject. We investigated current practices of Canadian undergraduate medical programs regarding the nature, amount, and Source of preclerkship MSK PE clinical skills teaching, and documented the frequency and extent that Patient Partners(C) in Arthritis (PP(R)IA) are used in this educational setting. Methods. A 2-page self-administered electronic questionnaire combining open- and close-ended questions was developed and piloted. It was distributed by e-mail to all Canadian undergraduate associate-deans and to 16/17 undergraduate MSK course organizers. Results. Supervised practice in small groups and the PP(R)IA are the most prevalent teaching methods. Objective structured clinical examinations are the most prevalent evaluation methods. The average number of hours devoted to teaching these skills is very small compared to the prevalence of MSK complaints in the population. Canadian schools' preclerkship MSK PE clinical skills teaching is heavily dependent on the contributions of non-MSK specialists. Conclusion. The weak link in the Canadian MSK PE educational cycle appears to be the amount of time available for students' deliberate practice with expert feedback. There is a need for methods to evaluate and further develop MSK PE teaching by non-MSK specialists. This and increased use of PP(R)IA at the preclerkship level may provide students more time for practice with feedback. (First Release Oct 15 2008; J Rheumatol 2008;35:2419-26; doi: 10.3899/jrheum.090308)