Background/Purpose:

Musculoskeletal (MSK) presentations in childhood are common and often present initially to clinicians who are not specialists in paediatric MSK medicine.

Many doctors report lack of confidence and competence in paediatric MSK clinical skills relating to lack of teaching both at undergraduate (1) and postgraduate levels (2). The paediatric Gait, Arms, Legs and Spine (pGALS) examination is a clinical skill targeting non-specialists and is widely taught (3).

One of the ongoing challenges in paediatric MSK education is the reliance on MSK specialists to deliver teaching yet often this resource is limited. Blended learning combines face-to-face with digital resources, and allows greater reach to learners. Using an evidence-based approach, we have developed an e-learning module focused on paediatric MSK clinical skills to complement pGALS teaching, and describe the development and evaluation process.

Methods:

Identification of the learning needs for this module came from previous research with medical students and family medicine clinicians, alongside curriculum review and qualitative work with medical students. In conjunction with web-developers we developed an interactive, case-based module using key e-learning strategies such as question & answer, click and reveal, and reiteration of key learning points. The module focused on key elements; MSK history, pGALS manoeuvres and common abnormalities found, red flags, next steps (investigations and management) and links to Paediatric Musculoskeletal Matters website (www.pmmonline.org) for more information.

The evaluative strategy focused on qualitative methods including pre-testing and focus groups to allow a greater understanding of the user experience of both the module and perceptions of e-learning in general. Focus groups were audio-recorded, transcribed and underwent thematic analysis.

Results:

The final e-module had 22 pages, taking 30 minutes to complete. Emergent themes from the focus groups were positive and related to navigation and usability, content and language, application and reach, learning styles and use of technology. An iterative approach to the module development gave greater clarity to the case and presentation of key learning points. The students valued cased based learning and the use of questioning to re-inforce learning. They deemed the variety of modalities useful for their learning.

Conclusion:

Iterative development of this e-learning module, in conjunction with learners, has led to a well-received resource as part of blended learning to complement face-to-face teaching. The module will be openly available to support teaching and learning of paediatric MSK clinical skills. Further e-module development is planned.

References:

1. Jandial S, Rapley T, Foster H: Current teaching of paediatric musculoskeletal medicine within UK medical schools – a need for change. Rheumatology (Oxford) 2009, 48(5):587-590.
2. Foster HE, Everett S, Myers A: Rheumatology training in the UK: the trainees’ perspective. Rheumatology (Oxford) 2005, 44(2):263-264
3. Foster, H.E. and S Jandial (2013) ‘pGALS – paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system. Pediatric Rheumatology 11 (1):44

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-blended-learning-approach-to-clinical-skills-teaching-e-learning-for-paediatric-gait-arms-legs-and-spine-examination-pgals/