Medical students’ unawareness of rheumatology ‘rooted right from the undergraduate level’
Key takeaways:
- A systematic review found marked variation in undergraduate rheumatology training.
- Emphasis on acute specialties and lack of faculty and training programs may drive low exposure among undergraduates.
Undergraduate medical schools show “significant variation” in rheumatology training, with some students receiving as few as 4 hours of teaching specific to the specialty, according to data published in Clinical Rheumatology.
“As per the latest British Society for Rheumatology report in 2021, there appears to be chronic workforce shortages to provide safe staffing in rheumatology in the U.K., with a deficit of consultant rheumatologists across the country,” Koushan Kouranloo, MBChB, of the department of rheumatology at Guy’s and St. Thomas’ NHS Foundation Trust, in London, and colleagues wrote.
“It is well documented that the experience of medical students on placement in various specialties during medical school is crucial in determining their future career choice,” they added. “Therefore, understanding the factors which influence medical students’ perceptions about different specialties remain the key to better understanding their potential future choices.”
To assess medical students’ exposure to rheumatology — and the quality of that exposure — around the world, Kouranloo and colleagues conducted a systematic literature review on undergraduate rheumatology training. The review primarily examined the training’s duration, methods and setting, as well as student feedback.
The review ultimately included eight cross-sectional studies performed between 1981 and 2024 in the United Kingdom, the United States, Australia and Uganda, with one study conducted across 11 European countries.
According to the researchers, the total time of exposure to rheumatology, where reported, ranged from 4 hours to 120 hours per medical student. Students were taught rheumatology every year in the one U.S.-based study, while in the three U.K. studies, exposure occurred only in later years.
The review revealed “significant variation” in the rheumatology topics being taught, even within small geographic areas, the researchers added. They highlighted a 2018 study conducted across 11 European countries in which nearly all medical schools taught mechanical vs. inflammatory joint pain, while only a few discussed different disease-modifying antirheumatic drugs and the long-term impacts of chronic autoimmune diseases.
“Addressing these discrepancies and ensuring appropriate inclusion of both physical and mental health consequences of chronic disease, in conjunction with other comorbidities, remain key for countries like the U.K. that are dealing with an ever-increasing rate of polypharmacy in a multimorbid, aging population,” Kouranloo and colleagues wrote.
The studies additionally highlighted some potential reasons for low exposure, including a lack of full-time rheumatologists on school faculty and rheumatology training programs in local teaching hospitals.
They also suggested that more general or acute specialties, such as general practice and emergency medicine, receive more attention.
Two of the studies also included student feedback. In a U.K.-based study, eight students considered rheumatology to be “a niche specialty of no interest,” the researchers wrote, while in a Ugandan study, 15% of 359 students believed the specialty was only about “rheumatic fever and/or rheumatic heart disease.” Only two students in the U.K. study described rheumatology as “fascinating.”
“Certain specialties may be perceived as ‘unpopular,’ and this will undoubtedly vary from region to region globally,” Kouranloo and colleagues wrote. “However, as demonstrated through this [systematic literature review], for rheumatology as a specialty, this seems to be due to a lack of awareness of what the specialty entails, and this is rooted right from the undergraduate level.
“Our results indicate a need for a minimum required number of hours of teaching dedicated to rheumatology, delivered by specialists, as well as a standardized undergraduate curriculum of competencies to better reflect the needs of our increasingly aging and multimorbid population,” they added.
Collapse