Background It is generally agreed that knowledge of musculoskeletal anatomy is a prerequisite to performing an adequate rheumatologic physical examination. However, little information is available regarding the level of anatomical knowledge of rheumatology fellows (RF) and practicing rheumatologists (PR).
Methods All participants in a series of musculoskeletal clinical anatomy seminars held in 5 Latin American countries under an ILAR grant in 2010 and 2011 had a one-to-one, standardized, pre-seminar evaluation in which they were asked to demonstrate or identify the structures or functions in the bodies of the participants and instructors of 20 anatomic structures. The average duration of the evaluations was 7 minutes. This exercise was accepted by the national societies, participating rheumatology services and seminar attendees. Standard summary statistics are presented. Differences between groups were tested with T test or ANOVA.
Results There were 191 participants in the study. These included 113 (59.1%) RF from 15 training programs, 55 (28.7%) PR and 23 (12%) non-rheumatologist health care professionals (NRHP). PR had a median experience of 10 (range 3-46) yrs. Mean number of correct answers (out of 20 questions) was 9.04 (95CI: 8.49 to 9.53) for all participants. Of these, 37.7% answered correctly <5 questions, 56.7% 5-15 questions and 5.8% >15 questions. Correct answers in RF averaged 9.24 (95CI: 8.55 to 9.92), in PR 9.03 (95CI: 8.05 to 10.03) and in NRHP 7.91 (95CI: 6.47 to 9.36) (ANOVA p=0.439). When 1st year fellows we recompared with 2nd, or 2nd plus 3rd (oneprogram) year fellows, a significant difference was found favoring the latter [8.38 (95CI: 7.37 to 9.40) vs 9.91 (95CI: 8.9 to 10.7), p=0.02]. Anatomical knowledge in PR was unrelated to length of experience (Pearson’s r=0.21, p=0.11), [0-5yr 8.59 (95CI: 6.94 to 10.24), 6 -10yrs 7.67 (95CI: 5.12 to 10.21) and >10yrs 9.70 (95CI: 8.2 to 11.21) (ANOVA p=0.363].
Conclusions Anatomical knowledge is far from satisfactory for most RF, PR and NRHP tested in Latin America. Although RF fared better in the 2nd plus 3rd year of training most fellows failed to correctly identify the majority of structures or functions and only 9.3% obtained >15 of the 20 correct answers. For PR length of practice had no bearing on anatomical knowledge. The lowest scores were found in NRHP. Efforts should be made to improve anatomical knowledge early during rheumatology training to improve physical examination skills and understanding of the anatomic basis of regional pain syndromes. Also, clinical anatomy should be emphasized in continuing medical education activities for PR and NRHP. Improved clinical skills in anatomic diagnosis and the resulting decreased dependence on technology may ultimately result in societal cost saving. Data from other parts of the world should be obtained as the knowledge gap we perceived may not be limited to Latin America.
Disclosure of Interest None Declared