To The Editor:
As orthopaedic caregivers, we must regard proper medical education as the foundation of informed and caring
musculoskeletal health in our
communities. As orthopaedic surgeons treating a progressively larger
cohort of patients, it is also critical to continue to recruit an increasing number of the best
and the brightest into our field.
Yeh and colleagues, in their article entitled “Impact of Clinical
Electives and Residency Interest on Education in Musculoskeletal Medicine”(1), have made significant strides in tackling the former
of the two issues by elucidating factors that contribute to cognitive
mastery of and clinical confidence in musculoskeletal medicine. In their
conclusion, they echo the challenge put forth in 2005 by the Association
of American Medical Colleges to enhance exposure to musculoskeletal
content over the course of a four-year medical education(2).
Yeh et al. “suggest that the current medical school
curricula may not be adequately preparing all medical students to deal
with common musculoskeletal conditions.”(1). They also note that “possible
approaches to addressing this issue include increasing the exposure that
students receive in this field.”(1). This increased exposure to
musculoskeletal medicine may not only enhance cognitive mastery of and
clinical confidence in the subject matter, as the authors suggest, but it
my also help tackle the second issue: enhance interest and potentially
increase residency application rates in orthopaedic surgery among medical
students.
Why should this concern us? After all, orthopaedics has always had
plenty of applicants and attracted the best. Recent trends from the NRMP,
however, suggest that the popularity and competitiveness of orthopaedics
in the Match is decreasing. So much so that the combined AOA and COA
meeting in 2008 has convened a special symposium to address this issue. In
addition, orthopaedic surgery has the second lowest relative rate of
female applicants (after cardiothoracic surgery(3)-- effectively losing
out on more than half of graduating medical student pool-- which will
further hamper our ability to meet the demands of a growing orthopaedic
patient population.
What can we do to fix this downward trend? Required medical school
instruction in musculoskeletal medicine has previously been associated
with higher rates of application to orthopaedic surgery residency
programs, with up to a 75% higher in rates of application among females(4).
Yet clinical courses in musculoskeletal medicine are required by only 20%
of American medical schools(5). Therefore, we have set out to prospectively
evaluate the effects of exposure to easily available supplemental
educational resources (Web-based or available materials, elective lectures
of musculoskeletal content) on interest in orthopaedics among the largest
but most neglected applicant pool: female medical students.
Preliminary data at two years reveals that interim enhanced exposure
to orthopaedic resources is significantly associated with increased
interest, intent to enroll in an elective, and intent to apply for
residency in orthopaedic surgery. As this cohort progresses in their
medical education, we will determine if increased exposure to elective
resources does, in fact, impact application and match rates among females in
our field.
Yeh et al.(1) comment that participants in their study rated “the amount
of time spent on musculoskeletal education throughout their four years
[as] ‘poor’”. Our preliminary data suggests that early exposure to
educational resources of musculoskeletal content may prove a critical tool
in recruiting more students, especially women, into enrolling in
orthopaedic electives. With time, our prospective study will elucidate if
this, in turn, translates into increased residency application and match
rates among females, which will be necessary to meet the anticipated
demands of the growing orthopaedic patient population.
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.
References:
1. Yeh AC, Franko O, Day CS. Impact of clinical electives and residency interest on medical students' education in musculoskeletal medicine. J Bone Joint Surg Am. 2008;90:307-315.
2. Association of American Medical Colleges. Report VII. Contemporary
issues in medicine: musculoskeletal medicine education. Medical School
Objectives Project. Washington, DC: Association of American Medical
Colleges; September 2005.
https://services.aamc.org/Publications/index.cfm?fuseaction=Product.displayForm&prd_id=204&prv_id=245.
Accessed 2008 Mar 10.
3. Jolly P, Hudley DM, editors. AAMC data book: statistical
information related to medical education. Washington, D.C.: Association of
American Medical Colleges; 1999, Table F9.
4. Bernstein J, DiCaprio MR, Mehta S. The relationship between
required medical school instruction in musculoskeletal medicine and
application rates to orthopaedic surgery residency programs. J Bone Joint
Surg Am. 2004;86:2335-2338.
5. DiCaprio MR, Covey A, Bernstein J. Curricular requirements for
musculoskeletal medicine in American medical schools. J Bone Joint Surg
Am. 2003;85:565-7.
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