Sharmila Jandial

pGALS - paediatric Gait Arms Legs and Spine: a simple examination of the musculoskeletal system

We describe pGALS (paediatric Gait, Arms, Legs and Spine) – a simple quick musculoskeletal assessment to distinguish abnormal from normal joints in children and young people. The use of pGALS is aimed at the non-specialist in paediatric musculoskeletal medicine as a basic clinical skill to be used in conjunction with essential knowledge about red flags, normal development and awareness of patterns of musculoskeletal pathologies. pGALS has been validated in school-aged children and also in the context of acute general paediatrics to detect abnormal joints. We propose that pGALS is an important part of basic clinical skills to be acquired by all doctors who may be involved in the care of children. The learning of pGALS along with basic knowledge is a useful way to increase awareness of joint disease, facilitate early recognition of joint problems and prompt referral to specialist teams to optimise clinical outcomes. We have compiled this article as a resource that can be used by the paediatric rheumatology community to facilitate teaching.

Current teaching of paediatric musculoskeletal medicine within UK medical schools—a need for change

OBJECTIVES Doctors involved in the assessment of children have low confidence in their clinical skills within paediatric musculoskeletal (pMSK) medicine and demonstrate poor performance in clinical practice. Core paediatric clinical skills are taught within undergraduate child health teaching but the extent and content of pMSK clinical skills teaching within medical schools is currently unknown. The aim of this study was to describe current pMSK teaching content within child health teaching at UK medical schools. METHODS Structured questionnaires were sent to child health leads at all medical schools within the UK delivering clinical teaching (n = 30). RESULTS Child health teaching was delivered in all responding medical schools (n = 23/30) predominantly by paediatricians (consultants and senior trainees) and within secondary care. pMSK clinical skills teaching was included in 9/23, delivered predominantly within lectures and featured uncommonly in assessment (6/23, 26%). pMSK clinical skills were reported as being less well taught than other bodily systems, although the majority ranked pMSK to be of equal importance, with the exception of development. CONCLUSIONS pMSK clinical skills medicine is not part of core teaching within child health in the majority of UK medical schools. There is a need to understand the barriers to effective pMSK clinical skills teaching, to achieve consensus on what should be taught and develop resources to facilitate teaching at undergraduate level.

pGALS performs well in the hands of a medical student

Background pGALS (paediatric Gait, Arms, Legs and Spine) is a paediatric musculoskeletal (pMSK) screening examination validated for use in school-aged children [1], aimed at medical students. It is envisaged that pGALS will improve clinical skills and facilitate access to specialist care. Our aim was to assess the validity of pGALS in student hands and compare it to assessment by a consultant paediatric rheumatologist.

What do they need to know: achieving consensus on paediatric musculoskeletal content for medical students

BackgroundChildren present commonly with musculoskeletal (MSK) problems, due to a spectrum of causes including potentially life threatening disease, to doctors in varied health care settings. However, doctors involved in the care of children report a lack of confidence in their paediatric musculoskeletal (pMSK) clinical skills and many have little exposure to pMSK teaching. There is no current guidance on the pMSK clinical skills and knowledge required for medical students. The objective of this study was to achieve consensus amongst experts on the learning outcomes for a pMSK curriculum for medical students.MethodsThis was a two-phase study. In Phase one, pMSK educational topics and categories were identified from UK medical students and experts (recruited from pMSK medicine, child health, education and primary care) utilising focus groups and interviews. These themes and concepts informed the structure of learning outcomes that were presented to a Delphi panel in Phase two, with the aim of achieving consensus on the final content of the curriculum.ResultsIn Phase 1 participants identified pMSK skills, knowledge and attitudes relevant for medical students. This content was translated into learning outcomes. In Phase 2, the proposed outcomes were submitted to scrutiny by a two-iteration Delphi process with experts in the field. The agreed learning outcomes (n = 45) were either generic to child health or specific to pMSK medicine, and related to history taking and examination, knowledge about normal development, key clinical presentation and conditions, approaches to investigation and referral pathways.DiscussionThis study has identified evidence and consensu based content for a pMSK curriculum for medical students, derived from key stakeholders and to be integrated into medical student pMSK teaching.ConclusionIt is envisaged that implementation of this content will equip graduating doctors with relevant and important skills and knowledge to assess children with MSK presentations, and facilitate early diagnosis and referral to specialist care.

