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While the health care delivery system in the United States is the subject of much criticism and debate, the medical education system in this country is unquestionably among the best in the world. The physicians, physician assistants, and nurse practitioners it produces each year constitute an elite group of health care providers with the knowledge and experience to handle even the most challenging injuries and illnesses. Despite its numerous strengths, one weakness in America's current medical education system is its lack of an adequate orthopedic curriculum for medical students and residents destined for careers in primary care. Many internal medicine residents, for example, feel more comfortable managing a critically ill patient in the intensive care unit than an ankle sprain, and they will see many more ankle sprains, rotator cuff tears, and cases of hip bursitis than they will intensive care unit patients in their practice. In fact, musculoskeletal complaints account for up to a third of the reasons why patients seek evaluation by their primary care providers.

It is this gap in the average medical resident's education that the faculty at the University of Colorado medical center and I sought to fill when we created an outpatient orthopedic rotation for internal medicine residents 20 years ago. The program was well received and very successful. My job was easy: teach orthopedics (perhaps the simplest and most basic of all medical specialties) to some of the brightest minds in health care. Soon, this program and others like it caught the attention of the American College of Physicians (ACP). I began receiving requests to present parts of the curriculum to practicing internists at the regional and, later, national ACP educational meetings. Primary care providers at all stages of their practice careers seemed hungry for this information. In the years since its inception, I have had the opportunity to teach this orthopedic curriculum hundreds of times. Each time, the residents and practicing primary care physicians I work with teach me how to make the presentations better. They help me understand what it is they want to learn and what teaching techniques work best for them.

Practical Office Orthopedics is an effort to put that curriculum together in written form. It is intended to provide the reader with a practical, efficient, and organized approach to outpatient orthopedics and to demystify the practice of musculoskeletal care.

The format of the book is meant to accomplish two very different objectives at the same time. The main text is written to allow quick and easy access to the basic facts. The sidebars in the book emphasize the "backstories" behind some of the conditions presented. The sidebars are written to make the book a more interesting read and, more importantly, to make it easier for the reader to remember the material. As a teacher (and a perpetual student), I am a strong believer in the old axiom: "Hear and I forget. Understand, and I remember." I am also a strong believer in the value of illustrations, so the book is packed with photographs, x-rays, and drawings to help explain the concepts discussed in the text. If this book does its job, reading it should provide you with a practical, easy-to-use approach to the orthopedics you will encounter in a primary care setting.

Ted Parks, MD

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