Learner Practice Gaps in Osteoporosis: Piloting a Metabolic Bone Disease Curriculum within a Fracture Liaison Service Framework

Abstract

Osteoporosis is a disease increasing in prevalence and a growing public health concern. However, health care gaps in the diagnosis and management of osteoporosis exist. One of the factors contributing to this observation may be that the disease does not receive significant attention particularly during internal medicine residency training. A curriculum was designed and implemented in a cohort of Loma Linda University internal medicine residents to address this issue. It consisted of a week-long rotation that allowed residents to enhance their knowledge of the recognition and management of osteoporosis through participating in an inpatient Fracture Liaison Service as well as attending osteoporosis conferences. A retrospective review of the osteoporosis management practices of residents who completed the curriculum was performed, with the objective of evaluating health care gaps among these residents and to inform educators about possible areas for curriculum improvement. Twenty-one internal medicine residents completed the MBD rotation during the designated period. Of those, 6, 9, and 6 were PGY 1, 2, and 3, respectively. 133 charts were reviewed for encounters occurring within 3 months of the MBD rotation completion. Residents who have completed the osteoporosis curriculum treated osteoporosis in 65.8% of patients who qualified, which is higher than the national average of 40% in the US, it less than an improvement than the authors expected. Itis the opinion of the authors that internal medicine residents should emphasize osteoporosis care more given the prevalence, morbidity and mortality of the disease. There is work to be done to create an effective curriculum for this disease during postgraduate medical training.