Background Musculoskeletal (MSK) disease is one of the most common problems encountered in primary care and specialist consultations. Clinical assessment is essential to approaching MSK complaints and central to management. However many physicians are not confident in the skills necessary to handle rheumatological conditions.
Objectives This study aims to assess the self-confidence of internal medicine (IM) trainees in our institution in rheumatological knowledge and clinical skills, determine factors that may affect this, and examine if being taught the GALS (gait, arms, legs, spine) screen makes a difference to confidence in MSK examination.
Methods An email invitation was sent to all IM trainees in June 2011 with an embedded survey link. Initiation of the web-based survey by clicking on the link implied consent. The survey consisted of 18 questions asking trainees to rank their confidence in MSK examination, rheumatology knowledge and management of various disease, compared against 3 other core specialties; cardiology, pulmonology and gastroenterology. A 5-point Likert scale was used. Perception of difficulty of specialties, year of training, rheumatology exposure and interest as a future career was also captured.
Results 58 (71.6%) residents responded to the survey. Exposure to rheumatology was low; 5.2% had done a rheumatology elective in school and only 19% had done a rheumatology posting after graduation. The mean rating for self-confidence was 2.31±0.94 for knowledge in rheumatology, 2.67±0.87 for examination of the MSK system and 2.55±0.90 for correctly diagnosing a rheumatological disorder. This was significantly lower than the other 3 specialties. Trainees rated rheumatology as the most difficult specialty (4.1±0.71, p<0.0001) citing unfamiliarity with a complex subject and lack of exposure as reasons in the free text option of that question. The ankle was the joint trainees were least confident in examining (2.12±0.88) while the knee was highest (3.29±0.77). Trainees rated themselves least confident in diagnosing and managing systemic vasculitis (1.86±7.6). Although soft tissue rheumatism is a common problem, trainees rated their confidence low as well (2.24±0.91). When we evaluated factors that might affect confidence, only having done a rheumatology posting consistently increased confidence in knowledge, examination and decreased perception of difficulty (p<0.05). A higher year of training only improved confidence in examination. Interest, being taught the GALS screen and undergraduate exposure made no significant impact. The mean rating for how well the institution had prepared trainees to handle a rheumatology case was 2.84±0.85.
Conclusions Overall confidence in rheumatological skills and diagnosis is poor but improves with rheumatology postings. This should be taken into consideration when planning the IM residency curricula.
Katz SJ, Oswald AE. How confident are internal medicine residents in rheumatology versus other common internal medicine clinical skills: an issue of training time or exposure? Clin Rheumatol 2008 30(8):1081
Matzkin E, Smith EL, Preccero D, Richardson AB. Adequacy of Education in musculoskeletal medicine. J Bone Joint Surg 2005; 87(2):310
Disclosure of Interest None Declared