Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Attitudes of Pediatric Residents Regarding Musculoskeletal Evaluation and Complaints.

Guirola1,  Ricardo, Muscal2,  Eyal, Arnold2,  Jennifer L.

Texas Children's Hospital, Houston, TX
Baylor College of Medicine, Houston, TX


Musculoskeletal (MSK) conditions may affect up to 30% of children and adolescents. Adult medicine trainees and general practitioners have expressed poor confidence in MSK knowledge and skills, confidence and comfort level. Similar domains have not been evaluated in US pediatric residency training programs.

The aim of this study was to evaluate attitudes regarding MSK skills and training of pediatric residents at a tertiary care residency program. We hypothesized that pediatric residents, like trainees in adult medicine, would: a) have low levels of comfort performing MSK exams and b) express low confidence in evaluating MSK complaints.


In January of 2011 pediatric residents at Texas Children's Hospital/ Baylor College of Medicine were sent a 16 question survey via a link in survey monkey. Survey results were compiled over a 5 month period. We analyzed relationships between survey responses and type of trainee (pediatric vs. medicine-pediatric), and post-graduate year (PGY level) using non-parametric tests of association for ordinal variables (Kendal tau-b coefficient, T).


101 out of 161 (62.7%) pediatric residents at our institution completed the survey. The responders included 31 (30.7%) PGY-1 residents, 36 (35.6 %) PGY-2 residents, 29 (28.7%) PGY-3 residents, and 5 (5.0%) PGY-4 residents (all medicine-pediatric). Fifteen of the survey respondents (14.8%) were medicine-pediatric residents. Eighty-two (82%) of responders believed that MSK medicine was important towards their future career. Medicine-pediatrics training was more strongly associated with this belief (T =0.208, p=0.02). Fifty-seven (56.4%) of the residents expressed discomfort in performing a MSK exam. Comfort levels increased after PGY-1 year and throughout training although these associations were not statistically significant (T =0.133, p=0.12). Seventy (69.3%) of the residents expressed a lack of confidence in making diagnoses for patients with MSK complaints. Confidence levels increased over time (maximum PGY-2 38.9 %[n=29] and PGY-4 80%[n=5]). Associations with PGY status was statistically significant (T=0.234, p<0.01). Higher comfort and confidence levels of medicine-pediatric residents were not statistically significant. Ninety-one residents (89.1%) believed that MSK training was not adequate and indeed only 48.5% stated previous formal MSK training. The acknowledgement of formal training increased throughout training (maximum % in PGY-3 and PGY-4 by 65.5% and 100% respectively, T =0.326, p=0.01). Medicine-pediatric residents (throughout all years of training) were not more likely to describe additional formal MSK training when compared to their categorical pediatric counterparts.


Pediatric trainees expressed low confidence, and discomfort with their MSK skills. Most residents expressed inadequacy of MSK medicine training. These negative perceptions were not ameliorated at the completion of training. Pediatric trainees at our institution were aware of the importance of MSK medicine and may be motivated to improve their skills. Evaluation of the effectiveness of standardized patients and web based modules to improve pediatric resident skills in MSK medicine is needed.

To cite this abstract, please use the following information:
Guirola, Ricardo, Muscal, Eyal, Arnold, Jennifer L.; Attitudes of Pediatric Residents Regarding Musculoskeletal Evaluation and Complaints. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :94

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