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Examination of the musculoskeletal system: junior doctors’ perceptions of the usefulness of the Gait, Arms, Legs and Spine (GALS) technique
  1. Veena Patel1,2,
  2. Prashanth Patel3,4,5,
  3. Rachel Jeffery6,
  4. James Taylor6,
  5. Hywel Thomas2
  1. 1Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2School of Education, University of Birmingham, Birmingham, UK
  3. 3Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
  4. 4NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
  5. 5Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
  6. 6Department of Rheumatology, Northampton General Hospital NHS Trust, Northampton, UK
  1. Correspondence to Dr Veena Patel, Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK; drveenabs{at}


Background Musculoskeletal (MSK) conditions affect millions of people around the world. Gait, Arms, Legs and Spine (GALS) is a simple and useful screening tool for routine MSK examination in hospitals and general practice and has been integrated into the undergraduate medical curriculum. Despite this, there is evidence that doctors lack competency in MSK examination and that GALS are underperformed routinely.

Objectives The study explored the views of junior doctors (JDs) on how they were taught MSK examination as undergraduates; the usefulness of GALS as a technique for excluding significant MSK problems; why MSK examination was often poorly carried out and how this could be improved.

Methods A qualitative study was performed with data gathered through focus group interviews from 32 JDs working in two acute NHS hospitals. Six interviews were conducted over a 6-week period from mid-June to the end of July in consecutive years 2013 and 2014.

Results Ninety JDs were invited to participate in the focus group interviews; 32 (36%) agreed to participate, 28 (88%) of whom had graduated in the UK. The perception of JDs was that undergraduate training for GALS and regional MSK examination was adequate, but reasons for lack of MSK competency in the workplace are multifactorial and complex.

Conclusions Proposing more practical and interactive sessions to reinforce MSK skills during postgraduate training may not resolve issues of MSK competency among JDs. Recognition of the complexity of workplace learning and the influence of tacit learning is required if MSK competency is to be enhanced.


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