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Picture it. The next patient is walking through the door and you don’t have a f*****g clue what to do with them. You just hope they don’t ask too many questions.

I know I’ve been there… have you?

Thankfully, less so in recent years, although I certainly do still have those moments! I’m experienced enough now however to openly acknowledge this and save myself the later embarrassment showing that I was winging it. An embarrassment that I endured time and time again in my early years as a physiotherapist.

“Patient’s had an ankle fusion? Hmm, not sure what that is and no real time to understand it or discuss it with my senior so to hell with it, I’ll just fall back onto pushing and rubbing it a bit.” This is the case that stands out to me when I reflect back. I cringe every time. Trying to restore movement in a joint that had been excised, packed with bone graft and held firmly together with a nail. What an idiot!

This is an uncanny representation of that fateful day!

Overconfidence in special tests, diagnosing everyone with complex biomechanical issues that existed purely in my own head and not having the foggiest idea of what would happen in the world of orthopaedics should my patient fail to improve. The list could go on.

And the way I see it, there are two possibilities here:

* I was in the bottom quartile when it came to knowledge after coming out of university and too arrogant to even think that this was a possibility.

* I was simply not prepared in the right way to be as effective, accurate or aware of my own limitations as I needed to be in the complex world of MSK.

Those who know me personally and read this will delight in telling me it’s number 1 and that they never experienced anything like what I’ve laid out above.

And to them I say; it’s okay, they’re only my feelings you’ve hurt and I’m sure they’ll heal… and also you’re lying. Experiences just like mine are extremely common. Based on the conversations I have had, I would actually go as far as to say it is the normal experience for new graduates in MSK!

But is it a sign of personal failure? Absolutely not.

It’s actually a fairly predictable situation. Yet, we seem to be okay with it as a profession; regardless of the negative impact that it has on the clinician who might experience high levels of stress, the patient who has waited months or invested their own money to come and see a specialist, or the reputation of the profession when these two previous scenarios mix and leave a sour taste in everyone’s mouth.

In this article, I want to challenge the status quo of MSK training and practice with a particular nod to the pre-registration degree, whether that be undergraduate or pre-registration masters. I will argue that it is no longer fit for purpose and can actually be counter-productive to producing good quality MSK clinicians.