What do internal medicine residents know about rheumatology? A needs assessment for curriculum design

Understanding Internal Medicine Residents' Rheumatology Knowledge Base

Rheumatology is one of the internal medicine subspecialties that residents train to become proficient in during their internal medicine training. Our study sought to understand how residents across all postgraduate year levels felt in terms of comfortability and exposure to rheumatology. We focused on the subjective measurement of resident knowledge and exposure rather than objective data. A five-question survey was distributed to all 75 residents of Lenox Hill Hospital's Internal Medicine categorical residency program, from PGY1 to PGY3. When asked if they get enough exposure or feel confident treating patients with rheumatology diseases, 96% of residents responded no. When asked about their confidence in boards, the average response was a 3/10. The residents at our program voiced a strong concern for lack of exposure and education. Other studies and institutions have shown this to be a problem that has also been seen with poor test performance on the subject. We explore educational modalities to help improve this gap in education.

A single center pilot study: assessing resident needs and faculty perceptions to improve training in rheumatology

BACKGROUND

Internal medicine (IM) residents lack confidence in rheumatology. Due to the wide variety of topics in rheumatology, identifying the most important subjects to learn during training is vital to create future interventions to increase confidence and knowledge. The preferred teaching modality for both attendings/fellows and residents is not known.

METHODS

An electronic survey was distributed to all IM residents, rheumatology fellows, and rheumatology faculty at the University of Chicago during the 2020-2021 academic year. Residents reported self-confidence levels on 10 rheumatology topics, while rheumatology attendings/fellows were asked to rank these from most to least important to learn during IM residency. All groups were asked preferred teaching modality.

RESULTS

Median confidence level [interquartile range] among residents for caring for patients with rheumatological conditions was 6 [3.6-7.5] for inpatient and 5 [3.7-6.5] for outpatient settings (10 being very confident). Attendings and fellows identified the most important topics to learn during the rheumatology rotation as ordering and interpreting autoimmune serologies and musculoskeletal exam. Both attendings/fellows and residents preferred bedside teaching in the inpatient setting and case-based learning in the outpatient setting.

CONCLUSIONS

While some disease-specific topics such as autoimmune serologies were identified as important rheumatology topics for IM residents to learn, more practical topics like musculoskeletal exam skills were also deemed important. This highlights the need for comprehensive interventions that focus on more than standardized exam topics alone to improve rheumatology confidence in IM residents. There are different preferences of teaching styles in various clinical settings.