A mixed-methods qualitative study of Northern Ireland GP specialty trainees’ clinical confidence and teaching expectations in musculoskeletal medicine

Background Musculoskeletal (MSK) conditions represent a substantial burden in primary care, accounting for one-third of disability-adjusted life years and approximately one in seven GP consultations. Despite this prevalence, concerns persist regarding GP trainee confidence and training adequacy in MSK medicine. Aim To evaluate the confidence, experience, and training preferences of Northern Ireland GP specialty trainees in musculoskeletal medicine. Design & setting A mixed-methods study carried out across Northern Ireland GP training localities, integrating an online survey and semi-structured interviews to examine GP trainees’ clinical confidence and educational needs in musculoskeletal medicine. Method Mixed-methods study combining an online survey (n=54 respondents from 103 eligible ST2 trainees, 40.7% response rate) with semi-structured interviews (n=8 participants). Thematic analysis identified key themes using NVivo software. Results Trainees demonstrated moderate confidence in common examinations (knee and spine) but significant gaps in specialist areas including sports injuries, neuromuscular deficits, and procedural skills. Five major themes emerged: inconsistent foundational learning, undervalued MSK medicine, confidence gaps, desire for structural improvements, and support for interdisciplinary learning. Physiotherapists were overwhelmingly preferred as allied health educators (95.1% ranked first). Most trainees (52.38%) were neutral about training quality, with 40% dissatisfied with training quantity. Conclusion A substantial mismatch exists between the prevalence of MSK presentations in general practice and the adequacy of training provided. Trainees advocate for increased practical, case-based learning in small groups with interdisciplinary involvement throughout their training programme.