Background The current curriculum for specialist registrars training in general internal medicine (GIM) is designed to expose trainees to manage a variety of conditions that are representative of the various medical specialties. It is expected they should have adequate training in order to deliver good quality care to patients when they come in contact with. Patients with rheumatologic diseases can present to multiple specialties as part of their disease process. GIM trainees should be confident to manage these patients as the initial point of contact before referring them on to rheumatology.
Objectives 1)To assess the confidence of GIM trainees in the assessment of patients with rheumatologic conditions.
2)To explore the confidence of GIM trainees in requesting and interpreting rheumatologic investigations.
Methods The survey was carried out using a questionnaire based proforma administered by the interviewer. Questionnaires were distributed to GIM trainees during the monthly regional royal college of physicians specialist registrar training days. The proforma had initially been piloted and redesigned. Data from 50 respondents were collected and analysed using online software.
Results N=50. Almost a quarter of respondents were in the penultimate year of completion of their GIM training and this grade represented the majority of the respondents. An average of 3 patients with rheumatic disease were seen in a 3-month period by the trainees with an average of one acute on-call every 9 days. Nearly half of the respondents were confident at managing patients with hot swollen joints. 25%(12) of GIM trainees were not confident at aspirating a hot swollen joint.
64%(32) of trainees were confident about assessing a patient with rheumatoid arthritis having an acute flare. 16%(8) however were not confident to do so. Nearly 50%(25) of trainees were not confident about assessing a patient with suspected inflammatory back pain.
Almost two-thirds of GIM trainees were fairly confident about requesting rheumatologic investigations, while 8%(4) of them were not confident at requesting these tests. Nearly a third of the GIM trainees were not confident at the interpretation of the rheumatologic tests once they have been requested.
Conclusions This is the first study of its kind exploring the confidence of GIM trainees in assessing patients with rheumatologic disease. We found overall that GIM trainees were less confident in assessing patients with suspected inflammatory back pain as well as in interpreting common rheumatologic investigations. A large number indicated that they were not confident at aspirating joints other than the knee joint. We recommend GIM trainees be given more education in rheumatology. Either in the form of web based learning or through increasing the amount rheumatology sessions included in the specialist registrar study days.
Federation of the Royal Colleges of Physicians of the UK. The physician of tomorrow. Curriculum for general internal medicine (acute medicine). London: RCP, 2007.
Royal College of Physicians. Continuity of care for medical inpatients: standards of good practice. London: RCP, 2004.
General Medical Council’s (GMC) Handbook Good Medical Practice.
Disclosure of Interest None Declared