Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice

Background: Musculoskeletal Women's Health (MSK WH) is a niche subspecialty within physical medicine & rehabilitation (PM&R). Women make up 50.7% of the population of the United States but are burdened with higher rates of musculoskeletal disease compared to men. MSK WH topics are not included in PM&R or Primary Care Accreditation Council for Graduate Medical Education (ACGME) program requirements. Given the comprehensive training provided in PM&R, physiatrists are ideal candidates to diagnose, treat, and provide education on MSK WH conditions. Objective: To identify the prevalence of formalized MSK WH education and of WH physiatrists at ACGME-accredited PM&R residency programs. Design: Cross-sectional survey design. Setting: Computer-based survey. Participants: ACGME-accredited residency programs (N = 86; as of February 2017). Methods: A single, multiple choice, computer-generated Research Electronic Data Capture (REDCap) survey with branching logic was sent to all ACGME-accredited PM&R residency programs (N = 86). Outcomes: The primary outcome was to assess the prevalence of women's health curricula at ACGME-accredited PM&R residency programs in the United States. The secondary outcome was to assess the prevalence of WH physiatrists at these programs. Results: Eighty-six ACGME-accredited PM&R residency programs were contacted with 55 completed responses (64% response rate). Only six programs (11%) reported the presence of a formal WH curriculum at their residency program. In contrast, 25 programs (45%) reported having WH physiatrists at their institutions, and 36 programs (65%) reported that general physiatrists were providing WH-related care. Conclusions: The study findings identify a mismatch between the prevalence of MSK WH residency education (11% of programs) and the prevalence of physiatrists providing MSK WH care (66% of programs). Physiatrists are ideally suited to manage MSK WH care. Based on the findings of this cross-sectional study, residency programs and governing bodies should evaluate these trends and consider the addition of topics pertinent to women's musculoskeletal health into PM&R graduate medical education. Level of Evidence: III.