Background/Purpose: Rheumatologic diseases are common and complex, requiring internal medicine physicians to develop skills in musculoskeletal examination, diagnosis, and management. Despite this, exposure during residency is often limited, leading to low confidence and variable competence. We conducted a needs assessment among residents to evaluate prior exposure, perceived confidence in core domains, and learning sources. This informed a targeted rheumatology curriculum implemented over one academic year, with evaluation of its impact on resident confidence.

Methods: In May 2023, an anonymous 31-item Likert scale (1-3) survey was administered to internal medicine residents at a large academic center to assess confidence across three domains: physical exam, diagnosis, and treatment. Based on survey data and in-training exam performance, targeted educational interventions were developed. These included a joint injection workshop with Sports Medicine and Rheumatology faculty, low back pain and SI exam sessions, and enhanced didactic content with small-group learning and structured feedback. Included in the survey were questions about preferred learning modalities and where they felt that they gained rheumatology knowledge during residency. The same survey was repeated in May 2024, with additional questions on preferred learning methods and perceived sources of rheumatology learning.

Results: Of 77 eligible residents, 36 (47%) responded in 2023 and 22 (29%) in 2024. In 2024, 32% had completed a rheumatology rotation during residency, compared to 19% in 2023. Confidence in musculoskeletal exams remained low, with declines in hand (−0.71), SI/lower back (−0.44), and enthesitis (−0.68) exams. Modest gains were seen in psoriasis exam (+0.24). In diagnosis, confidence improved in low back strain (+0.50) and knee OA (+0.51), but decreased for lupus (−0.27) and inflammatory back pain (−0.34). Treatment confidence improved for knee OA (+0.67), and infectious arthritis (+0.47), while decreasing for knee (−0.44) and shoulder injections (−0.48). Residents reported highest confidence in diagnosing/treating knee OA, hand OA, and low back strain; lowest in performing joint injections and specialized physical exams.Residents preferred case-based instruction, followed by patient narratives, lectures, and question banks. Least preferred were journal articles, flashcards, and podcasts. University inpatient wards were the most cited learning setting (86%), followed by Academic Half Day (AHD) lectures (57%), rheumatology rotations (33%), and ambulatory clinics (29%) for gaining new rheumatology knowledge. When asked which most contributed to their knowledge, the top responses were rheumatology rotation (29%) and AHD/simulations (24%).

Conclusion: Targeted didactics improved confidence in diagnosis and management of common rheumatologic conditions, but gaps persist in musculoskeletal and procedural skills. Residents value case-based and narrative instruction, with inpatient and elective experiences being key learning sources. A multifaceted curriculum integrating clinical exposure, hands-on practice, and engaging didactics is essential for building rheumatology competence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnosing-the-deficit-addressing-gaps-in-rheumatology-training-for-internal-medicine-residents/