Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey

BMC Med Educ. 2016 Oct 21;16(1):277. doi: 10.1186/s12909-016-0799-6.


Background: Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice.

Methods: Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training.

Results: Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools.

Conclusions: We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

Keywords: Clinical practice; Examination; GALS; Medical education; Musculoskeletal; Postgraduate; Questionnaire; REMS; Undergraduate; pGALS.

MeSH terms

  • Adult
  • Clinical Competence*
  • Education, Medical, Undergraduate / methods*
  • Female
  • Humans
  • Male
  • Musculoskeletal Diseases / diagnosis*
  • Physical Examination*
  • Surveys and Questionnaires
  • Teaching
  • United Kingdom