Do French medical schools provide appropriate training on gait and gait disorders?




Abstract


Aim


Evaluate the need for integrated teaching on normal and pathological gait at medical school.


Method


A questionnaire filled out by 91 French general practitioners (GPs, 130 of whom were contacted) with an average of 19 years of practice and 56 sixth-year medical students. Assessment of the students’ knowledge of normal and pathological gait.


Results


Seventy-two percent of the GPs and 82% of the students considered gait to be a frequent reason for consultation. Eighty-nine percent of the GPs and 98% of the students stated that they had difficulty analysing a gait disorder. Eighty percent of the GPs and 50% of the students considered that the teaching on gait and gait disorders at medical school was insufficient. The responses notably highlighted the poor coordination between teachers from the various disciplines involved. The students’ knowledge of gait was poor (only 20% of their answers were correct). This was especially true for semiological questions, which were correctly answered by less than one student in 10.


Conclusion


The results of the present study demonstrate that French medical schools need to provide better teaching on gait. We, therefore, propose the implementation of an integrated teaching programme with a sufficient focus on functional and semiological approaches.


Résumé


Objectif


Évaluer le besoin d’un enseignement intégré de la marche normale et pathologique à la faculté de médecine.


Méthode


Questionnaire rempli par 91 médecins généralistes installés en moyenne depuis 19 ans (sur 130 contactés) et 56 étudiants en fin de sixième année de médecine. Évaluation du niveau de connaissance de ces étudiants volontaires sur la marche normale et pathologique.


Résultats


Soixante-douze pour cent des médecins et 82 % des étudiants considéraient la marche comme un motif fréquent de consultation. Quatre-vingt-neuf pour cent des médecins et 98 % des étudiants se disaient être en difficulté pour analyser un trouble de la marche. L’enseignement de la marche à la faculté était jugé insuffisant pour 80 % des médecins et 50 % des étudiants qui pointaient l’insuffisance de coordination entre les enseignants des disciplines impliquées dans cet enseignement. Les connaissances des étudiants sur la marche étaient faibles (avec un taux moyen de bonnes réponses de 20 %), particulièrement en sémiologie où moins d’un étudiant sur dix répondait correctement à chaque question à choix multiple.


Conclusion


Cette étude plaide pour une amélioration de l’enseignement de la marche durant les études médicales. Nous suggérons un mode d’enseignement intégré faisant une bonne place à la sémiologie et l’analyse fonctionnelle.


1


English version


The main objective of the teaching provided at medical schools is to provide the students with the common body of knowledge and skills, which will enable them to deal with situations frequently encountered in routine practice. In France, there is a surprising contrast between the importance of functional gait in activities of daily living and the low amount of teaching devoted to this subject in initial medical training. Although the third, fourth, fifth and sixth years at medical school include modules which are directly or indirectly related to pathological gait , many students are ill at ease when faced with a gait disorder in the clinic. Does this lack of confidence result from high-quality but over-compartmentalized, discipline-by-discipline teaching? We decided to test this hypothesis in the present study. Moreover, normal gait is one of the few functions not to be addressed in a specific teaching programme. But what could be more difficult than learning about pathological gait when the student does not even understand normal gait? Furthermore, many of our correspondents have stated the need to improve their knowledge of normal and pathological gait. We, therefore, sought to objectively evaluate the need for integrated teaching on normal and pathological gait at medical school. We quantified:



  • •

    the need for this type of teaching stated by a sample of practicing general practitioners (GPs) and medical students nearing the end of their sixth year at a large French medical school;


  • •

    the students’ level of knowledge concerning normal and pathological gait.



This article presents the results of our survey.


1.1


Materials and methods


1.1.1


A survey of general practitioners’ opinion of medical school teaching on gait


We evaluated the need felt by GPs to improve their knowledge of normal and pathological gait. In particular, we asked them to state:



  • •

    the frequency of “gait disorders” as a reason for consultation in general practice;


  • •

    whether they ever had difficulty managing patients presenting a gait disorder;


  • •

    their opinion of the teaching on normal and pathological gait provided at medical school;


  • •

    their opinion concerning the need for individualized teaching on gait and its disorders at medical school.



