A145: Faculty and Resident Perceptions About Teaching and Learning the Pediatric Musculoskeletal Examination: An Exploratory Study
Authors: Hutchinson Clare , Reeves Scott , Martimianakis Tina , Schneider Rayfel , Yudkowsky Rachel , Harris Ilene 
Published: March 2014

Background/Purpose:

he purpose of this research project is to explore how we currently teach the musculoskeletal exam to Pediatric residents and how they experience the acquisition of this set of skills. All second year General Pediatric residents at the Hospital for Sick Children in Toronto, Canada, spend four weeks on the Pediatric Rheumatology service. For the majority of them this will be their only post‐graduate education in musculoskeletal medicine. Many diseases in Pediatric Rheumatology are diagnosed based on the clinical exam, and we rely on these future Pediatricians to identify children who require the assessment of a subspecialist. Unfortunately, despite our efforts in teaching the musculoskeletal exam, many Pediatric patients will have significant functional limitations identified on their first visit to a Pediatric Rheumatologist due to delays in recognition of their inflammatory joint disease. The manner in which the Pediatric musculoskeletal is taught and learned may be at the root of the problem.

Methods:

A qualitative study designed to investigate and describe the experiences of teachers and learners of the Pediatric musculoskeletal exam in a single tertiary care centre was conducted. The study population consisted of a purposeful sample of Pediatric Rheumatology teaching faculty and General Pediatric residents who have completed their Pediatric Rheumatology rotation. Semi‐structured individual interviews of approximately one‐hour duration were conducted in‐person with each participant. Sample size was determined as the study progressed; interviews were continued until saturation of themes was reached. Interviews were transcribed verbatim, and were analyzed on a rolling basis, using a constant comparative method of analysis associated with grounded theory. The primary investigator identified themes and a coding system was developed, with a sample of the interviews coded by a second investigator for assessment of inter‐coder agreement.

Results:

Twenty‐two (22) interviews were conducted, with 7 General Pediatric junior residents, 7 senior residents, and 8 Pediatric Rheumatology faculty. Themes identified included: 1) characteristics of the Pediatric musculoskeletal exam (accuracy and reliability of the exam, utility of a screening exam vs. specific maneuvers); 2) factors that support learning the exam (direct observation with immediate feedback and repetition, learning multiple examination techniques from different teachers); 3) barriers to learning the exam (multiple examiners become an inconvenience to families, passive learning as a missed teaching opportunity); and 4) issues of professionalism (residents' desire to appear professional and competent in front of patients, taking ownership of their learning).

Conclusion:

Themes identified illustrate multiple perceived strengths and weaknesses in how the musculoskeletal examination is taught to General Pediatric residents. The factors that facilitate learning the musculoskeletal examination may be used to inform future curriculum development.