EVALUATION OF THE IMPACT OF A PAEDIATRIC GAIT ARMS LEGS AND SPINE (PGALS) PHYSICAL EXAMINATION WORKSHOP ON THIRD-YEAR MEDICAL STUDENTS’ CONFIDENCE IN PERFORMING PEDIATRIC MUSCULOSKELETAL EXAMINATIONS

摘要

>BACKGROUND: Musculoskeletal (MSK) complaints in children account for up to 30% of visits to primary care providers. Studies show that delays in appropriate care for children with MSK complaints may be related to a lack of confidence in primary care providers performing paediatric MSK physical examinations. This may be due to the fact that examining the MSK system in children is under taught in medical school, and physical examination of the joints is uncommonly documented by trainees. The paediatric Gait, Arms, Legs, Spine (pGALS) examination is a quick MSK screening examination validated for use in school-aged children to discern normal from abnormal joints. It was introduced as a mandatory workshop during the 2015-16 paediatric clerkship for third-year medical students at our center. >OBJECTIVES: To assess the impact of a pGALS workshop on medical students’ confidence in performing paediatric MSK examinations. >DESIGN/METHODS: Students were invited to complete a pre-workshop questionnaire pertaining to baseline knowledge, prior learning, and confidence in examining childrens joints alone and compared to other body systems exams. Students completed a second confidence questionnaire at the end of their rotation,and again 6 months afterwards, to evaluate changes in confidence and whether they continued to use these skills.Paired t-test was used to compare confidence in performing MSK exam between pre- and post- workshop and between pre- and 6 months post workshop. >RESULTS: During the 2015-16 academic year, 127 third-year medical students completed the baseline questionnaire. Mean confidence at baseline was 1.87 (CI 1.71, 2.01) on a 4-point Likert scale (1=not at all, 2=confident in some aspects, 3=confident in most aspects, 4=very confident). Following the rotation, mean confidence increased to 2.86 (CI 2.75, 2.96) representing a 53% increase inmean confidence ratings (p=0.00). Six-month follow-up data for the first three cohorts of students demonstrates a mean confidence of 2.45 (CI 2.13, 2.77), a 31% increase in mean confidence (p=0.031) from baseline. During the pediatrics clerkship, 82/141 (58%) students used pGALS after the workshop. Six months after the pediatrics clerkship, 12/33 (36%) students had used pGALS in various settings (ER, wards, clinics) for MSK and non-MSK complaints. >CONCLUSION: Students report low levels of confidence in performing pediatric MSK physical examinations. The pGALS workshop significantly increased their confidence; this waned after 6 months, but remained above baseline confidence. Recurrent opportunities to practice and be assessed on these skills would likely be beneficial to sustain learners confidence so that they may integrate this into ongoing clinical care.