Background/Purpose: We plan to improve internal medicine (IM) resident competence in caring for patients with rheumatologic disease and increase resident interest in rheumatology as a career. To achieve this goal, we conducted a needs assessment to help inform curriculum revisions to enhance our rheumatologic ambulatory curriculum.

Methods: After interviewing IM and Rheumatology faculty we constructed a 16-item online self-assessment resident survey tool. This tool assessed  confidence (0=not confident, 100=extremely confident) in performing a rheumatologic history, exam and common rheumatology procedures (knee injection and aspiration, and shoulder and trochanteric bursa injection), ordering and interpreting rheumatologic labs (ESR, CRP, RF, CCP, ANA), and caring for patients with osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and fibromyalgia.  Additional questions included demographics, interest in rheumatology as a topic and career, and current career choice. Between February and May, 2013, we invited categorical PGY1 residents, just prior to the onset of their one week rheumatology ambulatory block, and all PGY3 residents to complete the Web-based survey. The results from the resident surveys were analyzed via two-sample Wilcoxon rank-sum (Mann-Whitney) test. IRB-approval and consent was obtained prior to completing the survey.

Results: Eighty-six percent (19/22) PGY1 IM residents and 70% (6/37) of PGY3 IM residents responded.  Twenty-three of 45 residents (51%) were females. Twelve (27%) residents planned careers in General IM vs. 33 (73%) in IM subspecialties. There was no significant difference in any self-assessed confidence ratings when analyzed by gender or career plans. Table 1 summarizes the results.  Overall PGY3 residents self-assessed their confidence ratings higher than PGY1s in all categories. There was no difference in interest in rheumatology between the PGY1 and PGY3  groups but there was significantly less interest in rheumatology as a career in the PGY3 group (p=0.002). Self-rated confidence in joint procedures was consistently lower for both groups compared to history, exam, lab interpretation and patient care.

Conclusion: Our results suggest we need to enhance training of procedural skills in our ambulatory curriculum. Further study on factors that influence a resident to consider rheumatology as a career is needed. Encouragement and support for rheumatology as a career should be given early and throughout training.

Table 1: Self rated confidence survey results of PGY1 and PGY3 IM residents Feb-May 2013; Visual analogue scale (0-100).