CONFIDENCE IN PERFORMING PEDIATRIC MUSCULOSKELETAL EXAMINATIONS IN CANADIAN PEDIATRIC RESIDENTS

Abstract

BACKGROUND: Pediatric Musculoskeletal (pMSK) complaints are common and lead to important diagnostic considerations. However, international studies suggest that pediatric health providers (residents and consultants) are not confident in their pMSK assessments. At present, little is known about the confidence of Canadian pediatric residents in performing MSK examinations. OBJECTIVES: Our study evaluates the confidence of Canadian pediatric residents in performing pMSK examinations. In a subgroup of residents, we assessed changes in confidence after targeted training. DESIGN/METHODS: All pediatric residents enrolled in an accredited Canadian pediatric residency during the 2015-2016 academic year were invited to participate in an anonymous nationwide questionnaire. Survey respondents rated their confidence in performing pMSK examinations alone and in comparison to other body systems using a 10-point Likert scale. Pediatric residents enrolled in two centers participated in a one-day standardized pMSK examination workshop to learn the pediatric Gait, Arms, Legs, and Spine exam, a validated screening tool to facilitate pediatric joint examination; focused regional joint examinations were also reviewed. A follow-up confidence questionnaire was distributed immediately and six months’ after the intervention. RESULTS: 143 pediatric residents from 14 Canadian residency programs responded to the nationwide survey. Of the respondents, 56% (n=80) were previously taught the pMSK examination yet only 14% (n=20) reported routinely examining a child’s musculoskeletal system as part of a complete physical examination. The vast majority of respondents were “somewhat confident” with their pMSK examination, with an average confidence level of 4.6 (95%CI 4.3-4.9; 1=No confidence, 10=Very confident). Confidence was lower in comparison to cardiovascular, respiratory, and abdominal exams, but higher in comparison to peripheral nervous system and ophthalmologic examinations. In our subgroup analyses (n=50), we found an average increase in confidence by 2.1 points immediately after the intervention, from an initial confidence level of 4.9 (95% CI 4.5-5.4) to 7.1 (95% CI 6.6-7.5). This increase was sustained with a mean confidence rating of 6.9 (95% CI 6.1-7.7) six months post-workshop. The most frequently reported barriers to musculoskeletal examination confidence were limited practice (n=34,68%) and limited training opportunities (n=19,38%). CONCLUSION: Few Canadian pediatric trainees perform a pMSK examination as part of a complete examination, and self-rated confidence in pMSK examination was evaluated as “average” by the majority. We demonstrate that a standardized educational intervention can lead to increased confidence in performing pMSK examinations, but a decline in confidence is observed with time and without consistent practice.