EVALUATION OF THE IMPACT OF A PAEDIATRIC GAIT, ARMS, LEGS AND SPINE (PGALS) PHYSICAL EXAMINATION WORKSHOP ON THIRD-YEAR MEDICAL STUDENTS’ CONFIDENCE IN PERFORMING PEDIATRIC MUSCULOSKELETAL EXAMINATIONS
Bibliographic record
Abstract
BACKGROUND: Musculoskeletal (MSK) complaints in children account for up to 30% of visits to primary care providers. Studies show that delays in appropriate care for children with MSK complaints may be related to a lack of confidence in primary care providers performing paediatric MSK physical examinations. This may be due to the fact that examining the MSK system in children is under taught in medical school, and physical examination of the joints is uncommonly documented by trainees. The paediatric Gait, Arms, Legs, Spine (pGALS) examination is a quick MSK screening examination validated for use in school-aged children to discern normal from abnormal joints. It was introduced as a mandatory workshop during the 2015-16 paediatric clerkship for third-year medical students at our center. OBJECTIVES: To assess the impact of a pGALS workshop on medical students’ confidence in performing paediatric MSK examinations. DESIGN/METHODS: Students were invited to complete a pre-workshop questionnaire pertaining to baseline knowledge, prior learning, and confidence in examining childrens joints alone and compared to other body systems exams. Students completed a second confidence questionnaire at the end of their rotation,and again 6 months afterwards, to evaluate changes in confidence and whether they continued to use these skills.Paired t-test was used to compare confidence in performing MSK exam between pre- and post- workshop and between pre- and 6 months post workshop. RESULTS: During the 2015-16 academic year, 127 third-year medical students completed the baseline questionnaire. Mean confidence at baseline was 1.87 (CI 1.71, 2.01) on a 4-point Likert scale (1=not at all, 2=confident in some aspects, 3=confident in most aspects, 4=very confident). Following the rotation, mean confidence increased to 2.86 (CI 2.75, 2.96) representing a 53% increase inmean confidence ratings (p=0.00). Six-month follow-up data for the first three cohorts of students demonstrates a mean confidence of 2.45 (CI 2.13, 2.77), a 31% increase in mean confidence (p=0.031) from baseline. During the pediatrics clerkship, 82/141 (58%) students used pGALS after the workshop. Six months after the pediatrics clerkship, 12/33 (36%) students had used pGALS in various settings (ER, wards, clinics) for MSK and non-MSK complaints. CONCLUSION: Students report low levels of confidence in performing pediatric MSK physical examinations. The pGALS workshop significantly increased their confidence; this waned after 6 months, but remained above baseline confidence. Recurrent opportunities to practice and be assessed on these skills would likely be beneficial to sustain learners confidence so that they may integrate this into ongoing clinical care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".