Paediatric musculoskeletal matters (pmm) – collaborative development of an online evidence based interactive learning tool and information resource for education in paediatric musculoskeletal medicine

BackgroundWe describe the collaborative development of an evidence based, free online resource namely ‘paediatric musculoskeletal matters’ (pmm). This resource was developed with the aim of reaching a wide range of health professionals to increase awareness, knowledge and skills within paediatric musculoskeletal medicine, thereby facilitating early diagnosis and referral to specialist care.MethodsEngagement with stakeholder groups (primary care, paediatrics, musculoskeletal specialties and medical students) informed the essential ‘core’ learning outcomes to derive content of pmm. Representatives from stakeholder groups, social science and web development experts transformed the learning outcomes into a suitable framework. Target audience representatives reviewed the framework and their opinion was gathered using an online survey (n = 74) and focus groups (n = 2). Experts in paediatric musculoskeletal medicine peer reviewed the content and design.ResultsUser preferences informed design with mobile, tablet and web compatible versions to facilitate access, various media and formats to engage users and the content presented in module format (i.e. Clinical assessment, Investigations and management, Limping child, Joint pain by site, Swollen joint(s) and Resources).ConclusionsWe propose that our collaborative and evidence-based approach has ensured that pmm is user-friendly, with readily accessible, suitable content, and will help to improve access to paediatric musculoskeletal medicine education. The content is evidence-based with the design and functionality of pmm to facilitate optimal and ‘real life’ access to information. pmm is targeted at medical students and the primary care environment although messages are transferable to all health care professionals involved in the care of children and young people.

Paediatric musculoskeletal learning needs for general practice trainees: achieving an expert consensus.

What is already known in this area Medical trainees of all specialties have poor confidence and skills in dealing with children presenting with musculoskeletal problems. There has not previously been a curriculum to direct learners in this area. What this work adds This work proposes a curriculum for paediatric musculoskeletal medicine to be taught to trainees in general practice. suggestions for future work Evaluation of the impact of introducing a curriculum on the confidence and competence of GPs in dealing with paediatric musculoskeletal disorders.

Detecting joint disease in children—dispelling the myths

Children frequently present to primary care, emergency departments and paediatricians with musculoskeletal (MSK) problems, and hence all of these professionals should be competent to perform a MSK assessment.1 Many of these children will have self-limiting illness/injury, however some will be presenting with chronic or life-threatening disease.2–4 The challenge is to reassure those with self-limiting disease, while identifying those presenting for the first time with new inflammatory arthritis such as juvenile idiopathic arthritis (JIA), or other serious conditions which can present with MSK features, such as malignancies, infections and neuromuscular diseases. There is a growing acceptance that early diagnosis and aggressive management of JIA leads to improved functional outcomes,5–7 while early access to therapies for non-inflammatory MSK disease reduces recovery times and prevents progression to pain amplification syndromes.8–10 This evidence stands in stark contrast to the reality experienced by many children with MSK disease, who still suffer long delays between disease onset and referral to a specialist service.11 ,12 Part of this delay is undoubtedly due to the paucity of training about MSK disease delivered to UK trainees in frontline specialties.13–16 This paper aims to dispel some of the myths that have developed regarding the diagnosis of joint disease in children. Children with musculoskeletal disease present with joint pain Although pain is the most common MSK symptom encountered by frontline paediatric clinicians, it is unusual for this to be the principal presenting feature of serious MSK disease.17 The majority of children with JIA present with stiffness, joint swelling, limp or functional impairment, with pain either not apparent or not verbalised. More frequently, parents notice abnormalities in an uncomplaining child such as clumsiness, a change in mood or avoidance of activities or play that were previously enjoyed. There may …

A102: Acceptability and Practicality of the Paediatric Gait, Arms, Legs and Spine Examination in Detecting Musculoskeletal Abnormalities in Peruvian Children

The paediatric Gait, Arms, Legs and Spine (pGALS) musculoskeletal examination tool (Foster & Jandial 2013) has been validated for use in school‐aged English Speaking children. pGALS detects significant joint abnormalities when performed by non specialists in paediatric rheumatology and has been shown to be practical and effective in acute paediatric practice in the UK (Goff 2010) and Malawi (Smith 2012). The aim of this study was to assess the acceptability and practicality of a Spanish translation of pGALS in an acute paediatric setting in Peru.

PReS-FINAL-2247: Confidence of UK general peadiatric trainees in musculoskeletal clinical assessment and preferences for future teaching resources

Musculoskeletal (MSK) problems in children and adolescents are common (1-4) and may represent serious life threatening disease (5-7). Many doctors have low confidence in examining childrens joints, stemming from MSK teaching not being core in many training programmes (8). In an attempt to address this, paediatric MSK competencies were introduced into the Royal College of Paediatrics and Child Health (RCPCH) training curriculum in 2007 and assessment of MSK knowledge and clinical skills was included in the mandatory professional clinical examinations for all paediatricians in 2009 (i.e. Membership of the RCPCH (MRCPCH) clinical examination).

What do medical students need to know about pediatric musculoskeletal (pMSK) medicine? Defining the learning outcomes

Purpose Musculoskeletal problems in childhood are common, presenting to both primary care and hospital specialities. However doctors involved in the care of children report poor confidence in their pMSK clinical skills; pMSK education is infrequently included in current medical school teaching within the UK and US. The development of the pediatric Gait, Arms, Legs and Spine MSK screening examination (pGALS) aimed at medical students is an important step to improving pMSK clinical skills but requires context. Our aim was to define learning outcomes (clinical skills and knowledge) within pMSK medicine to be acquired by graduation. pMSK medicine should be taught by both pMSK specialist and non-specialist teachers; a secondary aim was to identify barriers to pMSK teaching which would inform implementation of this curriculum.