Musculoskeletal education in undergraduate medical curricula - a systematic review

Rheumatic and musculoskeletal diseases encompass a vast spectrum of up to 200 conditions that are increasingly prevalent, with significant associated disability and socioeconomic burden. Their impact is pervasive, with musculoskeletal conditions being the second leading cause of years lived with disability worldwide, in addition to the 9th most common cause of disability-adjusted life years. It is therefore imperative that all graduating medical physicians are competent in their management, and that the quality of undergraduate musculoskeletal education is commensurate with patient and societal needs. A systematic literature review was conducted between April 1, 2021 and June 1, 2021 assessing the quality of undergraduate musculoskeletal education in medical schools. Educational interventions in musculoskeletal medicine were also included. Quality assessment appraisal of the studies was done using a Mixed Methods Appraisal Tool. One thousand and thirty-three titles were screened, and 44 studies were included in the final analysis. Our analysis of these studies showed that the quality of undergraduate musculoskeletal education, as determined by the cognitive mastery and clinical confidence of undergraduate medical students remains inadequate. Multiple educational interventions were assessed with mixed results. Despite the prevalence, and burden associated with rheumatic and musculoskeletal diseases, the musculoskeletal education of undergraduate medical students remains inadequate. Urgent international collaboration is required to devise teaching strategies and curriculum initiatives that are globally and reproducibly applicable and effective. Further research into educational interventions and teaching strategies is also required. </p

Schematic representation of the probe inserted between the noseband and midline of the nasal plane.

<p><i>N</i> is the noseband force, <i>L</i> is the measured force/load, <i>P</i> is the height of the probe and <i>W</i> is the lift-off width at the nasal plane.</p

Descriptive statistics for field trial 1: DGTv3 normal force readings in Newtons (N) for different ISES taper gauge noseband settings.

<p>Sample size n.</p

Box plot of frontal sub-noseband forces measured using DTGv3 for three ISES gauge settings.

<p>Box plot symbols for this and subsequent box-plots: solid black square—mean; rectangle lower and upper limits—25 and 75 percentiles; whiskers—5 and 95 percentiles; crosses—min and max values; line across rectangle—median.</p

Digital tightness gauge, version 4 (DTGv4) deployed at a frontal site—nasal plane.

<p>Inset shows a close up of the gauge along side the ISES taper gauge.</p

Box plot of noseband normal forces, frontal and lateral, measured using DTGv4 for three ISES gauge settings.

<p>Dotted lines added to guide the eye.</p

Box plot of frontal sub-noseband band normal tensions measured using DTGv3 for three ISES gauge settings.

<p>Box plot of frontal sub-noseband band normal tensions measured using DTGv3 for three ISES gauge settings.</p

Descriptive statistics for field trial 2: DGTv4 derived band normal tension data in N/cm, sample size n.

<p>Descriptive statistics for field trial 2: DGTv4 derived band normal tension data in N/cm, sample size n.</p

Descriptive statistics for field trial 1: DGTv3 derived noseband band normal tension data in N/cm, sample size n.

<p>Descriptive statistics for field trial 1: DGTv3 derived noseband band normal tension data in N/cm, sample size n.</p

Relationship between measured normal force and band tensile force for various lift off widths.

<p>Relationship between measured normal force and band tensile force for various lift off widths.</p