Doctors Likely to Encounter Children
With Musculoskeletal Complaints Have
Low Confidence in Their Clinical Skills

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:   Frankp@chiro.org

FROM:   The Journal of Pediatrics 2009 (Feb); 154 (2): 267–271

Sharmila Jandial, Andrea Myers, Elspeth Wise, Helen E. Foster

Musculoskeletal Research Group,
Newcastle University,
Newcastle Upon Tyne,
United Kingdom.
sharmila.jandial@ncl.ac.uk

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OBJECTIVE:   To assess self-rated confidence in pediatric musculoskeletal (MSK) 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 pediatric musculoskeletal clinical 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 pediatric musculoskeletal clinical 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 pediatric musculoskeletal (pMSK) clinical assessment medicine.

CONCLUSIONS:   Self-rated confidence in pediatric musculoskeletal clinical 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.

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