A recent study in the Journal of Bone and Joint Surgery1 concluded what many doctors of chiropractic have long suspected: "Current medical school training in musculoskeletal medicine is inadequate."
About 23% of patient visits to the family physician and 20% of visits to emergency rooms are for musculoskeletal complaints.
To test the level of musculoskeletal competency among recent medical school graduates, researchers developed a 25-question test. The test was reviewed and validated by 124 orthopedic chairpersons from residency programs across the United States. Further validation was made by having eight chief residents in orthopedic surgery take the test. The eight surgeons passed the test with a mean score of 98.5%. Basic competency was judged to be a score of 73%.
Eighty-five first-year medical and surgical residents at the University of Pennsylvania School of Medicine were administered the test on their first day of residency: 61 were medical residents, 17 were surgical residents and seven were orthopedic residents. The 85 residents were graduates of 37 medical schools.
In their medical school training:
The orthopaedic residents performed the best with an average score of 74.1% (only one percent over passing). The medical and surgical residents did about the same with average scores of 58.4% and 58.1% respectively. The failure rates broke down as follows:
Orthopedic Residents: 3 of 7 (43%) failed
Medical Residents: 53 of 61 (87%) failed
Surgical Residents: 14 of 17 (82%) failed
The authors concluded
"The current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine. The duration of the residents' preparation in this area was inadequate. For the study population as a whole, the mean duration of instruction in orthopaedics was only 2.1 weeks. In addition, 28 residents (33%) had graduated from medical school with no rotation, required or elective, in orthopedic surgery; these residents had the lowest mean score (55.9%) on the examination and the highest rate of failure (93%)."However, those who had taken a course in orthopedic surgery in medical school were not found to have a significantly higher mean score than those who had not, perhaps because the standard required course was too brief for the essential information to be conveyed."
One can't help but wonder how this shortcoming can be overcome. Perhaps it will be DCs that teach MDs what they didn't learn in medical school.
Reference
1. Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone and Joint Surg, 80A:1421-1427. Oct. 1998.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
