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Do medical students in the united states learn clinical rheumatology.

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Do medical students in the United States learn
clinical rheumatology? Because most patients with rheumatic disease are and will be for many years treated by
physicians with no special training in this field ( l ) , the
question is crucial. An answer has been sought by several committees and task forces of the American Rheumatism Association (ARA) Section of The Arthritis
Foundation (AF) over the past few years.
A 1975 survey conducted by the AF Professional
Education Committee chaired by Gordon C. Sharp indicated that one-fourth of American medical schools
have little or no capability for teaching clinical rheumatology, “capability” being defined by the respondent
schools confirming the presence of faculty personnel in
this field (2). (The results of this survey contrast with
experience in Canada, where every medical school now
has a rheumatology section.) A subsequent AF task
force survey revealed a ) that many schools previously
lacking rheumatology faculty did recruit rheumatologists in 1975-1976 (but some other schools lost faculty),
b ) that at least three schools devoted to pri.mary care
medicine do not want subspecialty sections within deFrom the Division of Rheumatic Diseases. Hospital for Special Surgery. affiliated with the New Y ork Hospital-Cornell University Medical Center. New York. New York.
Michael D. Lockshin. M.D.: Associate Professor of Medicine.
Address reprint requests to Michael D. Lockshin. M.D..
Hospital for Special Surgery, 535 East 70th Street, New York, New
York 10021.
Submitted for publication September 10, 1976: accepted
September 18. 1976.
Arthritis and Rheumatism, Vol. 20, No. 2 (March 1977)
partments of internal medicine, and c) that the Printer
or! Rkeuriiatic Diseases distributed by the A F is the
major source of teaching for many students.
Common disincentives to recruiting and keeping
rheumatologists on staff can be identified as a ) competition for patients-usually
inpatients with collagen
diseases-and patient-derived laboratory income by established specialty groups within the hospital complex;
b) relegation of the rheumatologist to the role of outpatient physician; and c ) reduction of his or her teaching
time by forcing very large clinical, i.e. income-producing, loads. Another complaint is that departmental
chairpersons do not permit expansion of small units or
otherwise back-financially
or administratively-the
growth and training functions of these units.
The quality of teaching in schools with rheumatology sections was not directly studied, but additional
facets of the problem came t9 light. First, because many
schools send students to outlying hospitals for their
clinical training, many students may have no contact
with a rheumatology section, even if there is a strong
one at the major teaching hospital. Second, rheumatologic experience within the departments of pediatrics,
orthopedics, and rehabilitation medicine is often nonexistent. Third, some programs confidently described as
adequate by respondents were, on close review of material taught and students reached, considered by the task
force to be unsatisfactory.
These surveys reveal several desiderata. High priority should be assigned to establishing a rheumatology
section in every medical school in the United States. To
d o this, a proposed AF/ARA statement of the expected
responsibilities of a rheumatology section should be
helpful. With this statement, AF/ARA staff could a p proach deficient schools to encourage removal of disincentives, t o aid in recruiting personnel, a n d in some
cases to convince responsible personnel of the need for
rheumatology training. Financial support from the A F
and from the federal government, if available, may assist
this effort.
A second, larger, a n d longer range goal will be t o
assess the quality of rheumatology teaching: who is
taught, how much is h e o r she taught, a n d what is the
content of the material taught? A third goal will be t o
remove the deficiencies that will likely be found. Certainly, the objective of giving every medical student in
the United States clinical experience under the guidance
of a physician knowledgeable in rheumatology should
be an achievable aim.
Members of the task forte were Michael Lockshin
(Chairman). Gordon Sharp (ex-officio), Gerson Bernhard,
Janice Pigg, Ralph Hinckley, and Owen Pollard. John Baum
a n d J o h n Calabro contributed valuable advice.
The Arthritis Foundation: Professional Manpower in
Rheurnatology. January, 1975 (unpublished)
2. The Arthritis Foundation: Professional Education Committee Survey. June, 1975 (unpublished)
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