Orthopedics Should be a Separate Subject in MBBS Course and Curriculum

Introduction Basic orthopedic knowledge is essential for effective medical practice after graduation. Musculoskeletal disorders affect 1.71 billion people worldwide and are the leading cause of disability, contributing 17% of years lived with disability.[1] Orthopedic surgeons deal with injuries, infections, tumors, degenerative disorders, and metabolic disorders that are often late or not treated, which is not common in Western countries. With limited healthcare resources, orthopedic training and services must work together to provide evidence-based care and improve national bone health, highlighting the need for medical education tailored to the country’s specific healthcare challenges.[2] Older adults (≥65 years) are at high risk of musculoskeletal disabilities, poor balance, and falls, which can cause serious injuries. Orthopedic care is also very important for dealing with complicated fractures and injuries like rotator cuff tears.[3] There is a strong base for making orthopedics its own subject in the MBBS course. This editorial examines how the current MBBS curriculum model does not accurately reflect the burden of musculoskeletal diseases, does not give enough training to undergraduates, and limits chances for new ideas and academic growth in orthopedics. Making orthopedics its own subject would not only fill in gaps in education, but it would also make medical training more relevant to today’s healthcare needs. Global Burden of Musculoskeletal Disorders In 2020, an estimated 494 million people around the world had other musculoskeletal disorders, which are conditions like systemic lupus erythematosus and spondylopathies. This is more than double the number of people who had them in 1990.[4] By 2040, one in four adults is expected to have arthritis, and almost half of them will have trouble doing things, which shows how important it is to pay more attention to musculoskeletal health.[5] By 2050, the number of cases is expected to rise by 115%, reaching more than a billion. Women and older adults will be the most affected. In 2020, these conditions ranked sixth globally as a cause of years lived with disability and were linked to more than 83,000 deaths. Despite this major burden, policy action remains difficult because many individual conditions and risk factors are still poorly quantified.[6] Current State of Orthopedic Training in MBBS In India, MBBS students receive limited orthopedic training, with only 8 weeks of postings and just 12.5% weightage in surgery exams. Orthopedics remains subsumed under general surgery, and regulatory bodies have not recognized it as an independent subject. Because orthopedics isn’t very important on tests and is often combined with other subjects, students often don’t pay attention to it.[7] There are a number of international universities, such as those in Singapore, Malaysia, Nepal, Turkey, and Saudi Arabia, that teach and test orthopedics as a separate subject from general surgery. The MBBS orthopedic curriculum requires reform to encompass cognitive, psychomotor, and affective domains, incorporating explicit objectives, milestones, and multimodal assessments. Research ought to assess the sufficiency of existing training, pedagogical approaches, and perceptions of orthopedics as a distinct discipline. Studies from around the world show that medical students and doctors consistently do poorly on musculoskeletal competency tests. This shows that undergraduate programs fail to teach orthopedics.[8] Despite musculoskeletal disorders accounting for a large share of clinical practice, medical schools in countries like Canada, the US, and India devote very little time to orthopedic education.[9,10] Poor anatomy knowledge, low clinical confidence, and little weight on the exam make the problem worse. Many students choose subjects with higher marks over orthopedics. Previous studies strongly support for the restructuring of the MBBS curriculum, establishing orthopedics as an independent subject with specialized instruction, sufficient clinical exposure, and pertinent evaluations to enhance preparedness and patient care.[7] The average scores in different settings range from about 48% to 59%. Many students believe that orthopedic training is insufficient, primarily due to restricted instructional time and its minimal emphasis in examinations within the context of general surgery. These things make students less interested in and focused on the subject, which shows that undergraduate orthopedic education needs to be better. A study conducted on final-year MBBS students scored 48.3%, and 42.5% found orthopedics difficult; 32.5% felt training time was inadequate.[7] Another study reported that the interns scored an average of 58.79% in orthopedics.[11] Another study conducted by Wijenayake et al.[12] in Australian students achieved an average score of 55%. Another study conducted by Sivani et al.[13] reported that the 13% of students found orthopedics difficult, though 42% felt training was inadequate. Another study reported that orthopedic time allocation in the curriculum was poor.[14] In India, a growing elderly population adds to cases of arthritis, osteoporosis, and spinal problems. Even though this is the case, MBBS graduates lack much training in orthopedics because it is combined with general surgery, which means they don’t have enough practical skills to treat musculoskeletal conditions. Internships often focus on getting ready for tests instead of hands-on learning, which makes it even harder to be good at orthopedics.[2] Evolution of Orthopedic Science From simple fracture treatment with plaster casts to extremely sophisticated surgical and regenerative methods, orthopedic science has advanced. Joint replacements and trauma care have been transformed over the past 50 years by advancements like arthroscopy, robotic and computer-assisted surgery, and contemporary biomaterials. In the treatment of bone tumors, limb-saving techniques have taken the place of amputations, and regenerative strategies like biologics and bioprinting are growing the field even more.[15] A key component of orthopedic trauma care, fracture fixation is essential for preserving bone integrity and accelerating healing. With over 178 million new cases each year, fractures are a significant health burden worldwide, primarily due to aging populations and traffic accidents. Over 200 million people worldwide suffer from osteoporotic fractures, which is on the rise. Therefore, creative and flexible fixation techniques are crucial to enhancing results for patients of all ages.[16] Orthopedics is now a vibrant, multidisciplinary specialty because of developments in trauma surgery, arthroscopy, joint replacement, spinal surgery, and regenerative medicine. These developments underscore its intricacy and influence on patient care, ranging from stem cell therapies to minimally invasive fracture management and sports procedures. By exposing undergraduates to this scope, orthopedics is established as a separate and crucial field outside of general surgery, stimulating curiosity, research, and evidence-based practice. Educational Imperatives for Orthopedic Independence and Recommendations Competency-based medical education offers flexibility and accountability by moving away from a time-based approach and toward an outcome-focused, student-centered methodology. However, there are obstacles to its implementation, including shorter MBBS course lengths, more assessments, faculty resistance, scarce resources, and trouble coordinating departmental training. Although well-prepared programs, such as in orthopedic training, have shown smooth implementation, studies show that careful planning, faculty development, and interdepartmental coordination are necessary to ensure a successful rollout.[17] Orthopedics as a stand-alone subject would ensure that students acquire both theoretical knowledge and practical skills through specialized teaching hours, organized clinical postings, and independent assessments. Although some contend that the MBBS curriculum would become overburdened by the addition of orthopedics as a separate subject, the necessity of proper orthopedic training outweighs worries about curriculum fatigue. Focus should be redirected to give high-burden specialties priority rather than increasing volume. Since MBBS graduates frequently act as first-contact providers, particularly in places with limited access to specialists, relying solely on postgraduate training is insufficient. Conclusion In conclusion, there is an urgent need to include orthopedics as a distinct subject in the MBBS curriculum due to the rising prevalence of musculoskeletal disorders and the quick development and complexity of orthopedic science. In addition to improving clinical confidence and student knowledge, orthopedics’ independence will promote research, improve patient care, and bring medical education into line with the needs of modern healthcare. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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