We posted a paper questionnaire to 130 GPs practicing in urban or rural areas of the Languedoc-Roussillon region of southern France. This panel comprised 93 physicians particularly involved in the continuing medical education of GPs at Montpellier Faculty of Medicine and 37 GPs with whom the authors of the present work correspond on a regular basis. The 8-item questionnaire is given in Table 1 . Some questions were closed (requiring a “yes”/“no” answer) and others required a short, open answer.



Table 1

The questionnaire sent to 130 general practitioners in order to evaluate their opinion on the need to improve their knowledge of normal and pathological gait.

















































Question 1 How do you rate the teaching on gait and gait disorders provided during the first 6 years at medical school?
1a. Insufficient: reply by either “yes” or “no”
Replies given by the practicing GPs: 13.6% did not reply. 80.2% stated that medical school teaching on gait was insufficient, whereas 6.2% had the opposite opinion
1b. Lack of coordination between the lecturers: reply by either “yes” or “no”
Replies given by the practicing GPs: 37% did not reply, 53.1% stated that the teaching suffered from a lack of coordination between the lecturers, whereas 9.9% had the opposite opinion
1c. Appropriate: reply by either “yes” or “no”
Replies given by the practicing GPs: 34.6% did not reply, 54.3% stated that the teaching was not appropriate, whereas the 11.1% had the opposite opinion
Question 2 In your practice, do gait disorders (or their complications) constitute a frequent reason for consultation?
Replies given by the practicing GPs: all provided an answer and 71.6% considered that gait disorders (or their complications) constitute a frequent reason for consultation
Question 3 Do you have difficulty analyzing a gait disorder?
Replies given by the practicing GPs: 2 physicians (2.5%) did not reply, 88.9% said that they did have difficulty and only 8.6% said that they did not have any difficulty
Question 4 In your opinion, would it be of value to individualize the teaching on gait and its disorders provided during the first 6 years at medical school?
Replies given by the practicing GPs: 3 physicians (3.7%) did not reply, 88.9% considered that it would be of value to individualize the teaching, whereas 7.4% disagreed
Question 5 Do you have any comments to add to questionnaire?
Question 6 For how many years have you been in practice?
Question 7 How many consultations do you do per day? (optional)



















Question 8 What is your caseload’s breakdown by age class (in %)?
0 to 15 years of age % 16 to 65 % 66 to 75 % Over 75 %


We received 91 responses, i.e., a satisfactory response rate of 70% (especially since all the responses were analyzable). On average, the respondees had been practicing for 18.6 ± 6.6 years (the data for this parameter were normally distributed) and performed 23 ± 5.6 consultations per day (median: 23); 4.5 ± 2 with children (under the age of 16), 10.3 ± 4.8 with adults aged from 16 to 65, 4.5 ± 2.6 with adults aged from 66 to 75 years and 3.9 ± 2.8 with adults over the age of 75.


1.1.2


The students’ opinion of medical school teaching on gait


We asked 56 medical students at the end of their sixth year or the start of their seventh year at Montpellier-Nîmes Faculty of Medicine to give their opinion of medical school teaching on gait. The students were asked the first four questions put to the qualified, practicing GPs ( Table 1 ).


1.1.3


Assessment of the students’ knowledge of gait


We evaluated the 56-student panel’s knowledge of normal and pathological gait during an end-of-year meeting in a lecture room. We asked the participants to complete a 12-item questionnaire ( Table 2 ). The respondees could take as long as they wished to answer the questions but were not allowed to consult other documents. The wide-ranging set of “yes”/“no”, multiple-choice and short, open questions was chosen to broadly assess the various aspects of normal and pathological gait, including evaluation, semiology and treatment in children, adults and the elderly ( Table 2 ). We checked that all the answers to the 12 questions had indeed been given during the first 5 years of the students’ medical education. For the multiple choice questions, only single, exact answers were scored as correct.


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Apr 23, 2017 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Do French medical schools provide appropriate training on gait and gait disorders?

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