This study showed that most of IUA students in Clerkship semesters did not have a basic level of competence in orthopedics medicine. This is clearly demonstrated by a low average cognitive score of 56.9%, and only six (6.12%) participants obtained a passing score of ≥ 73.1%. This study showed that the anatomy section was answered poorly with an average score of 51.43% in comparison to orthopedics emergencies questions which were better answered with an average of 67.98%. However, when our findings were compared to J K Jones et al (11), students’ scores in their study were less than what encountered in this study.
In Rojan Tamrakar et al (3) study demonstrated a poor score in general orthopedics and anatomy questions with the average scores, which in contrary, is less than what shown in this study for IUA students. Elizabeth Matzkin et al (6) study demonstrated that most of the graduate students as well as practicing physicians do not have the basic competence knowledge in orthopaedics and traumatology medicine; moreover, this was also noted among our study group. Furthermore, Freedman and Bernstein (7), Jagdish Menon and Dilip K Patro (8), Rob Dachs et al. (4), all those authors their result agreed to our findings and they concluded that graduate students were poorly prepared to manage musculoskeletal problems. More instructional time and reassessment of the orthopedics curriculum is recommended to meet the educational requirements and fill this gap among medical graduates. Despite the fact that anatomy is one of the basic courses of medical schools education, the time devoted to anatomical teaching and dissection is declining. The lack of exposure to basic anatomy and musculoskeletal medicine as a whole may contribute to the underlying lack of musculoskeletal medical knowledge. This also appeared in this study as the average score on the basic anatomy questions was 51.43%, in comparison to 49% in Elizabeth et al. (6) study which shows fewer score than in this study.
The duration of orthopedics teaching was different at different medical centers. In IUA, Orthopedic surgery is combined as part of the general surgery module, in the first nine weeks, with a total of twelve lectures and weekly rounds. In UK, the average undergraduate teaching time dedicated to orthopedics surgery teaching is around two and a half weeks (12). This is typically delivered within a five to eight week block combined with other allied specialties. Freedman and Bernstein mentioned the duration of only two weeks of orthopedics teaching among their study population (7). Moreover, in South African medical schools, six weeks duration was allocated for the orthopedics education (4). As compared to the other medical institutions, aforementioned we had few weeks more allocated for teaching orthopedics surgery. In Nepal (3), students while at their medical school were posted for the eight weeks in the orthopedics department. Further, they had to undergo 4 weeks of the rotational internship in the orthopedics department. As opposed to our institute, medical students in IUA did not undergo any further exposure to orthopedics teaching apart from medical college, i.e., during the internship period. Many studies show that undergraduate medical students spend very few hours on the musculoskeletal system, both in basic science and clinical training (4,10,12,14−15). In this study, the amount of time spent on musculoskeletal medicine in the curriculum of IUA was reported inadequate by 40% of students. This compare to Jagdish Menon et al. (8) study in which 30 of their students (32.5%) felt that the time devoted to orthopedics in the medical curriculum was inadequate. In a similar study done at Harvard Medical School (10), (86%) of the students in the study recommended more time as a way to change the current musculoskeletal curriculum.
In this study, one-third (32.7%) of the students consider orthopedics cases hard to do diagnosis and physical examination compared to other medical specialties. In comparison with another study (9), seventeen students (42.5%) felt that orthopedics was the most challenging specialty to make a clinical diagnosis. Moreover, Harvard Medical School study (10) shows that the students felt low to the average level of confidence in examining the musculoskeletal system compared to their confidence levels in examining pulmonary systems (P < .001 for all years). Among our participants, one-third (32.7%) of the students consider orthopedic cases hard to do diagnosis and physical examination compared to other medical specialties. In comparison with another study (9), seventeen students (42.5%) felt that orthopedics was the most challenging specialty to make a clinical diagnosis. Moreover, Harvard Medical School study (10) shows that the students felt low to the average level of confidence in examining the musculoskeletal system compared to their confidence levels in examining pulmonary systems (P < .001 for all years).
Moreover, in this study the most important element of learning methods that have an impaction on orthopedics education among students was the bedside teaching rounds with the consultant. This finding was similar to those shown in previous studies (2, 4, 9). Learning environments that allow for direct contact with patients appear to be more valuable learning environments. This type of interaction when guided by faculty members they appear to be more beneficial to students, as evidenced by the fact that the majority of students consider consultant bedside teaching to be the preferred learning setting.
Positive student experiences during surgical rotations, according to research, may contribute to students deciding to pursue a future career in surgery (4). About half of the students in this study have mention that they may consider considering the orthopedics and traumatology career in the future. This is also reported by 54% of students in IUA. Hence, other factors such as interest in orthopedics and traumatology career, teacher role model, and seeing patients in clinic, ward and emergency room were also reported by students. Boutefnouchet et al. (17)found that students mentioned that quality of teaching and seeing patients within the clinical setting are the most significant motivating factors in developing an interest in Orthopaedics and Traumatology as a future career. Early exposure and teaching of medical students to orthopedics and traumatology are substantial to obtaining sufficient knowledge and sustaining their interest in this career (4). It is crucial to ensure a good learning environment and a well-structured curriculum to enhance the quality of musculoskeletal learning among undergraduate students. These factors will affect the students' perception of orthopedics and traumatology careers, which will improve learning outcomes among these students. In addition, a previous reported the assessment of 112 junior doctors after completion of two-year foundation training in the UK, and only 8.9% passed the assessment. The scores followed a similar pattern based on the doctors' career intentions. (14)
Considering the high prevalence of musculoskeletal problems in the community and the necessity for doctors to be able to handle them correctly, it is crucial that medical education at all levels pay attention for training in musculoskeletal conditions in the future, in order to graduate competent doctors. In a more professional clinical context Epstein and Hundert defined competence as ―the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values and reflection in daily practice for the benefit of the individual, and the community being served (18). Hence, the basic orthopaedic and traumatology knowledge gained by the medical students during undergraduate period form a platform for future progress and motivations, a review of the orthopedic curriculum in undergraduate education, including time allocation, teaching techniques, materials, and faculty skills, is essential to provide the upcoming medical doctors with the necessary knowledge and skills for a safe and good orthopedic practice.