Medical student referral patterns for musculoskeletal disorders

The purpose of this study was to determine the relationship between medical student knowledge and exposure to physiatry and the student's referral patterns for musculoskeletal disorders. Surveys were mailed to senior medical students at five United States medical schools across the country with a response rate of 26% (n = 191). Five common musculoskeletal and neurologic disorders were presented as clinical vignettes and the student was asked to assume the role of a primary care physician and refer the patient to one of eight specialists listed. A section to assess the student's subjective overall knowledge and exposure to these fields was also included. Physiatrists received 27% of the referrals for evaluation and treatment of chronic low-back pain, 3% of the referrals for acute low-back pain, 10% of the referrals for carpal tunnel syndrome, 22% of the referrals for an industrial medicine injury, and 20% of the referrals for a sports medicine injury. The frequency of physiatry referrals for three of the five cases was significantly correlated (P < 0.05) with the student's overall knowledge of physical medicine and rehabilitation (PM&R). The presence of a department of PM&R at the student's school, however, did not have a significant impact on the rate of referrals. The results indicate that senior medical students referral patterns are strongly influenced by knowledge of PM&R. This suggests that focusing efforts on increasing this awareness may be an effective means of increasing referrals to physiatry in the future.