Doctors likely to encounter children with musculoskeletal complaints have low confidence in their clinical skills

J Pediatr. 2009 Feb;154(2):267-71. doi: 10.1016/j.jpeds.2008.08.013. Epub 2008 Sep 27.


Objective: To assess self-rated confidence in pediatric musculoskeletal (pMSK) clinical assessment in trainees and experienced doctors in primary care and selected secondary care specialties to whom children with MSK problems are likely to present.

Study design: Attendees at programmed postgraduate teaching sessions within a health care region of the United Kingdom completed an anonymous questionnaire to self-rate confidence in pMSK assessment compared with other bodily systems and describe exposure to MSK teaching.

Results: Respondents (n = 346) were qualified from 23 different medical schools (United Kingdom and 9 non-United Kingdom) and included trainees in Primary Care (n = 75), Pediatrics (n = 39), Emergency (n = 39), Orthopedics (n = 40), and experienced doctors in Primary Care (n = 93), and Pediatrics (n = 60). Self-rated confidence in pMSK assessment was low; the majority had "no" or "some" confidence (21% and 53%, respectively). Conversely, most respondents were confident "in most aspects" or "very confident" for cardiovascular, respiratory, and abdominal systems. pMSK ranked lowest below all other systems. Most respondents (92%) recalled some teaching of adult MSK medicine, mostly at undergraduate level. Fewer (51%) recalled any teaching of pMSK medicine.

Conclusions: Self-rated confidence in pMSK assessment was lowest, compared with other bodily systems, within doctors to whom children with MSK problems are likely to present. Core clinical skills are learnt at undergraduate level, and this study reflects poor levels of pMSK training which needs to be addressed.

MeSH terms

  • Attitude of Health Personnel
  • Child
  • Clinical Competence*
  • Education, Medical
  • Humans
  • Medicine*
  • Musculoskeletal Diseases / diagnosis*
  • Physicians / psychology*
  • Self Concept*
  • Specialization*
  • Surveys and Questionnaires
  • United Kingdom