Reply

L. J. Kay, D. A. Coady and D. J. Walker

Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, UK

Correspondence to: L. Kay, Consultant Rheumatologist, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. E-mail: Lesley.Kay{at}ncl.ac.uk or Lesley.Kay{at}nuth.northy.nhs.uk

We are grateful to Drs Jawad and Dubey and colleagues for their interest in our editorial. Their letters illustrate the general agreement amongst rheumatologists that the examination skills taught to medical students are a matter of concern and that it is important to work together to improve the current situation.

It is perhaps surprising that the GALS (gait, arms, legs, spine) examination has had such a high uptake in undergraduate teaching and such a disappointing one in primary care, for which it was designed. This may reflect the lack of priority given to the musculoskeletal system in primary care vocational training, and the direct input of rheumatologists into medical undergraduate but not postgraduate training. It is not all bleak, however. Recent work by Lillicrap et al. [1] has shown that there are signs that the teaching of the GALS screening examination at medical schools is filtering through into the practice of junior doctors, leading to increased awareness and detection of musculoskeletal problems in medical patients.

We agree with Dubey and colleagues that assessment is a vital tool in learning and that students would be strongly influenced by knowledge of the existence of robust OSCE (objective structured clinical examination) stations concerning musculoskeletal examination. We also share their view that it would be a good idea for rheumatologists around the country to work together to devise and test such OSCE stations to ensure consistency and validity, as well as to save us from re-inventing the wheel.

Where we differ slightly from Dubey and colleagues is that we would regard it as more logical to start from the other end of the learning process: to put together an agreed set of learning outcomes for medical students; to facilitate the sharing of learning and teaching materials to support this set of learning outcomes; and then to design OSCE stations which test elements of this core set. We believe that, whilst it might be extremely difficult to ask clinicians to agree on a common method of musculoskeletal examination for their own use, it is much more likely that we would be able to agree on a core set of clinical skills that medical students should know and use.

We are nearing completion of a project (for which DAC is holder of an ARC Education Research Fellowship) which has sought consensus amongst rheumatologists, orthopaedic surgeons, general practitioners and geriatricians regarding core regional examination skills for medical students [2, 3]. Consensus from this wide range of specialists has been relatively straightforward to obtain, with some interesting variation between groups, and the description of core skills expected for medical students at the point of graduation is almost complete. Supporting literature and educational materials will be available via the ARC, which can then provide material for the development of OSCE stations, teaching courses and so on. We hope that these findings will be supported by the rheumatology community and can form the basis for improved and more consistent teaching and assessment of medical students for patients in whom the GALS examination has identified an abnormality.

The authors have declared no conflicts of interest.

References

  1. Lillicrap MS, Byrne E, Speed CA. Musculoskeletal assessment: 10 years on. Rheumatology 2002;41(Suppl. 1):37
  2. Coady DA, Walker DJ, Kay LJ. Which regional examination skills do clinicians think medical students should learn? Arthritis Rheum 2001;44(Suppl. 9):934
  3. Coady DA, Walker DJ, Bamford C, Kay LJ. Examination skills for medical students: results of a pilot questionnaire. Arthritis Rheum 2002;46(Suppl. 9):475[CrossRef][ISI][Medline]
Accepted 5 March 2003





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