Background/Purpose: Children commonly present with musculoskeletal complaints to primary care providers who work in a busy practice with diverse populations. Musculoskeletal complaints may result from mechanical causes including trauma or from inflammatory etiologies such as juvenile idiopathic arthritis. Pain may not be the presenting musculoskeletal complaint, which makes evaluation difficult. General knowledge of how to evaluate a patient with musculoskeletal complaints and how to do an appropriate musculoskeletal exam is necessary to effectively triage patients. However, many physicians report a lack of confidence and competence in the musculoskeletal examination due to limited training. Pediatric Gait, Arms, Legs, and Spine (pGALS) is a validated screening tool aimed at general practitioners to help discern normal from abnormal pediatric musculoskeletal findings. Its utilization at the medical student level has not been well described.

Methods: Graduating fourth year medical students were surveyed regarding their future specialty choice, confidence in pediatric exam skills (including the pediatric musculoskeletal exam), and the amount of pediatric musculoskeletal training they received in medical school. They performed a scored baseline pediatric musculoskeletal exam on a pediatric standardized patient presenting with chronic joint complaints consistent with juvenile idiopathic arthritis; the total score had a theoretic range from 0 to 42. Following the initial survey and baseline exam, they watched training videos in the pGALS assessment. After the pGALS intervention, they returned to complete a follow-up pediatric musculoskeletal exam and survey.

Results: 14 graduating medical students participated in the study. 11 planned to enter a pediatric residency. On the initial survey, participants were least confident in their pediatric musculoskeletal exam skills compared to all other pediatric exam skills. Prior to pGALS training, 21.4% of participants reported being confident or very confident in their pediatric musculoskeletal exam skills, compared to 100% of participants reporting confidence after training (p<0.0001). The average musculoskeletal exam score also increased significantly (pre: 22.1±4.2 vs. post: 32.2 ±4.9, p=0.0001). In regards to pediatric musculoskeletal training, there were no participants who felt that they received extensive education in the pediatric musculoskeletal exam. All participants desired additional training. 100% of participants felt that the pGALS training was beneficial to their education.

Conclusion: Graduating fourth year medical students may not be confident nor proficient at the pediatric musculoskeletal exam based on our analysis. While our study population was small, many of the student participants plan to enter pediatrics. Instruction in using a validated pediatric musculoskeletal screening tool, such as pGALS, may be a low cost and efficient way to improve medical student confidence and proficiency in the pediatric musculoskeletal exam. The information found from this study will be the basis for testing pGALS in a larger population at different centers.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluating-medical-student-confidence-and-performance-of-the-pediatric-musculoskeletal-exam/