Ensuring that all paediatricians and rheumatologists recognise significant rheumatic diseases

In many health-care systems around the world, many generalists (defined here as a clinician who is not an expert in paediatric musculoskeletal [pMSK] medicine) will be the doctor to whom children with MSK problems are most likely to present. The generalist is likely to have a clinical background in family medicine and paediatrics, but may be a specialist in adult orthopaedics, adult rheumatology or emergency care. Therefore, it is critical that the generalist is able to quickly recognise a child with significant rheumatic disease in order to initiate the proper treatment or referral to a specialist. However, most generalists are ill equipped to be able to do so, because of current deficiencies in education and training. The aims of this article are as follows:
• Demonstrate the need to improve the generalist's performance of clinical assessment in musculoskeletal medicine
• Suggest solutions within medical education and manpower planning in health care
• Focus on important areas of pMSK medicine to be learned by the generalist to help identify children with significant rheumatic disease