Academic journal article Bulletin of the World Health Organization

Improved Education in Musculoskeletal Conditions Is Necessary for All Doctors

Academic journal article Bulletin of the World Health Organization

Improved Education in Musculoskeletal Conditions Is Necessary for All Doctors

Article excerpt

Abstract It is likely that everyone will, at some time, suffer from a problem related to the musculoskeletal system, ranging from a very common problem such as osteoarthritis or back pain to severely disabling limb trauma or rheumatoid arthritis. Many musculoskeletal problems are chronic conditions. The most common symptoms are pain and disability, with an impact not only on individuals' quality of life but also, importantly, on people's ability to earn a living and be independent. It has been estimated that one in four consultations in primary care is caused by problems of the musculoskeletal system and that these conditions may account for up to 60% of all disability pensions. In contrast, teaching at undergraduate and graduate levels--and the resulting competence and confidence of many doctors--do not reflect the impact of these conditions on individuals and society. Many medical students do not have any clinical training in assessing patients with bone and joint problems. Under the umbrella of the Bone and Joint Decade 2000-2010, experts from all parts of the world with an interest in teaching have developed recommendations for an undergraduate curriculum to improve the teaching of musculoskeletal conditions in medical schools. The goal for each medical school should be a course in musculoskeletal medicine concentrating on clinical assessment, common outpatient musculoskeletal problems and recognition of emergencies. Improving competency in the management of musculoskeletal problems within primary care settings through improved education is the next aim, but there are needs for improvement for all professionals and at all levels within the health care system.

Keywords Musculoskeletal diseases; Education, Medical, Undergraduate/standards; Education, Medical, Graduate/standards; Education, Medical, Continuing; Curriculum/standards; Clinical competence/standards (source: MeSH/NLM)

Mots cles Appareil locomoteur, Maladies; Enseignement medical premier cycle/normes; Enseignement preparatoire diplome medical (USA)/normes; Enseignement medical post-universitaire; Programme etudes/normes; Competence clinique/normes (source: MESH, INSERM)

Palabras clave Enfermedades musculoesqueleticas; Educacion de pregrado en medicina/normas; Educacion de postgrado en medicina/normas; Educacion medica continua; Curriculum/normas; Competencia clinica/normas (fuente: DeCS, BIREME).

Voir page 681 le resume en francais. En la pagina 681 figura un resumen en espanol.


Musculoskeletal conditions are common and consume enormous social and health care resources. The direct costs are only a quarter of the indirect costs, which comprise sick leave, sick pensions, early retirement and the inability to support oneself. The consequences of this inability may be even more serious in developing countries. Worldwide, up to 15 million injured persons survive road traffic accidents, most of whom will suffer sequelae of musculoskeletal trauma.

Patients with complaints about bones and joints are often ignored and their problems underestimated by doctors. This is partly a reflection of inadequate education at undergraduate level and partly the result of the common notion that we all have to live with aches and pains and there is nothing that can be done about them. Today, however, new treatment options are available that can improve the patient's functioning and diminish the pain.

Surveys show that undergraduate medical students spend very few hours on the musculoskeletal system, both in basic science and in clinical training (1, 2). It would be considered negligent for a medical graduate to be incompetent at adequately assessing the heart or lungs, yet it is quite common for students to leave medical school without being able to make a general assessment of the musculoskeletal system. Furthermore, training in orthopaedics and rheumatology are rarely mandatory in systems with rotating internships or in family practice training programmes, despite the large number of patients treated by doctors in these programmes (3). …

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