Elsevier

The Journal of Pediatrics

Volume 154, Issue 2, February 2009, Pages 267-271
The Journal of Pediatrics

Original article
Doctors Likely to Encounter Children with Musculoskeletal Complaints Have Low Confidence in Their Clinical Skills

https://doi.org/10.1016/j.jpeds.2008.08.013Get rights and content

Objective

To assess self-rated confidence in pediatric musculoskeletal (pMSK) clinical assessment in trainees and experienced doctors in primary care and selected secondary care specialties to whom children with MSK problems are likely to present.

Study design

Attendees at programmed postgraduate teaching sessions within a health care region of the United Kingdom completed an anonymous questionnaire to self-rate confidence in pMSK assessment compared with other bodily systems and describe exposure to MSK teaching.

Results

Respondents (n = 346) were qualified from 23 different medical schools (United Kingdom and 9 non–United Kingdom) and included trainees in Primary Care (n = 75), Pediatrics (n = 39), Emergency (n = 39), Orthopedics (n = 40), and experienced doctors in Primary Care (n = 93), and Pediatrics (n = 60). Self-rated confidence in pMSK assessment was low; the majority had “no” or “some” confidence (21% and 53%, respectively). Conversely, most respondents were confident “in most aspects” or “very confident” for cardiovascular, respiratory, and abdominal systems. pMSK ranked lowest below all other systems. Most respondents (92%) recalled some teaching of adult MSK medicine, mostly at undergraduate level. Fewer (51%) recalled any teaching of pMSK medicine.

Conclusions

Self-rated confidence in pMSK assessment was lowest, compared with other bodily systems, within doctors to whom children with MSK problems are likely to present. Core clinical skills are learnt at undergraduate level, and this study reflects poor levels of pMSK training which needs to be addressed.

Section snippets

Methods

Postgraduate training within the Northern Deanery (a large health care Region in North East England), includes programs for trainees in primary care, pediatrics, accident and emergency, and orthopedics. Attendance is mandatory and within each program, there is a minimum of one session focussed on pMSK medicine delivered by one of the authors (HF/SJ/AM). Over a 2-year period of this rolling program, and with trainees attending on one occasion, attendees were invited to complete an anonymous

Results

The Table shows that most of the respondents (n = 346) were doctors from primary care and general pediatrics, with equal proportions of trainees and experienced clinicians (namely GP principals, GPwSIs, and Consultant Pediatricians). The response rate from each teaching sessions was >65%. Postal questionnaires to consultant pediatricians and experienced GPs gave response rates of 40% and 90%, respectively. Medical schools were reported in 43% returns, with most (84%) respondents qualifying

Discussion

This study documents self-rated confidence in pMSK clinical skills in trainee and experienced doctors and compared with different bodily systems. We have shown that there was widespread low self-rated confidence in pMSK clinical assessment skills among trainees and experienced clinicians in primary care and selected secondary care specialties to whom children with MSK problems are likely to present. This could contribute to the reported delay in access to specialist care for children with

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  • Cited by (0)

    The authors declare no conflict of interest.

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