Background/Purpose: With the launching of the Choosing Wisely campaign, there has been a growing emphasis in the medical community on addressing unnecessary tests and procedures and their impact on patient care, costs and resources. This study aims to: 1) assess internal medicine and rheumatology residents’ attitudes towards appropriate ordering of rheumatology investigations and cost-conscious care; 2) assess residents’ knowledge of costs of care in rheumatology; and 3) identify areas of need in the post-graduate rheumatology curriculum with respect to this topic.

Methods: An anonymous survey was distributed to rheumatology trainees at several academic centres and internal medicine residents rotating at one academic hospital between July 1, 2014 and December 31, 2014. Participants were asked to rate statements on a 5-point Likert-scale and estimate costs of common rheumatology investigations. Descriptive statistics were conducted using Microsoft Excel.

Results: The survey was completed by 23 of 49 eligible participants (response rate 46.9%). Fifteen participants (65%) were female. Respondents included 5 internal medicine (post-graduate year 3) residents and 18 rheumatology trainees (post-graduate year 4-5). All participants agreed or strongly agreed that all physicians should be familiar with appropriate use of investigations and costs of care. Twenty-one (91%) participants agreed or strongly agreed that residents should receive training on this topic. Fourteen (61%) felt that teaching on this topic should be mandatory. Fourteen participants (61%) consider pretest and posttest probabilities and test sensitivity/specificity in clinical decision-making, while only eight (35%) consider costs. Only 9% of responders felt confident in appropriately ordering a whole-body bone scan, and fewer than half felt confident in appropriately ordering dual X-ray absorptiometry (DXA) scans. Participants overestimated all the costs except for complete blood count (CBC). The average discrepancy between estimated and true cost was greatest for spine MRI, uric acid level, rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR).

Conclusion: The results reveal areas of need in the post-graduate curriculum with regards to appropriate ordering of rheumatology investigations and costs of care. Future steps include developing a teaching tool outlining this topic for residents.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/appropriate-investigations-and-costs-in-rheumatology-residents-attitudes-and-knowledge/