Subject Hours Comparison Between
DC's and MD's
The chart below is a common chart that is shown to chiropractic
patients and the general public.
You may be surprised by the number of hours comparing chiropractic students to medical
As is shown, the chiropractic students have received several more hours in certain areas such
as Diagnosis as the medical students.
In my opinion, this looks great on paper, but what is not mentioned is the experience and
education the medical student receives during their internships and residences working in hospitals and clinics
regarding the diagnosis and treatment of serious disease conditions.
On the other hand, medical students are not properly training in diagnosing and treating
musculoskeletal pain, whereas the chiropractic student excels in this area.
I would not
consider treating a patient with pneumonia or a serious disease with chiropractic adjustments when the patient
would be better off being treated with their medical physician, just as a patient in pain would be better off
being treated with acupuncture, chiropractic and/or physical therapy.
It is my opinion, that all health care professionals should work in cooperation with each
other to benefit the outcome and health of you the patient.
ADDITIONALLY REQUIRED STUDIES
Below are a few studies and outcomes regarding the education and training of Medical
Physicians with musculoskeletal pain.
This is not to discredit the great services and treatments that Medical Physicians give each
and every day to save the life’s of their patients.
We in the health care profession must know and work within our limitations and be willing to
refer to other health care professionals when warranted.
Competence levels in musculoskeletal medicine: comparison
osteopathic and allopathic medical
J Am Osteopath Assoc. 2006;
106(6):350-5 (ISSN: 0098-6151)
Stockard AR ; Allen TW
Virginia College of Osteopathic Medicine, 2265 Kraft Dr, Blacksburg,
VA 24060-6360, USA. firstname.lastname@example.org
Consistent with osteopathic principles and practice, the
nation's colleges of osteopathic medicine (COMs) have emphasized the significance of the
musculoskeletal system to the practice of medicine. The authors hypothesized that graduating
COM students would, therefore, demonstrate superior knowledge and competence in
musculoskeletal medicine when compared with graduates of allopathic medical
METHODS: The authors asked graduating COM students to complete a standardized and
previously validated 25-question basic competency examination on musculoskeletal medicine in
short-answer format. Originally developed and validated in the late 1990s, the examination was
distributed to allopathic medical residents at the beginning of their residencies. The authors
compare their results with those reported by Freedman and Bernstein for allopathic
RESULTS: When the minimum passing level as determined by orthopedic program
directors was applied to the results of these examinations, 70.4% of graduating COM students (n=54) and 82% of
allopathic graduates (n=85) failed to demonstrate basic competency in musculoskeletal
medicine. Similarly, the majority of
both groups failed to attain the minimum passing level established by the directors of internal
medicine programs (graduating COM students, 67%; allopathic graduates, 78%).
CONCLUSION: In an examination of competence levels for musculoskeletal medicine,
students about to graduate from a COM fared only marginally better than did their allopathic
counterparts. To ensure that all graduating COM students have attained a level of basic competence
in musculoskeletal medicine, the authors recommend further study as a prelude to evaluation of the
didactic and clinical curriculum at all 22 COMs and their branch campuses.
An assessment of the attitudes and knowledge of medical students at
Harvard Medical School
From the May 2007 issue of Academic Medicine
Day CS, Yeh AC, Franko O, Ramirez M, Krupat E. Musculoskeletal
medicine: An assessment of the attitudes and knowledge of medical students at Harvard Medical
School. Acad Med 2007; 82(5):452-457.
PURPOSE: To assess medical students’ knowledge and clinical confidence in
musculoskeletal medicine as well as their attitudes toward the education they receive in this
cross-sectional survey of students in all four years of Harvard Medical School was conducted during
the 2005-2006 academic year. Participants were asked to fill out a 30-question survey and a
nationally validated basic competency exam in musculoskeletal medicine.
RESULTS: The response rate was 74% (449/608). Medical students rated musculoskeletal education to be of
major importance (3.8/5) but rated the amount of curriculum time spent on musculoskeletal medicine
Third-year students felt a low to adequate
level of confidence in performing a musculoskeletal physical examination and failed to demonstrate
cognitive mastery in musculoskeletal medicine (passing rate on competency exam: 7%), whereas fourth-year students
reported a similar level of confidence (2.7/5) and exhibited a higher passing rate
Increasing exposure to the subject by taking clinical electives
resulted in greater clinical confidence and enhanced performance on the exam (P < .001).
Students’ feedback suggested that musculoskeletal education can be better integrated into the
preclinical curriculum, more time should be spent in the field, and more focus should be placed on
common clinical conditions.
findings, which are consistent with those from other schools, suggest that medical students do not
feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and
cognitive mastery in the field. Implementing a four-year integrated musculoskeletal curriculum is one way
that medical schools can address this concern.
