We assessed musculoskeletal training in primary care residency programs at the University of Arizona to determine whether formal orthopedic instruction increased musculoskeletal knowledge. The University of Pennsylvania Basic Competency Examination in Musculoskeletal Medicine was administered to 38 of 52 primary care resident volunteers. The established "passing" score to demonstrate basic competency on this test is 73.1%. The overall score of the residents tested was 56.3% (range, 21%-88%). Eight of 38 residents had a score of 73.1% or higher. The mean scores were 61.5% with orthopedic rotation and 47.3% without orthopedic rotation. The difference was statistically significant (P=.05). Pediatric residents had the least exposure to musculoskeletal training, and none of them "passed" the competency examination. Primary care providers have a larger role in managing musculoskeletal problems with current managed health care systems in the United States. Many primary care residency programs do not provide adequate training in musculoskeletal medicine. The majority of exiting primary care residents do not have basic competency in managing musculoskeletal problems. Our study results show that residents who take an orthopedic rotation have a larger knowledge base. It seems reasonable to increase primary care residents' formal education regarding musculoskeletal problems.