The Country Where You Perform Your Rheumatology Training Is Associated with the Acquired Confidence, the Education Received and the Assessment in Core Competences

Francisca Sivera¹, Sofia Ramiro², Nada Cikes³, Maxime Dougados⁴, Laure Gossec⁵, Tore K. Kvien⁶, Ingrid E. Lundberg⁷, Peter Mandl⁸, Arumugam Moorthy⁹, Sonia Panchal⁹, J.A.P. da Silva¹⁰, Johannes W J Bijlsma¹¹ and Working Group on Training in Rheumatology across Europe, ¹Reumatología, Hospital General Universitario de Elda, Alicante, Spain, ²Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ³University Hospital Centre Zagreb, Zagreb, Croatia, ⁴Hopital Cochin, Paris Descartes University, Paris, France, ⁵AP-HP, Hôpital Pitié Salpêtrière, Rheumatology Department; Sorbonne Universités, UPMC Univ Paris 06, Paris, France, ⁶Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ⁷Karolinska University Hospital, Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden, ⁸Dpt Rheumatology, Medical University of Vienna, Vienna, Austria, ⁹Rheumatology, University Hospitals of Leicester, Leicester, United Kingdom, ¹⁰Centro Hospitalar e Universitário de Coimbra - Hospitais da Universidade de Coimbra, EPE, Coimbra, Portugal, ¹¹Rheumatology and Clinical Immunology, ARC Amsterdam; UMC Utrecht, Utrecht, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Education, educational research and trainee, medical

Session Information

Date: Monday, November 9, 2015

Title: Education Poster I

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

To assess the association between the country where rheumatology training takes place and the acquired confidence, exposure to education, practical experience and competence assessments in 21 core competences

Methods:

As part of a European project to evaluate the differences in training in rheumatology across Europe, we developed an online survey to assess the training experience. The target population was rheumatology trainees and rheumatologists certified in the past 5 years. We selected 21 competences, core to rheumatology: 13 clinical (MSK examination, detecting synovitis, managing a patient with monoarthritis, lab test interpretation, managing a patient with OA, gout, early RA/undifferentiated arthritis, SpA, CTD, vasculitis, OP, with a biologic DMARD, using disease activity measures), 4 procedures (knee arthrocentesis, crystal identification, hand X-ray interpretation, performing an MSK US) and 4 generic competences (engaging in a multidisciplinary team, interpreting a research paper, performing a scientific presentation, and patient communication). For each competence, respondents were asked to assess the confidence in their abilities (0-10), the exposure to formal education (yes/no), the amount of patient experience (0; 1-10; 11-50; 51-100; 101-150; >150) and assessment (yes/no) where appropriate. For each competence, regression models (linear or logistic, as appropriate) were developed to assess the influence of country of training on the level of confidence, education, practical experience and assessment for that given competence.

Results:

1079 answers were included in the analysis (30% male, 52% trainees) from the 41 EULAR countries that offer rheumatology post-graduate training. For all given competences, the country of training was significantly associated with the acquired confidence. For example, trainees from the UK (arbitrary reference) had on average 1.4 points higher confidence in their ability to manage a patient with early RA than a trainee from France (Table 1). Education and managing >10 patients were also associated with the acquired confidence for all competences. The existence of an assessment was associated to the level of confidence for only some competences (MSK exam, managing a patient with CTD, with vasculitis, crystal ID, MSK US, multidisciplinary team and interpreting a paper).