Notes: Dr Day is assistant professor in orthopedic surgery and
director, Musculoskeletal Curriculum, Harvard Medical School, and chief, Orthopedic Hand Surgery,
Beth Israel Deaconess Medical Center, Boston, Massachusetts Mr Yeh is a fourth-year undergraduate,
Harvard College, Cambridge, Massachusetts Mr Franko is a second-year medical student, Harvard
Medical School, Boston, Massachusetts Mr Ramirez is a third-year medical student, Harvard Medical
School, Boston, Massachusetts Dr Krupat is director of evaluation and associate professor of
psychology, Center for Evaluation, Department of Psychiatry, Harvard Medical School, Boston,
More evidence of educational inadequacies in
Clin Orthop Relat Res. 2005; (437):251-9 (ISSN: 0009-921X)
Children's Hospital and Regional Medical Center, University of
Washington, Seattle, 98105, USA
In their study,
Freedman and Bernstein suggested that 80% of a group of graduates from many of the best medical
schools in the United States were deficient in their knowledge of basic facts and concepts in
How do these results compare with results from students attending a
medical school with a long-standing dedicated program to musculoskeletal education?
Does additional clinical experience in musculoskeletal medicine
improve understanding of the basic facts and concepts introduced in a second-year
A modified version of an exam used to assess the competency of
incoming interns at the University of Pennsylvania was used to assess the competency of medical
students during various stages of their training at the University of Washington.
Despite generally improved levels of
competency with each year at medical school, less than 50% of fourth-year students showed
Students who completed a musculoskeletal clinical elective scored
higher and were more competent (78%) than students who did not take an elective.
These results suggested that the
curricular approach toward teaching musculoskeletal medicine at this medical school was
insufficient and that competency
increased when learning was reinforced during the clinical years.
Educational deficiencies in musculoskeletal
J Bone Joint Surg Am. 2002; 84-A(4):604-8
Freedman KB ; Bernstein J
University of Pennsylvania School of Medicine, Philadelphia, 19104,
We previously reported the results of a study in which a
basic competency examination in musculoskeletal medicine was administered to a group of
recent medical school graduates. This examination was validated by 124 orthopaedic program
directors, and a passing grade of 73.1% was established.
According to that criterion, 82% of the
examinees failed to demonstrate basic competency in musculoskeletal
medicine. It was suggested that perhaps
a different passing grade would have been set by program directors of internal medicine
departments. To test that hypothesis, and to determine whether the importance of the individual
questions would be rated similarly, the validation process was repeated with program directors of
internal medicine residency departments as subjects.
METHODS: Our basic competency examination was sent to all 417 program directors of
internal medicine departments in the United States. Each recipient was mailed a letter of
introduction explaining the purpose of the study, a copy of the examination, and our answer key and
scoring guide. There was no mention of the results of the first study.
The subjects were requested to rate the importance of each question
on the same visual analog scale, ranging from "not important" to "very important," as had been used
by the orthopaedic program directors. These ratings were converted into numerical scores. The
program directors were also asked to suggest a passing score for the examination, and this score
was used to assess the examinees' performance on the examination. The results on the basis of the
internal medicine program directors' responses and those according to the orthopaedic program
directors' responses were compared.
RESULTS: Two hundred and forty (58%) of the 417 program directors of internal
medicine residency departments responded. They suggested a mean passing score (and standard
deviation) of 70.0% +/- 9.9%.
As reported previously, the mean test score of the eighty-five
examinees was 59.6%.
Sixty-six (78%) of them failed to
demonstrate basic competency on the examination according to the criterion set by the internal
medicine program directors.
The internal medicine program directors assigned a mean importance
score of 7.4 (of 10) to the questions on the examination compared with a mean score of 7.0 assigned
by the orthopaedic program directors.
The internal medicine program directors gave twenty-four of the
twenty-five questions an importance score of at least 5 and seventeen of the twenty-five questions
an importance score of at least 6.6.
CONCLUSIONS: According to the standard suggested by the program directors of internal medicine
residency departments, a large majority of the examinees once again failed to demonstrate basic
competency in musculoskeletal medicine on the examination.
It is therefore reasonable to conclude that
medical school preparation in musculoskeletal medicine is inadequate.
Chronic Low Back Pain in Older Adults:
What Physicians Know, What They Think They Know, and What They Should
Danelle Cayea, MD, MS; Subashan Perera, PhD; Debra K. Weiner,
J Am Geriatr Soc. 2006; 54(11):1772-1777. ©2006 Blackwell
Chronic low back pain (CLBP) is a
common and debilitating problem in older adults. Little exists in the literature about primary care physicians' (PCPs')
knowledge of and confidence in managing this problem.
A self-administered survey was mailed to PCPs in western Pennsylvania
to measure knowledge of the evaluation and treatment of common contributors to CLBP in older
adults, confidence in diagnosing these contributors through physical examination, and the
association between confidence levels and knowledge.
The survey combined items with an ordinal scale on which PCPs ranked
their confidence in detecting various contributors to CLBP (e.g., fibromyalgia) using physical
examination and patient vignettes followed by multiple choice questions designed to assess
One hundred fifty-three of 634 surveys were returned (24.1%).
Overall, the majority of PCPs did not
feel "very confident" in their ability to diagnose any of the contributors of CLBP
listed (most items <40%). PCPs felt
most confident in detecting scoliosis and least confident detecting myofascial pain of the
There was a wide range in the number of respondents answering all
questions related to a particular topic correctly (3.9% for sacroiliac joint syndrome to 70.4% for
hip osteoarthritis). There was no relationship between knowledge scores and confidence ratings (P
>.05 for all comparisons).
The results point to a need for more
PCP education about CLBP in older adults . It
also suggests that accurate needs assessment should not rely on physician confidence ratings
Improved education in musculoskeletal
conditions is necessary for all doctors
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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
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
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
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