Background/Purpose: ANA testing is recommended when there is a reasonable clinical suspicion for systemic autoimmune disease. Testing in the setting of low pre-test probability, however, leads to unnecessary specialist referrals, subsequent testing, medical costs, and patient anxiety. An ACR ad hoc committee published recommendations regarding ANA testing in 2002. The American Board of Internal Medicine (ABIM) and ACR partnered in 2013 to provide more specific recommendations on this topic to minimize unnecessary testing. Yet, we hypothesized that today’s trainees are unaware of these recommendations. Our study aims to assess awareness of available ANA testing guidelines and the practice patterns among internal medicine residents at a large teaching hospital.

Methods: A 10-question Google survey was created and emailed to all internal medicine trainees at Westchester Medical Center. Trainees were instructed to answer all questions independently and without additional references. They were informed that their answers would be anonymized. Twenty-five (42%) of internal medicine residents responded, and their answers then collected and analyzed.

Results: 52% of trainees know that 1:80 is the correct cut-off for a positive ANA, but only 12% know that indirect immunofluorescence assay on HEp-2 cells is the preferred technique for measuring ANA. 72% are either “not at all” or “minimally” confident about knowing when to order ANA, and 36% can “never” or “rarely” interpret the results. 56% would include ANA in a workup for a patient with fatigue and myalgias, and 24% would check ANA serially in a patient with established SLE. Almost 70% feel that they have received contradictory instructions regarding ANA testing, and 0 respondents were able to identify any recommendations/guidelines regarding ANA.

Conclusion: Basic knowledge regarding ANA testing and appropriate interpretation is low among internal medicine house staff. No trainees were able to verbalize awareness of the ABIM’s Choosing Wisely Campaign and/or its recommendations, suggesting that a relaunch of this campaign may be warranted. Further, the high percentage of trainees reporting conflicting instruction pertaining to ANA suggests that clearer guidelines are needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-qualitative-survey-of-internal-medicine-residents-understanding-of-appropriate-ana-testing-an-11-year-update-since-the-choosing-wisely-campaign/