It is important to note two important caveats at the outset. The first is that a coherent clerkship experience cannot be “business as usual,” if the baseline is simply to offer a tourist experience for the student. To be sure, a student interested in orthopaedic surgery as a career (the typical participant in an orthopaedic surgery course) will be highly motivated to please, and unduly acquiescent; these students traditionally have placed few demands on the residents and faculty. By contrast, students with other career plans will demand more attention. A new course, therefore, must be built with the understanding that more effort may be needed from the faculty. The second caveat is that a new course should not be undertaken on the assumption that it will necessarily improve recruitment to orthopaedic residency programs. It might [3], but that is gravy: in general, by the time a clerkship rolls around, students have already begun to shape their career plans. (Many students still have an open mind in the first year of school—and that’s a strong argument for having orthopaedic surgeons participate in anatomy and other first-year courses.) These caveats sum to a simple recognition that offering any new or improved course will require orthopaedic surgery departments to do more, with few immediate rewards. Only with the larger perspective (of improving patient care and musculoskeletal outcomes) in mind does making this effort this make any sense.

Instruction at the University of Pennsylvania is divided among modules, but the general form of the four curriculum is 18 months of preclinical instruction; 12 weeks of clinical clerkships; and 18 months or more of additional study, covering a few additional requirements, electives, sub-internships, research opportunities, and others (about half of the students in any one entering class graduate more than 4 years after the start, many of whom earn a second degree).

Within the 18 months of preclinical instruction, there is no formal course in musculoskeletal medicine at the University of Pennsylvania, but, of course, musculoskeletal topics are covered in anatomy, pathophysiology, and other blocks.

The clinical year, which begins in January of the student’s second year at the University of Pennsylvania , is devoted to ten required clerkships (Table 6.2). Orthopaedics 200, a required clinical rotation in orthopaedic surgery, is offered within the 3-month-long surgery block, but educationally independent of it. In addition to orthopaedics, students are required to spend 1 week in otorhinolaryngology and ophthalmology—together these are known as “the three Os”—and 1 week in anesthesia.

University of Pennsylvania has approximately 160 students, such that in each quarter 40 students are in the surgery block. Thirteen students then perform their specialty rotations in any given month. Orthopaedics 200 is then offered 1 week every month (12 times a year), carrying approximately 13 or 14 students in each iteration.

Although Orthopaedics 200 is technically a week-long course, the surgery didactics curriculum runs throughout the entire 12-week block—the students take a high-stakes shelf examination at the end of the 3 months—and half of every Friday is reserved for a general surgery education program that all 40 students participate in. Thus, there are 4 days available for clinical instruction (Table 6.3).