Joint examination skills: are rheumatology specialist registrars adequately trained? Reply

Abstract

Mistlin’s survey is a timely reminder that the well-known problem of poor confidence in musculoskeletal examination skills is not confined to medical students [1], general practitioners [2, 3] or general physicians [4], but is present also in rheumatology specialist registrars. This problem has been generally overlooked and has a number of possible causes. There has historically been little or no agreement on what to teach students [5], with resulting diversity of student experience [6] and lack of confidence and use of such skills [7]. With this background, most clinicians have developed their own examination techniques and routines, which may in turn affect their confidence to teach others. Specialist registrars may regard their own lack of confidence as a personal failure, not realizing that it is shared by others, and therefore feel diffident about asking for such teaching and revealing their lack of skill. There has been a lack of easily available teaching resources for self-directed learning [8]. The evidence base for many of the examination techniques used is poor. Once the problem is identified, there are a number of possible solutions. Increased specific teaching, as Mistlin suggests, is one answer, but this does not address a number of the points raised above. We had identified this concern in medical students [1], and, in a project funded by the Arthritis Research Campaign, have obtained a national, multispecialty consensus on the core set of musculoskeletal clinical examination skills that a student should learn by the time they qualify [9]. Supporting educational materials are being produced and the medical student learning guide,