Background/Purpose:

Musculoskeletal (MSK) manifestations are a common reason for outpatient consults accounting for 6-9% of pediatric clinic visits in developed countries. Patients are initially evaluated by primary care practitioners, general pediatricians and emergency physicians. It has been suggested that low confidence in pediatric MSK assessment is a key factor contributing to diagnostic delays and poor outcomes.

pGALS (pediatric Gait, Arms, Legs, Spine) is a simple tool for MSK assessment, which facilitates early recognition and prompt referral of patients with joint problems. When performed by non-pediatric specialists and compared with pediatric rheumatologists, pGALS has been shown to have excellent sensitivity (97–100%) and specificity (98–100%) for detecting abnormal joints.

We undertook this study to evaluate pediatric residents’ confidence in conducting an MSK evaluation and the effect that a pGALS training session had on enhancing this perception.

Methods:

Pediatric residents working at the two training centers in Nairobi, Kenya (Aga Khan University Hospital and Kenyatta National Hospital) participated in a 60 minute hands-on session on pGALS given by a pediatric rheumatologist. Written anonymized questionnaires performed prior and post training assessed the participants’ level of confidence in examining the MSK system.

Results:

Sixteen residents with an average of 2.9 ± 0.8 years of training completed the survey. Ten out of 16 (63%%) reported previous MSK exam training. None of the participants had been trained in pGALS before. A third of residents (31%) were not comfortable examining the MSK system, while the remaining felt comfortable in some aspects only.  The level of confidence in examining the MSK system was significantly lower than that for all of the following systems: cardiovascular, respiratory, abdominal and neurological (p<0.005).

Ninety four percent of the residents reported increased level of confidence (p<0.001) following the pGALS training session. Most physicians considered the training session extremely beneficial (75%) or very beneficial (25%). Ten residents (63%) reported planning to use this tool for all patient visits, 4 (25%) in patients with minimal joint complaints and 2 (12%) in those with obvious joint concerns.  In their clinical setting, the residents thought that office posters (63%) and pocket cards (63%) would be more useful than web-based video demonstrations (25%) to facilitate the use of the pGALS in clinical practice.  They felt that the best way to increase confidence in the MSK exam was with one-on-one bedside coaching (81%) rather than web-based video demonstrations (50%) and workshops (44%). 

Conclusion:

pGALS training together with routine reminders to facilitate pGALS incorporation into the regular exam translates into increased physician confidence, which may lead to earlier recognition of rheumatic diseases in children. pGALS teaching materials may need to be tailored to the clinical setting that they will be used in.

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« Back to 2014 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pgals-training-increases-kenyan-pediatric-residents-confidence-in-performing-a-musculoskeletal-exam/