Background/Purpose: Testing for antinuclear antibodies (ANA) is essential for diagnosing autoimmune and rheumatologic diseases. The testing has become increasingly popular in primary and specialized clinics, especially for patients with nonspecific symptoms such as myalgia and fatigue. The American College of Rheumatology has published its top five Choosing Wisely recommendations, with the first focusing on ANA and ANA sub-serology testing. However, there is concern that ANA testing is being overused without a proper understanding of its indications and interpretations, leading to false positive results, unnecessary rheumatological consultations, and additional tests. This study intends to evaluate internal medicine residents’ current knowledge and competency levels regarding ANA testing and identify areas for improvement in their medical education.

Methods:  A multicenter cross-sectional study involving internal medicine residents from 10 programs across Alabama, Michigan, and Pennsylvania was carried out. The study utilized a 12-item multiple-choice questionnaire to assess the residents’ knowledge of ANA testing. The questionnaire focused on various aspects of ANA testing, including its fundamental principles, appropriate clinical uses, interpretation of test results, and the significance of positive or negative findings in different clinical scenarios.

Results: A total of 84 internal medicine residents responded to the questionnaire. 60% of the residents identified the primary clinical indication of ordering ANA testing. About 44.83% of them correctly identified the pattern of ANA in SLE. Only 34.12% could interpret the meaning of ANA titer 1:160. Preliminary results indicate that while most residents are familiar with the basic principles of ANA testing, significant gaps exist in their ability to interpret test results and understand their clinical implications correctly. Only 60% of respondents could correctly identify the diseases most commonly associated with positive ANA results. The most commonly misunderstood areas included the differentiation between specific ANA patterns and their association with various autoimmune conditions.

Conclusion: The results of this study emphasize the importance of improving educational programs that focus on ANA testing within internal medicine residency programs. There is a need to understand better specific ANA patterns and titers and the necessary follow-up steps for positive ANA results. Enhanced training could improve diagnostic accuracy, more appropriate test utilization, and better patient outcomes. To address the knowledge gaps identified in this study, targeted educational interventions like workshops, case-based discussions, and integrated learning modules could be implemented.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-knowledge-and-aptitude-in-antinuclear-antibody-testing-among-internal-medicine-residents/