The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Can Medical Students Learn the Pediatric Musculoskeletal Examination Independently?

Authors: Kimberly L. Hays, MD, MSCR, Natasha M. Ruth, MD, MS, Paul J. Nietert, PhD, Lutfiyya N. Muhammad, PhD, Michele Knoll Watson, MA, CHES, Patricia McBurney, MD, MSCR

Abstract

Objective: The objective was to investigate whether medical students can learn a pediatric musculoskeletal examination independently by studying the pediatric Gait, Arms, Legs, and Spine (pGALS) assessment.

Methods: Fourth-year medical students were surveyed in 2018 regarding confidence and experience with the pediatric musculoskeletal training. Students performed an initial scored musculoskeletal examination on a standardized pediatric patient reporting chronic joint concerns. The total score had a theoretic range from 0 to 42, and scoring was based on the pGALS examination for children presenting with joint pain. Subsequently, students watched training pGALS videos. After this intervention, students completed follow-up physical examinations and surveys.

Results: Fourteen graduating medical students participated. Of these students, 12 students planned to enter a pediatric residency. On the initial survey, participants were the least confident in their pediatric musculoskeletal examination skills compared with all other pediatric physical examinations. Before the pGALS training, 21.4% of participants reported being confident or very confident in their pediatric musculoskeletal examination skills, compared with 100% of participants after training (P < 0.0001). The pre- and post-musculoskeletal examination scores were also statistically different (P = 0.0001). There were no participants who believed that they received extensive education in the pediatric musculoskeletal examination as part of their medical education. All of the participants desired further musculoskeletal training. All of the participants believed that the pGALS tool was beneficial.

Conclusions: Graduating medical students may not be confident nor proficient at the pediatric musculoskeletal examination. Instruction in the pGALS assessment may be a low-cost and efficient way to improve confidence and proficiency in the pediatric musculoskeletal examination.

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References

1. Al Maini M, Adelowo F, Al Saleh J, et al. The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases. Clin Rheumatol 2015;34:819–829.
 
2. Sen ES, Clarke SL, Ramanan AV. The child with joint pain in primary care. Best Pract Res Clin Rheumatol 2014;28:888–906.
 
3. Day CS, Yeh AC, Franko O, et al. Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School. Acad Med 2007;82:452–457.
 
4. Jandial S, Myers A, Wise E, et al. Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills. J Pediatr 2009;154:267–271.
 
5. Schultz K, Klein M, Sucharew H, et al. The impact of a gamified curriculum using Kahoot! on musculoskeletal knowledge and skill acquisition among pediatric Residents. Acad Pediatr 2022;22:1265–1270.
 
6. Foster HE, Jandial S. pGALS - paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Pediatr Rheumatol Online J 2013;11:44.
 
7. Sukharomana M, Charuvanij S. The Thai translation of the Pediatric Gait, Arms, Legs, Spine tool is useful for pediatric residents in detecting musculoskeletal abnormalities in children. J Clin Rheumatol 2021;27:e323–e329.
 
8. Baker KF, Jandial S, Thompson B, et al. Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice—a UK survey. BMC Med Educ 2016;16:277.
 
9. Gillispie M, Muscal E, Rama J, et al. Pediatric rheumatology curriculum for the pediatrics resident: a case-based approach to learning. MedEdPORTAL 2018;14:10767.
 
10. Foster HE, Kay LJ, Friswell M, et al. Musculoskeletal screening examination (pGALS) for school-age children based on the adult GALS screen. Arthritis Rheum 2006;55:709–716.