Study follow-up confirms original conclusion: Musculoskeletal prep in med school inadequate

Study follow-up confirms original conclusion: Musculoskeletal prep in med school inadequate

In our January 12, 1999 issue,1 we reported on a study2 by MDs Kevin Freedman and Joseph Bernstein that found 82 percent of 85 first-year medical and surgical residents at the University of Pennsylvania School of Medicine “failed to demonstrate basic competency in musculoskeletal medicine,” based on a written examination rated by 124 orthopedic program directors. After the study was published, Drs. Freedman and Bernstein, recognizing that orthopedic surgeons offer only a small percentage of specialized musculoskeletal care, wondered if they shouldn’t have had the written exam rated by a different group of providers.

To add further objectivity to their previous study, Freedman and Bernstein completed a follow-up study’ designed to evaluate if program directors of internal medicine residency departments would similarly rate the importance of the individual questions, and as designate a similar required passing score on the examination.

The original 25 exam questions given to the 85 medical school graduates and the group of orthopedic program directors were mailed to all 417 internal medicine program directors in the U.S. The directors were asked to rate the importance of the questions, and suggest a passing score for medical graduates taking the examination (without having knowledge of the test results).

Of the 58 percent of the internal medicine program directors who responded to the exam questionnaire, an average passing score of 70 percent was suggested for the examination; the orthopedic program directors in the first study had suggested a 73-percent passing grade for the exam. The mean score of the examinees, however, was only 59.6 percent. Thus, based on the internal medicine department directors’ new suggested passing grade, 78 percent of the examinees were judged to lack “basic competency” on the musculoskeletal exam, compared to the original 82-percent failure rate based on the scale of the orthopedic directors.

A large percentage of medical students may be unable to show basic competency in musculoskeletal medicine upon graduation, according to the authors of the study. They warn. “It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.”


1. Med grads flunk musculoskeletal exam: 82% failed to demonstrate basic competency. DC Jan. 12, 1999. www.

2. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone and Joint Surg, SOA: 1421-1427. Oct. 1998.

3. Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. The Journal of Bone and Joint Surgery 2002:84-A(4), pp. 604-608.

Copyright Dynamic Chiropractic Jun 3, 2002

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