|Year : 2018 | Volume
| Issue : 2 | Page : 82-83
Rheumatology training in India and the UK: Time for a unified and bespoke approach
Nilesh Nolkha1, Kaushik Chaudhuri2, Srinivasan Venkatachalam3
1 Department of Rheumatology, Cannock Chase Hospital, Cannock, UK
2 Department of Rheumatology, University Hospital of Coventry and Warwickshire, Coventry, UK; Chair, Education Committee, BSR, UK
3 Department of Rheumatology, Cannock Chase Hospital, Cannock, UK; Chair, Specialist Advisory Committee for Rheumatology, Joint Royal Colleges of Physicians Training Board, UK
|Date of Web Publication||24-May-2018|
Dr. Srinivasan Venkatachalam
Cannock Chase Hospital, Brunswick Road, Cannock
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nolkha N, Chaudhuri K, Venkatachalam S. Rheumatology training in India and the UK: Time for a unified and bespoke approach. Indian J Rheumatol 2018;13:82-3
The healthcare and training needs in India and the United Kingdom, from a Rheumatology perspective, are significantly different. This informs the organization and delivery of training programs in either country. Das et al. in their recent article have compared two surveys: that of the UK trainees in 2013 and the Indian trainees in 2016 highlighting the differences between the rheumatology training programs. However, the training scenario has changed a lot in the UK and to some extent in India since then.
Specialty training in rheumatology in the UK has evolved over a greater period of time, and the structure is more centralized. The Specialist Advisory Committee of the Joint Royal Colleges of Physicians Training Board is responsible for the organization and delivery of all specialists training devolved through 17 regional training program directors covering nearly 250 trainees for a population of 66.5 million. There are nearly 9 rheumatologists for a population of 1 million in the UK, but still, there are service gaps.
In contrast, in India with a commensurate burden of rheumatologic disease, there are only 0.2 rheumatologists for a population of 1 million. There are about 75 trainees over 3 years in 25 training places (Doctorate of Medicine [DM] and Diplomate of National Board [DNB]) in adult rheumatology for a population of 1.35 billion. This highlights the unmet need for more trained rheumatologists and by extension more centers that can offer this training.
In the UK, from 2016, higher medical training in rheumatology is combined with internal medicine to meet the needs of the aging population with multiple comorbidities. Future rheumatology trainees will be all dually accredited in both internal medicine and rheumatology after a 5-year program in contrast to nearly half accrediting only in rheumatology now. The 2-year core medical training will be extended to a 3-year internal medicine training program from 2019 with the “Shape of Training” reform in the UK. This will be followed by specialist rheumatology training for 4 years including a year of internal medicine. This is akin to the 3-year residency program in internal medicine (MD) in India, which precedes higher rheumatology training.
Of late, there is a welcome emphasis on training in musculoskeletal ultrasound in Indian rheumatology training programs, which should be an essential skill for all rheumatologists of the future. Its role as an integral part of the training program is still evolving in the UK and is being considered as an optional module in the new curriculum.
In the UK importance is given to the development of “soft skills” besides clinical skills throughout training. Trainees are encouraged to develop good communications skills and to deal with patient expectations which impact on health outcomes, compliance, and satisfaction. In the Indian context, generic skills can be developed as part of a national curriculum. Allied health professionals play a major role in delivering rheumatology services in the UK. An integral part of rheumatology training in the UK is to learn to work collaboratively with specialist nurses, physiotherapists, and occupational therapists. Trainees are trained to participate in and eventually, lead multidisciplinary teams. Indian rheumatology trainees can similarly benefit from working more closely with allied health professionals.
UK trainees can opt out of their training for up to 3 years to undertake research in either clinical or basic science subject to funding and some of them become academic rheumatologists. Indian trainees undertake research projects including dissertation/thesis besides their clinical workloads within the 3 years and may benefit from a structured academic career path with focused research after clinical training.
The UK rheumatology curriculum is changing with the times to a “Capabilities in Practice” approach following the New Internal Medicine Curriculum approved by the General Medical Council. A national integrated curriculum for rheumatology training adapted to the Indian context is the urgent need of the hour. The Indian rheumatology association should work with the medical council of India and Universities to harmonize the curricula across different regions of the country.
We feel that although there are several centers offering excellent training opportunities in India – the numbers are relatively small compared to the large patient base. The addition of new centers offering DM and DNB training and the establishment of a College of Rheumatology is a welcome step in the right direction.
Indian rheumatology training can benefit from the UK model by adapting to the local needs the electronic portfolio as a record of training and the structured workplace-based assessments such as case-based discussions, directly observed procedural skills, and multisource feedback. The UK specialty certificate examination in rheumatology testing trainees' knowledge with validated multiple choice questions can be adapted in place of the short notes and essays in India. Faculty development with training the trainer's programs and central accreditation like in the UK would help enhance and expand rheumatology training in India. The paucity of trainers in rheumatology in India needs to be addressed. Many of the Indian rheumatologists who are trained abroad need to be pragmatically welcomed as trainers to expand access to training.
The UK rheumatology training can benefit from Indian model by tapping on the vast repository of clinical material and devoting more attention to the basis of immunological tests and practical skills such as polarized microscopy. A structured clinical examination at the end of rheumatology training as in India would also enhance assessment in the UK.
International fellowship programs in the UK for 1–2 years through the medical training initiative of the Royal College of Physicians provide an excellent opportunity for Indian trainees to initiate or consolidate their rheumatology training. The Indian Rheumatology Association and the British Society of Rheumatology have reciprocal exchange programs for trainees, which need to be expanded in the coming years to include trainers. Exchanging the best practice in training and assessment between the two countries and adapting the curriculum to the local needs is the best way forward.
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