Evaluation of knowledge of common hand surgery problems in internal medicine and emergency medicine residents

Musculoskeletal disorders are the principal reason for primary care outpatient visits and make up 14% of visits to emergency departments, with the upper extremity as the most common site affected. However, formal musculoskeletal education is inconsistent in medical school and primary care residencies, with many first-year residents reporting a lack of confidence in examination and diagnosis of musculoskeletal conditions. The authors evaluated the level of knowledge of common upper-extremity conditions with a validated examination taken by internal medicine and emergency medicine residents. A 38-question upper-extremity examination was created by a group of hand and upper-extremity surgeons from the Resident Education Committee of the American Society for Surgery of the Hand. The examination was reviewed by 30 hand fellowship directors, who rated each question on a Likert scale and determined a recommended passing percentage. The Web-based examination was taken by emergency and internal medicine residents from multiple institutions. The fellowship directors' recommended passing grade averaged 73%. The majority of respondents were in their first (33%) or second (33%) year of training. The average scores were 56% and 46% for the internal and emergency medicine residents, respectively. This evaluation of a cross-section of internal and emergency residents indicates a deficiency in knowledge of common upper-extremity conditions.