Musculoskeletal Preclinical Medical School Education: Meeting an Underserved Need ByCharles S. Day, MD, MBA, Yangyang R. Yu, BA, Albert C. Yeh, BA, Lori R. Newman, MEd, Ronald Arky, MD, and David H. Roberts, MD Musculoskeletal problems including both rheumatologic and orthopaedic pathologies are the primary reason for physician office visits across the United States, with approximately 92.1 million encounters reported annually, accord- ing to the 2004 National Ambulatory Medical Care Survey 1 . Despite the impact that musculoskeletal diseases have on society and the wide range of medical practitioners who treat these conditions, there is compelling evidence that undergraduate medical curricula do not adequately prepare physicians in musculoskeletal medicine 2-5 . In 2005, the Association of American Medical Colleges (AAMC) issued a Medical School Objectives Project Report on musculoskeletal medicine highlighting the need for medical schools to improve the education of future physicians in this area 6 . The report outlined educa- tional guidelines to establish a more coherent undergraduate musculoskele- tal curriculum. We conducted a study at our medical school during the 2005-2006 academic year that substantiated the need for improving the musculoskeletal curriculum. Students lacked cognitive mastery, demonstrated low clinical confidence, and were dissatisfied with the amount of time spent learning musculoskeletal medicine. Findings of the study suggested the need to improve the integration of musculoskeletal medicine into the curriculum 3 . Data from the 2005 Step-1 United States Medical Licensing Examination at our institution also revealed that perfor- mance on the musculoskeletal section was the lowest of all the subsections. Thus, both national as well as institu- tional concerns prompted us to lobby for, develop, and begin implementation of a four-year integrated musculo skeletal curriculum. We focused our initial reform endeavors on the pre- clinical (first and second-year) curriculum. The process of curriculum reform and development differs among various medical schools. As such, the purpose of this study was to provide a framework that may assist educators in achieving the adoption of an integrated muscu- loskeletal curriculum into the preclini- cal curriculum at their own school. We offer insight from our experience iden- tifying the areas for improvement within an existing curriculum, using results to generate interest and garner support from faculty and administrative stakeholders, and building a consensus on the development of educational objectives. Moreover, we provide guid- ance about lobbying for curricular time and integrating key objectives into existing courses, tailoring course mate- rial and lectures to those objectives, and developing faculty to teach the new curriculum. Materials and Methods Identify the Existing Musculoskeletal Curriculum In 2005, we examined all four years of the 2005-2006 traditional curriculum at Harvard Medical School for muscu- loskeletal content in each course and clinical rotation. Course objectives and syllabi for all courses were collected and assessed for their relevance to musculoskeletal education. The amount of time devoted to this topic at Harvard Medical School was compared with the national average presented by the Association of American Medical Colleges’ AAMC Curriculum Directory 7 . Assess Existing Musculoskeletal Curriculum Once the existing musculoskeletal cur- riculum was identified, we sought to assess the effectiveness of this curricu- lum. In that study 3 , we used a nationally validated basic competency examina- tion in musculoskeletal medicine to measure the students’ cognitive mastery of the subject. Moreover, a survey was administered simultaneously to assess the students’ clinical confidence and attitudes toward musculoskeletal education. Identify Key Supporting Educators Several senior Harvard Medical School administrators and faculty, including Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated. 733 COPYRIGHT Ó 2009 BY THE J OURNAL OF BONE AND J OINT SURGERY,INCORPORATED J Bone Joint Surg Am. 2009;91:733-9 d doi:10.2106/JBJS.H.01305