Background/Purpose: Despite increased risks of infection in patients with systemic autoimmune rheumatic disease (SARD), vaccination rates for this population are suboptimal. In 2023 the American College of Rheumatology (ACR) published guidelines on the use of vaccinations in patients with rheumatic and musculoskeletal diseases. Internists play a central role in engaging patients in shared decision-making on vaccination, yet the degree of guideline awareness and guideline-concordant practice among internal medicine (IM) trainees is unknown. We performed a needs assessment in an IM residency clinic to inform future educational interventions related to ACR vaccination guideline implementation.

Methods: We reviewed the literature on uptake of ACR vaccination guidelines in IM residency clinic, and barriers to vaccination. Based on barriers described in the literature for vaccinating patients with SARD, we designed an 18-item questionnaire (Figure 1) inquiring about attitudes toward vaccinating patients with SARD, ACR vaccination guideline awareness and barriers to implementation, as well as demographics. The questionnaire was distributed electronically via REDCap to all IM residents and faculty involved in outpatient clinic precepting in a large academic center between 12/2024 – 5/2025. Survey results were analyzed using descriptive statistics and differences between residents and faculty were examined with the Fisher exact test. The study was deemed exempt by the local Institutional Review Board.

Results: Survey responses were received from 13 out of 35 faculty (37%) and 11 out of 131 residents (8%). Among participants, 79% of faculty compared with 45% of residents reported they felt confident about their knowledge of vaccine efficacy, safety, and impact on disease (p=0.0035). Only 9% of residents and 8% of faculty felt that rheumatologists should be the sole provider of vaccinations for patients with SARD (Table 1). Only 45% of residents and 15% of faculty felt their clinic was too busy to provide vaccines for this population. A total of 73% of residents and 38% of faculty reported they did not receive training in this topic in their medical education. Only 27% of residents and 23% of faculty were aware of the ACR vaccination guidelines. Among residents, 64% reported making vaccination recommendations for this population in their clinic compared with 92% of faculty.

Conclusion: A majority of IM residents and precepting faculty participating in this single-center needs assessment reported making vaccine recommendations in clinic for their patients with SARD, and most respondents felt that vaccine guidance was a shared responsibility between rheumatologists and internists. However, over 70% were unaware of the ACR vaccination guidelines. A potential limitation of this study is the low response rate. These data help inform educational interventions to improve ACR vaccination guideline implementation by IM residents in this setting.

Figure 1. Needs assessment survey distributed to IM residents and faculty

Table 1. Barriers to providing vaccinations in IM residency clinic among residents and attendings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilization-of-american-college-of-rheumatology-vaccination-guidelines-in-clinic-a-needs-assessment-in-an-internal-medicine-residency-program/