Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
Correspondence to: L. Kay. E-mail: Lesley.Kay{at}ncl.ac.uk
Mistlin's survey is a timely reminder that the well-known problem of poor confidence in musculoskeletal examination skills is not confined to medical students [1], general practitioners [2, 3] or general physicians [4], but is present also in rheumatology specialist registrars. This problem has been generally overlooked and has a number of possible causes.
There has historically been little or no agreement on what to teach students [5], with resulting diversity of student experience [6] and lack of confidence and use of such skills [7]. With this background, most clinicians have developed their own examination techniques and routines, which may in turn affect their confidence to teach others.
Specialist registrars may regard their own lack of confidence as a personal failure, not realizing that it is shared by others, and therefore feel diffident about asking for such teaching and revealing their lack of skill.
There has been a lack of easily available teaching resources for self-directed learning [8].
The evidence base for many of the examination techniques used is poor.
Once the problem is identified, there are a number of possible solutions. Increased specific teaching, as Mistlin suggests, is one answer, but this does not address a number of the points raised above. We had identified this concern in medical students [1], and, in a project funded by the Arthritis Research Campaign, have obtained a national, multispecialty consensus on the core set of musculoskeletal clinical examination skills that a student should learn by the time they qualify [9]. Supporting educational materials are being produced and the medical student learning guide, Introduction to the locomotor system [10], is being revised to incorporate this. We propose that this approach could be used for different parts of postgraduate training, as a series of building blocks. It is likely that the musculoskeletal examination skill set required for medical general professional training will have elements not required by medical students, and that it will be different again for rheumatology higher trainees, and for other professional groups, such as paediatricians and orthopaedic surgeons. Such an approach, ensuring agreement about a core skill set, allows more consistent teaching and learning, fairer assessment, and the development of materials for self-directed learning. It may also give specialist registrars and their supervisors the confidence to discuss these problems more openly.
The authors have declared no conflicts of interest.
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