Musculoskeletal training in Rheumatology - What the trainees think

摘要

One in four adults are affected by longstanding musculoskeletal (MSK) problems, which are responsible for up to 30% of GP consultations. With a move towards providing rheumatology services in the community there is need for rheumatology trainees to become competent in diagnosing and managing MSK conditions. Rheumatology trainees have expressed the anecdotal view that training in MSK is compromised, partly due to the reduction of referrals of MSK conditions to secondary care and partly due to the focus on more complex inflammatory conditions.A survey was carried out on behalf of the Rheumatology Specialist Advisory Committee, to assess rheumatology trainees’ confidence and ability in dealing with MSK conditions during, and on recent completion of training. The survey was sent to the rheumatology trainee representative of each LETB, to be disseminated to rheumatology trainees in their region. 77 responses from a total of an estimated 223 trainees were received. 20 of these surveys were incomplete, with not all questions being answered. Responses from trainees across all career grades from ST3 to 2 years post Certificate of Completion of Training were received.92% thought MSK medicine to be an important part of rheumatology training; 64% had managed patients with soft tissue pathology on a daily basis; 30% felt they managed MSK conditions on a weekly basis; 32% of trainees felt they were not yet confident in diagnosing and distinguishing between different types of soft tissue pathologies; 16% felt they were lacking in competency for their level of training in managing MSK pathologies as outlined in the JRCPTB 2010 rheumatology curriculum; the majority of trainees felt they were either partially competent in all, or some areas, satisfactory for their level of training; 67% felt their training in injection techniques had been at least ‘adequate’. Exposure to, and experience with MSK medicine in current jobs and throughout training ranged from poor to excellent.Within this limited survey, the views of 77 trainees have shown that training in MSK could be improved at all levels. Although trainees felt they were lacking confidence in dealing with certain areas of MSK medicine, when competencies were mapped out to the rheumatology curriculum, trainees felt they were achieving appropriate competency for their level of training. Trainees were keen to have further MSK training specifically in sports medicine. Free text comments for ways to improve skills repeatedly mentioned shadowing physiotherapists and exposure to more teaching and supervision focusing on examination techniques.With changes in the nature and geography of rheumatology services we feel these aspects of training should not be overlooked to ensure trainees are equipped to deal independently with MSK conditions by completion of training.