Clin Rheumatol (2007) 26: 5–7
Educational issues in rheumatology. The musculoskeletal
examination: a neglected skill
Received: 10 March 2006 / Accepted: 10 March 2006 / Published online: 12 April 2006
# Clinical Rheumatology 2006
Despite the high prevalence and the impact that they have on
health-related quality of life, as well as their social and
economic impact, musculoskeletal conditions are under-
recognized, misunderstood, and/or poorly treated. Under-
and postgraduate education is still underdeveloped worldwide
and does not get the attention it deserves.
The article by Almoallim et al., in this issue of Clinical
Rheumatology, illustrates that there is still a need for better
education in rheumatology and highlights the importance
of a screening locomotor evaluation in patients .
In 1997, the International League of Associations of
Rheumatology (ILAR) launched the Undergraduate Med-
ical Education in Rheumatology-2000 (UMER-2000)
project in order to fill this gap. With the support of the
WHO, regional leagues, American College of Rheumatol-
ogy, and Bone and Joint Decade, a sensitization program in
all parts of the world was started . This project certainly
has had a major impact, which needs, however, to be
formally measured. The perfection of orthopedic proce-
dures such as total hip and total knee prostheses have given
a much better quality of life for our most disabled end-stage
patients. The introduction of better and more specific drugs
(biologics) and the development of new technologies, such
as MRI, ultrasound, and arthroscopy, have certainly
profoundly changed our insights in disease processes as
well as our diagnostic and therapeutic capacities.
In contrast to what most people might expect from
specific education programs, namely, the latest discoveries
in molecular biology and technological advancements, it is
the teaching of integrated knowledge and skills to assess
patients clinically in terms of both diagnosis and disability
that is important for individual and societal needs.
Modern technology and sophisticated techniques might
be helpful in staging the disease, but only correct clinical
evaluation will allow a proper use of the new techniques and
treatments in the correct patient in a timely manner. More
technology is not ipso facto better care; less can be more.
Therefore, more attention has to be given also to aspects
of care and patient-centered outcomes such as functionality
and quality of life [3–5].
Screening the musculoskeletal system
Routine evaluation of the musculoskeletal system is often
not taught because the physical examination teachers are
often not skilled in musculoskeletal examination and thus
bone and joint diseases are not screened. A system for
screening the musculoskeletal system quickly, with em-
phasis on rapid identification of significant abnormalities
and any physical ability, has been developed and validated:
the GALS (gait, arms, legs, and spine) locomotor screen .
If rheumatologists, orthopedics, and neurologists could
use this screening routing before their specific examina-
tions and teach it to their medical and health professional
students, a big step forward could be taken to early
detection of musculoskeletal abnormalities because of
reinforcement. Advantage can be taken from computer-
assisted learning methods .
In the framework of the Bone and Joint Decade 2000–
2010, global core recommendations for a musculoskeletal
undergraduate curriculum have been proposed by experts
from different specialties, organizations, and countries with
expertise in medical education .
R. Westhovens (*)
Department of Rheumatology,
University Hospitals K.U. Leuven,
3000 Leuven, Belgium