Topics in Training Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students

Background: Despite the prevalence of musculoskeletal disorders, the degree to which medical schools are providing students with the knowledge and confidence to treat these problems is unclear. This study evaluated the factors that impact musculoskeletal knowledge and clinical confidence among fourth-year medical students. Methods: Over a three-year period, 253 fourth-year medical students participated in the study at a single institution. Musculoskeletal knowledge was evaluated using a National Board of Medical Examiners ’ musculoskeletal medicine subject examination. Factors analyzed included sex, class year, musculoskeletal elective experience, duration of mus-culoskeletal elective, career choice, and musculoskeletal curriculum satisfaction. Results: The participation rate was 95%. The mean National Board of Medical Examiners ’ musculoskeletal assessment score (and standard deviation) was 70.7 ± 9.5 points for all fourth-year medical students. Taking a musculoskeletal elective significantly increased knowledge (p < 0.001) but not clinical confidence. Increased satisfaction with how musculoskeletal medicine was taught was associated with increased clinical confidence (p < 0.001). No significant differences were seen if studentswere going intomusculoskeletalmedicine or primary care for eithermusculoskeletal knowledge or clinical confidence. Multivariate analysis of musculoskeletal knowledge found that taking a musculoskeletal elective for two weeks led to an in-crease of 6 points (from a possible 100 points) in the National Board of Medical Examiners ’ subject examination scores. Conclusions: This study reveals that participation in a clinical elective is the only factor that led to a significant increas