Context: In September of 2005, the Association of American Medical Colleges published a report on musculo-skeletal medicine education expressing growing concern that physicians lack the skills necessary to recognize and treat the expected increase in musculoskeletal disorders. Recent studies have suggested that American and Canadian medical schools may not be effectively addressing musculoskeletal medicine in their curriculums. Objectives: To assess the medical students' attitude towards

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... skeletal medicine and the musculoskeletal curriculum and to measure their knowledge in this subject by using a validated instrument. Design, Setting, and Participants: A cross-sectional volunteer survey study of first, third, and fourth year Harvard Medical School students was conducted during the 2005-2006 academic school year. Overall response rates were 101/165 (61%), 120/183 (65%), and 80/153 (52%) of first, third, and fourth year medical students respectively. Participants were recruited through various courses and also through USMLE Step II review sessions. Main Outcome Measures: Perception towards impact of musculoskeletal education on future career, self-reported confidence in performing a physical examination, attitudes towards the current musculoskeletal curriculum, and basic knowledge in musculoskeletal medicine. Results: The graduating class ranked musculoskeletal medicine as being of "major importance" (3.95/5, [95% confidence interval {CI}: 3.78-4.12]) towards their career but rated the required curriculum time spent on musculoskeletal medicine as "poor" (1.92/5, [95% confidence interval {CI}: 1.76-2.08]). Students who took clinical electives in the subject improved their confidence in examining the musculoskeletal system (electives: 2.04/5, no electives: 2.38/5, p<.001) and enhanced their performance on the competency exam (elec-tives: 71.4%, no electives: 57.6%, p<.001). Only 25% (20/80) of the graduating class demonstrated competency in musculosk-eletal medicine using a passing benchmark set by U.S. internal medicine residency program directors. Conclusions: Medical students' attitude and knowledge of musculoskeletal medicine indicate that the undergraduate medical institution may not be providing adequate training in this field to address the current and projected trends in muscu-loskeletal health care.