title: Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?
abstract: Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.
authors.affiliation: Department of Rheumatology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK. iain.goff@ncl.ac.uk.|Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. iain.goff@ncl.ac.uk.
authors.forename: Iain
authors.initials: I
authors.lastname: Goff
authors.affiliation: Washington Primary Care Centre, Washington, Tyne and Wear, UK.|Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Elspeth Mary
authors.initials: EM
authors.lastname: Wise
authors.affiliation: Sunderland Royal Hospital, Sunderland, UK.|Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: David
authors.initials: D
authors.lastname: Coady
authors.affiliation: Department of Rheumatology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK.|Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: David
authors.initials: D
authors.lastname: Walker
mesh_terms: D002983:Clinical Competence; D058006:General Practice / Q000193:education*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000453:epidemiology*; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology
keywords: Epidemiology; General arthritis; Medical education