Musculoskeletal Anatomy Education: A Survey of North American Medical Programs

Postgraduate data reveal that most physicians lack adequate anatomical knowledge and clinical confidence when practicing musculoskeletal (MSK) medicine. Curricular data from nationally accredited medical programs clearly indicate that the total time dedicated to gross anatomy instruction has decreased over recent decades. However, little information is available regarding the MSK anatomy learning environment across accredited medical programs in North America. The purpose of this study was to document the current state of preclinical MSK anatomy education across North American medical programs. A survey was sent to all 14 English-speaking Canadian and 135 of the 158 American accredited medical programs. The survey had a 100% response rate from Canadian programs and 43% from American programs. The results indicated that the mean time spent learning preclinical MSK anatomy varied widely across both Canadian (29.8 h ± 13.7, range 12-60, median 29, mode 12) and American (50.8 h ± 46.2, range 2-280, median 35, mode 30) programs, most of them integrating anatomy learning into the clinical learning environment (56%). All but one program reported using cadaveric-based instruction (99%) and the majority taught radiological correlates (94%) and surface anatomy (71%) within their curriculum. Diverse modes of instruction were used by all programs, but didactic lectures remained the most frequent form (89%). While a variety of learning resources were used to support student learning, the type of resource varied significantly, Canadian programs most commonly providing a "curriculum-specific" notes package (86%) and American programs most commonly requiring an anatomy atlas (84%). Summative and formative methods of evaluation were used by most programs (96%), final written examinations (79%) and ongoing in-course evaluation (81%) being most popular. The results serve to document the current state of preclinical MSK anatomy education within nationally accredited allopathic medical programs and to illustrate the wide variability of the learning environment. Future research should be directed at establishing consistent standards for preclinical MSK anatomy education and investigating the long-term effects on knowledge retention and clinical confidence.