The Confidence of Pediatric Trainees in Performing Musculoskeletal Screening Examination in Children in the Emirate of Abu Dhabi

Background: Pediatric residents have limited training in musculoskeletal (MSK) screening examination. This causes delay in identifying red flags that warrant referral to pediatric rheumatology. This study assessed the confidence of pediatric residents in two public teaching hospitals: Al-Mafraq Hospital (AMH) and Sheikh Khalifah Medical City (SKMC) in performing (MSK) examination. It also improved their performance by teaching them to follow a screening examination; pGALS (pediatric Gait, Arms, Legs, Spine) using video and tutor demonstration. This is a simple and reliable tool for MSK assessment, which facilitates early recognition and prompt referral. Methods: Pediatric residents anonymously answered a survey assessing their confidence in performing musculoskeletal examination. They were then offered training by a pediatric rheumatologist with video demonstration of pGALS and a practice period. Three months later, the survey was repeated. Our primary outcome was to improve the residents ́ confidence in musculoskeletal examination. The secondary outcome was to increase identification of pathology. Results: Thirty-four residents in both hospitals completed the initial survey and attended the session, 29 of them completed the follow up survey. Fifty percent of residents reported having to perform musculoskeletal examination at least once a month. Only 38% of them reported being comfortable performing it prior to the tutorial. Seventy-four percent of residents evaluated themselves at six out of ten or less in their musculoskeletal examination skills with a mean of 4.5 out of 10 indicating low level of confidence. Thirtythree residents had no systematic approach to their musculoskeletal screening. After the tutorial, all residents were using pGALS for screening and that increased confidence as 72% of residents evaluated themselves at six out of ten with a mean of 6.72 out of 10. The training has given an improvement in the resident’s mean score of 22% (p value= 0.000153). Seventeen percent of the residents reported identifying pathologies using pGALS. Conclusions: Our numbers are small but the surveys confirmed the lack of confidence in musculoskeletal examination amongst pediatric residents. Teaching the residents pGALS increased their confidence and ability to identify pathologies. PGALS should be integral to pediatric residents’ training.