		Regression coefficient	95% CI
Age	≤ 25 years	Reference
	26-30 years	0.73	0.06, 1.39
	31-35 years	0.72	0.03, 1.40
	36-40 years	0.79	0.07, 1.51
	>40 years	0.71	-0.05, 1.46
Gender	Male vs female	-0.20	-0.37, -0.03
Trainee vs rheumatologist		0.25	0.06, 0.44
Country*	UK	Reference
	1 – Albania	-2.62	-3.55, -1.69
	2 – Armenia	-1.05	-3.45, 1.34
	3 – Austria	-0.12	-0.81, 0.57
	4 – Belarus	0.15	-1.27, 1.56
	5 – Belgium	-0.55	-1.26, 0.16
	6 – Bosnia	0.42	-0.56, 1.41
	7 – Bulgaria	-0.14	-1.06, 0.78
	8 – Croatia	-0.49	-1.46, 0.48
	10 – Czech Rep	-0.92	-1.49, -0.36
	11 – Denmark	-0.08	-0.54, 0.38
	12 – Estonia	-0.21	-1.15, 0.72
	13 – Finland	-0.49	-1.26, 0.28
	14 – France	-1.44	-1.91, -0.97
	15 – Georgia	-0.55	-1.62, 0.52
	16 – Germany	-0.20	-0.88, 0.48
	17 – Greece	-0.87	-1.40, -0.33
	18 – Hungary	-0.86	-1.41, -0.32
	20 – Ireland	0.11	-0.58, 0.80
	21 – Israel	-0.43	-1.11, 0.24
	22 – Italy	-0.86	-1.58, -0.14
	23 – Lebanon	-0.06	-1.03, 0.92
	24 – Latvia	-2.55	-3.96, -1.14
	25 – Lithuania	-0.69	-1.75, 0.36
	26 – Macedonia	-0.19	-1.31, 0.92
	27 – Malta	-0.90	-2.61, 0.81
	28 – Moldova	-1.75	-4.13, 0.63
	30 – Netherlands	-0.03	-0.63, 0.57
	31 – Norway	-0.20	-0.73, 0.32
	32 – Poland	-1.24	-1.74, -0.74
	33 – Portugal	-0.10	-0.64, 0.44
	34 – Romania	-0.82	-1.32, -0.31
	35 – Russia	-1.16	-1.81, -0.50
	37 – Serbia	-0.97	-1.71, -0.24
	38 – Slovakia	-0.41	-1.11, 0.28
	39 – Slovenia	0.04	-0.79, 0.87
	40 – Spain	-0.51	-0.99, -0.03
	41 – Sweden	-0.29	-0.94, 0.36
	42 – Switzerland	-0.16	-0.76, 0.44
	43 – Turkey (GIM)	-0.80	-1.34, -0.27
	44 – Turkey (Physical therapy)	-0.40	-1.17, 0.38
	46 – Ukraine	-1.54	-2.95, -0.13
Education (yes vs no)		0.54	0.28, 0.81
Assessment (yes vs no)		-0.05	-0.22, 0.12
Patient exposure (>10 vs ≤10)		0.88	0.60, 1.15
* p<0.0001 for overall effect of country variable (with all dummies in the model)

The country of training was also associated with a higher odds of receiving formal education, of being exposed to >10 patients and of being assessed in a given competence (all separate multivariable models).

Conclusion:

The European country where rheumatology postgraduate training is performed is associated with the level of confidence acquired, the odds of receiving formal education, the odds of acquiring patient experience and the odds of being assessed in core rheumatic competences. Further attempts are needed to harmonize educational outcomes of rheumatology training across Europe.

Disclosure: F. Sivera, None; S. Ramiro, None; N. Cikes, None; M. Dougados, None; L. Gossec, None; T. K. Kvien, None; I. E. Lundberg, None; P. Mandl, None; A. Moorthy, None; S. Panchal, None; J. A. P. da Silva, None; J. W. J. Bijlsma, None.

To cite this abstract in AMA style:

Sivera F, Ramiro S, Cikes N, Dougados M, Gossec L, Kvien TK, Lundberg IE, Mandl P, Moorthy A, Panchal S, da Silva JAP, Bijlsma JWJ. The Country Where You Perform Your Rheumatology Training Is Associated with the Acquired Confidence, the Education Received and the Assessment in Core Competences [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-country-where-you-perform-your-rheumatology-training-is-associated-with-the-acquired-confidence-the-education-received-and-the-assessment-in-core-competences/. Accessed .

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