Background/Purpose: In an effort to redesign our rheumatology curriculum for internal medicine (IM) residents, we sought to understand the correlations between IM resident in-training exam (ITE) scores, self-reported confidence, rheumatologists’ perception of residents’ proficiency, and diagnoses seen in rheumatology clinic.

Methods: All data was collected from a single academic medical center. We analyzed IM resident ITE scores on rheumatology-related educational objectives from 2010-2017. Objectives were divided into 10 categories defined by the ABIM Certification Examination Blueprint: RA, SpA, SLE, SSc, OA, crystalline arthritis, infectious arthritis, vasculitis, bone disease, and regional musculoskeletal. In spring 2018, we surveyed IM residents on their self-reported confidence and rheumatology fellows, faculty, and advanced practice providers (APPs) on their perceived proficiency of IM residents in these same 10 categories on a 10-point Likert scale. In addition, we tallied diagnoses seen by IM residents in rheumatology clinic from January-April 2018 in each of these categories. Pearson correlation coefficients were calculated between these measures.

Results: The average ITE score on rheumatology-related educational objectives was 66.3%. The lowest average score was in crystalline arthritis (55.9%) and the highest was in SLE (73.4%). Regarding survey data, everyone who received a survey responded (response rate 100%). The resident survey included 38 residents (17 interns, 21 upper-levels). The lowest average confidence was in vasculitis (3.68) and the highest was in OA (7.53). The rheumatologist survey included 22 respondents (7 fellows, 12 faculty, 3 APPs). The lowest average perceived proficiency was in SSc (3.80) and the highest was in OA (6.14). Of 143 diagnoses seen by IM residents in rheumatology clinic, the least common diagnosis category was infectious arthritis (n = 0) and the most common was RA (n = 40). There was a positive correlation between resident confidence and rheumatologists’ perceived proficiency (r = 0.934, p < 0.001). In contrast, there was no statistically significant correlation between resident ITE scores and resident confidence (r= -0.474, p = 0.166), rheumatologist’s perceived proficiency (r = -0.442, p = 0.201), or number of diagnoses seen in rheumatology clinic (r = -0.319, p = 0.369), all showing a trend towards a negative correlation. In particular, crystalline arthritis was second highest in resident confidence (6.95), third highest in perceived proficiency by rheumatologists (5.43), and the third most common diagnosis encountered by residents in rheumatology clinic (n = 16), though it had the lowest ITE scores.

Conclusion: IM resident confidence correlates with rheumatologists’ perceptions of their proficiency in core rheumatology topics. However, ITE scores do not correlate with either of these measures. Thus, common diagnoses like crystalline arthritis and OA that are felt to be simple may be overlooked in IM resident education. When designing curricula, rheumatology educators should not rely on perceptions and instead must analyze objective assessments like the ITE to identify significant gaps in IM resident knowledge.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-needs-assessment-to-inform-rheumatology-curriculum-re-design-for-internal-medicine-residents/