Department of Medical Education and Rheumatology and Division of Genomic Medicine, University of Sheffield, Sheffield, Yorkshire, UK
Correspondence to:
S. Dubey. E-mail: s.dubey{at}shef.ac.uk
We would like to compliment Drs Kay and Walker [1] for their excellent summary of current musculoskeletal teaching practice and future approaches for improvement and research. We agree that the lack of unanimity over the curriculum confuses not only medical students but also their teachers, who are not entirely sure of what the students need to know. While there is some degree of agreement among rheumatologists across the country with regard to a core curriculum, this has not yet been formally defined and universally accepted within the UK. This year has seen the publication of the postgraduate curriculum, and it becomes even more important to try to address the undergraduate curriculum in the UK.
The authors have highlighted the fact that leading rheumatology teachers in the UK have expressed a wish for a national agreement about core requirements in musculoskeletal undergraduate education. Very few people would disagree with that. Unfortunately, agreement on such a curriculum has proved elusive and we feel will continue to be so as long as we keep trying to approach the problem from the wrong end. Individual rheumatologists will have their own epistemological view of rheumatology and, consequently, their own opinions on what should be taught, thereby preventing consensus. We feel that the way to approach this particularly tricky issue would be to try to outline aspects that are already common to all of us. As an example, if we look at musculoskeletal examination as part of undergraduate assessment, there are only a finite number of OSCE (Objective Structure Clinical Examination) stations that can be used. Inclusive of the GALS screen, we have a total of nine commonly used OSCE stations for musculoskeletal examination. Virtually all UK medical schools are using some or all of these for undergraduate assessments. It would not be that difficult for rheumatologists to agree on what they expect the student to demonstrate during an OSCE on these stations. This would lay the groundwork, which can then be built upon, accepting that to an extent there will always be some differences between clinical teachers. We should, however, be able to utilize the similarities between us to help develop a core undergraduate curriculum and ultimately help the medical students we teach. This outcome-based approach is one we are adopting for the new curriculum for the University of Sheffield medical school as a whole, commencing in 2003. This approach is also being encouraged by the General Medical Council. Assessment drives learning, and by first agreeing the product (i.e. the required musculoskeletal knowledge, skills and attitudes of a qualified medical practitioner) as well as what we should assess (i.e. a bank of common OSCEs, EMQs, etc), we will develop a functional core musculoskeletal curriculum. With a little more concerted action, the core musculoskeletal curriculum will be readily achievable.
The authors have declared no conflicts of interest.
References