Indian Journal of Rheumatology

LETTER TO EDITOR
Year
: 2017  |  Volume : 12  |  Issue : 2  |  Page : 116--117

Internal medicine residents' perception of rheumatology as a subspecialty: A web-based survey


Keerthi Talari1, Kirthi Theja Bommakanti2,  
1 Department of Rheumatology, Yashoda Hospitals, Secunderabad, Hyderabad, India
2 Department of Neurology, Osmania General Hospital, Hyderabad, Telangana, India

Correspondence Address:
Keerthi Talari
Department of Rheumatology, Yashoda Hospitals, Secunderabad, Telangana
India




How to cite this article:
Talari K, Bommakanti KT. Internal medicine residents' perception of rheumatology as a subspecialty: A web-based survey.Indian J Rheumatol 2017;12:116-117


How to cite this URL:
Talari K, Bommakanti KT. Internal medicine residents' perception of rheumatology as a subspecialty: A web-based survey. Indian J Rheumatol [serial online] 2017 [cited 2020 Oct 26 ];12:116-117
Available from: https://www.indianjrheumatol.com/text.asp?2017/12/2/116/202127


Full Text



Dear Editor,

With India being home to the 2nd largest population in the world, the burden of patients with musculoskeletal disorders and autoimmune diseases is overwhelming.[1] However, there is gross inadequacy of trained rheumatologists with only 26 fellows receiving training in DM/DNB rheumatology/clinical immunology every year.[2] Rheumatology is sought as a career option by very few postgraduates. In this study, we sought to assess residents' perception about rheumatology by conducting a web-based survey among MD/DNB internal medicine residents.

Seventy-nine internal medicine residents from 2 different government medical colleges pursuing MD and a few DNB residents in the same city whose e-mail id could be obtained were mailed the survey form. The survey form was created on google forms. Overall response rate for the survey was 61% (48/79). Of 48, 42 felt that there was no adequate rheumatology training time spared during their course. Thirty-five felt conducting regular seminars on clinical management of rheumatology cases by a trained rheumatologist, 40 felt bedside case discussions by a qualified rheumatologist, 24 felt having a rheumatologist in their hospital, 22 felt conducting regular CMEs could improve rheumatology training. When asked about individual conditions within rheumatology; 10/46 were confident of managing rheumatoid arthritis while 36/39 of managing lupus, but only 11/39 of systemic sclerosis, vasculitis and Sjogren's syndrome. Very few reported confidence in managing conditions such as spondyloarthritis, fibromyalgia, dermatomyositis and soft tissue rheumatism. All residents felt that there was lack of awareness about rheumatology in the general population and the reasons quoted were rheumatological diseases are under-diagnosed and referred only when the disease becomes disabling (34/47), inadequate number of rheumatologists in the state (21/47), no rheumatologists in several government hospitals of the state (21/47), rheumatology cases are managed by other specialties (21/47), people believe that there is no treatment for arthritis in allopathy (22/47), and lack of multispecialty coordination in rheumatology (14/47).

This survey throws light on the perception of internal medicine residents about rheumatology as a subspecialty. The knowledge of institutes offering a DM course in rheumatology/clinical immunology was grossly lacking. Except for Nizam's Institute of Medical Sciences which is in the same city where the survey was conducted, PGIMER, Chandigarh was the other institute which was listed out correctly by 50% of residents. Career training about subspecialties available should be a part of postgraduate curriculum for residents to make the right choice. With a common superspecialty entrance examination being planned, this becomes all the more necessary and important.

Ninety percent of residents felt that not enough time was spent for rheumatology training. It is also quite surprising that 36 residents were confident about managing lupus while only ten were confident about rheumatoid arthritis and nine of spondyloarthritis. We could make an assumption that probably residents are not exposed to the varied presentations of lupus and the life-threatening complications that arise out of it. As highlighted in a recent review, the biggest challenge in India is posed by huge patient population and this is further compounded by the grossly inadequate number of rheumatologists.[3] This results in a lack of awareness in the population with a lot of precious time (the so-called “window period”) lost in moving from one specialty to other before they reach a rheumatologist. As physician becomes the first contact for a lot of patients, patient's perception is best understood by them. Seventy-five percent of residents uniformly felt that patients do not reach a rheumatologist for their disease because rheumatologic diseases are underdiagnosed and referred only when the disease becomes disabling. Patient education programs, community education programs, disease information pamphlets, awareness walks, articles, and programs through media are some of the possible ways to enhance awareness in the society.

To conclude, this survey highlights certain very important issues regarding rheumatology training. Lack of adequate knowledge about rheumatology as a subspecialty, institutes offering the course, inadequate time spent on rheumatology training during residency add up to a low confidence in identifying rheumatic diseases, and inability to manage a patient. This takes a huge toll on a patient's productivity in the long-term, with misconceptions about rheumatologic conditions only adding up to the current problems. An appropriate career training program for internal medicine residents' is of utmost importance. More number of trained rheumatologists, especially in the public sector, would probably change the current scenario.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Chopra A. Disease burden of rheumatic diseases in India: COPCORD perspective. Indian J Rheumatol 2015;10:70-7.
2Misra DP, Agarwal V, Negi VS. Rheumatology in India: A Bird's Eye View on Organization, Epidemiology, Training Programs and Publications. J Korean Med Sci 2016;31:1013-9.
3Handa R. Rheumatology in India - Quo vadis? Nat Rev Rheumatol 2015;11:183-8.