Freedman-Bernstein musculoskeletal competence testing of South African intern doctors: is there a difference between health science faculties?

Background: Basic competency in musculoskeletal medicine is necessary for all graduating doctors due to the growing burden of disease. Globally and nationally research has shown deficiencies in musculoskeletal knowledge according to the Freedman–Bernstein test. In South Africa, different health science faculties show different approaches to training; this article considers if any of these demonstrate adequate training and whether significant differences exist between the faculties’ results. The aim of the study is to determine whether there are significant differences between musculoskeletal learning outcomes between graduates from different health science faculties. Methods: A multi-centre, cross-sectional study was performed in which medical interns completed the Freedman–Bernstein test after graduation and prior to commencing their formal two-month block in orthopaedics. Data was then analysed to determine whether significant differences existed between the test scores of the eight health science faculties’ graduates. Results: A total of 259 completed tests were analysed. The mean score was 46% (range 4-88%, 95% CI 44-48%), and 244 of the 259 interns failed the test (94% failure rate). The lowest and highest mean scores, by health science faculty, was 34% (95% CI 28-40%) and 60% (95% CI 55-64%) respectively. An ANOVA test indicated statistically significant differences between test scores of the different health science faculties (p<0.001). Conclusion: We have demonstrated competency scores consistent with previous literature from South Africa and shown that there are statistically significant differences between the health science faculties based on Freedman–Bernstein test scores. This evidence suggests differing levels of musculoskeletal knowledge attained at health science faculties in South Africa, and no improvement in undergraduate education in the last decade. Level of evidence: Level 4