Rheumatology 2003; 42: 703
© 2003 British Society for Rheumatology
Letters to the Editor |
Quality of care of musculoskeletal conditions
Northeastern Ohio Universities College of Medicine, 5500 Market, Youngstown, OH 44512, USA
SIR, The article by Roberts et al. [1] may well represent UK primary care physicians' perspective of the state of the rheumatological care they deliver. At least 50% of these physicians seem quite comfortable with their musculoskeletal condition management skills.
However, it may be premature to assume a relationship between comfort level and management skills. Claude Bernard and Mark Twain have rightly stated [2] that it is not so much what we don't know that gets us into trouble, as what we know that isn't so. Perhaps there is a difference in medical training between the UK and USA, but Smith et al. [3] did document poor musculoskeletal disease training in US training programmes. Rothschild [4] relates the US problem to limited curriculum time. He demonstrated a minimal requirement of at least 40 full ‘exposure days' in rheumatology to establish ability to actually start managing musculoskeletal disease.
It is impressive that 50% of surveyed UK general practitioners expressed a desire to ‘sit in with a consultant in clinic’ [1, p. 503]. Hopefully, a mechanism will be established to provide an effective programme to provide such motivated individuals with the necessary clinical experience. Their desire might also be considered a wake-up call to medical schools and residency programmes, suggesting curriculum modification to provide more effective musculoskeletal training.
References
- Roberts C. Adebajo AO, Long S. Improving the quality of care of musculoskeletal conditions in primary care. Rheumatology 2002;41:503–8.
[Abstract/Free Full Text] - Spodick DH. On experts and expertise. The effect of variability in observer performance. Am J Cardiol 1975;36:592–6.[CrossRef][Web of Science][Medline]
- Smith MD, Walker JG, Schultz D et al. Teaching clinical skills in musculoskeletal medicine: The use of structured clinical instruction modules. J Rheumatol 2002;29:813–7.
[Abstract/Free Full Text] - Rothschild BM. Relationship of length of clinical rotation to achievement of skills necessary for clinical management of musculoskeletal disease. J Rheumatol
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