Rheumatology Teaching: The Need to Review

  • Yasser El Miedany


The past decade has witnessed a remarkable transformation in the field of rheumatology. The progress has been startling, with major advances in patient treatment attributed to the impressive array of new biologic therapies and the development of new treatment approaches which dramatically improved patient outcomes. However, while the situation has engendered optimism for the future, concerns have been raised about sustaining the momentum. Over recent years, there has been increasing concern among rheumatologists that fewer trainee doctors have been choosing rheumatology as a career. In some regions, training posts have remained unappointed. This unexpected contrast warrants a thorough look at the reasons behind such attitude. This chapter will discuss why do we need to revise ways rheumatology is being taught and its impact on attracting, rather than deterring, junior doctors to the speciality.


Rheumatology Teaching rheumatology Musculoskeletal conditions Continuous medical education in rheumatology Education in musculoskeletal diseases 


  1. 1.
    Al Maini M, Adelowo F, Al Saleh J, Al Weshahi Y, Burmester G, Cutolo M, Flood J, March L, McDonald-Blumer H, Pile K, Pineda C, Thorne C, Kvien T. The global challenges and opportunities in the practice of rheumatology: white paper by the world forum on rheumatic and musculoskeletal diseases. Clin Rheumatol. 2015;34:819–29.CrossRefGoogle Scholar
  2. 2.
    Key components of a well-functioning health system. World Health Organization, 2010. http://www.whoint/healthsystems/EN_HSSkeycomponentspdf?ua=1. Accessed 15 Dec 2017.
  3. 3.
    Putrik P, Ramiro S, Kvien TK, Sokka T, Pavlova M, Uhlig T, Boonen A, Tafaj A, Harutyunyan R, Radner H. Inequities in access to biologic and synthetic DMARDs across 46 European countries. Ann Rheum Dis. 2014;73(1):198–206.CrossRefGoogle Scholar
  4. 4.
    Fiehn C, Hajjar Y, Mueller K, Waldherr R, Ho A, Andrassy K. Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment. Ann Rheum Dis. 2003;62(5):435–9.CrossRefGoogle Scholar
  5. 5.
    Nell V, Machold K, Eberl G, Stamm T, Uffmann M, Smolen J. Benefit of very early referral and very early therapy with disease modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology. 2004;43(7):906–14.CrossRefGoogle Scholar
  6. 6.
    Day CS, Yeh AC. Evidence of educational inadequacies in region-specific musculoskeletal medicine. Clin Orthop Relat Res. 2008;466:2542–7.CrossRefGoogle Scholar
  7. 7.
    Alonso J, Ferrer M, Gandek B, Ware JE Jr, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, Leplege A. Health-related quality of life associated with chronic conditions in eight countries: results from the international quality of life assessment (IQOLA) project. Qual Life Res. 2004;13:283–98.CrossRefGoogle Scholar
  8. 8.
    Almoallim H, Bukhari E, Amasaib W, Zaini R. How to avoid delay in SLE diagnosis and management. In: Almoallim H, editor. Systemic lupus erythematosus. Croatia: InTech; 2012. p. 219–42. Scholar
  9. 9.
    Almoallim H, Khojah E, Allehebi R, Noorwali A. Delayed diagnosis of systemic lupus erythematosus due to lack of competency skills in musculoskeletal examination. Clin Rheumatol. 2007;26:131–3.CrossRefGoogle Scholar
  10. 10.
    Beattie KA, Bobba R, Bayoumi I, Chan D, Schabort I, Boulos P, Kean W, Obeid J, Mccallum R, Ioannidis G, Papaioanno A, Cividino A. Validation of the GALS musculoskeletal screening exam for use in primary care: a pilot study. BMC Musculoskelet Disord. 2008;9:115.CrossRefGoogle Scholar
  11. 11.
    Akesson K, Dreinhöfer KE, Woolf AD. Improved education in musculoskeletal conditions is necessary for all doctors. Bull World Health Organ. 2003;81:677–83.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Abou-Raya A, Abou-Raya S. The inadequacies of musculoskeletal education. Clin Rheumatol. 2010;29:1121–6.CrossRefGoogle Scholar
  13. 13.
    Matzkin E, Smith MEL, Freccero CD, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 2005;87:310–4.CrossRefGoogle Scholar
  14. 14.
    Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. J Bone Jt Surg. 1998;80:1421–7.CrossRefGoogle Scholar
  15. 15.
    Skelley NW, Tanaka MJ, Skelley LM, Laporte DM. Medical student musculoskeletal education: an institutional survey. J Bone Joint Surg Am. 2012;94:e146.CrossRefGoogle Scholar
  16. 16.
    Beran MC, Awan H, Rowley D, Samora JB, Griesser MJ, Bishop JY. Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents. J Bone Jt Surg. 2012;94:e36.CrossRefGoogle Scholar
  17. 17.
    Comer GC, Liang E, Bishop JA. Lack of proficiency in musculoskeletal medicine among emergency medicine physicians. J Orthop Trauma. 2014;28:e85–7.CrossRefGoogle Scholar
  18. 18.
    Ramani S, Ring BN, Lowe R, Hunter D. A pilot study assessing knowledge of clinical signs and physical examination skills in incoming medicine residents. J Grad Med Educ. 2010;2:232–5.CrossRefGoogle Scholar
  19. 19.
    Di Caprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine. J Bone Joint Surg Am. 2003;85:565–7.CrossRefGoogle Scholar
  20. 20.
    Day CS, Yeh AC, Franko O, Ramirez M, Krupat E. Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School. Acad Med. 2007;82:452–7.CrossRefGoogle Scholar
  21. 21.
    Craton N, Matheson GO. Training and clinical competency in musculoskeletal medicine. Identifying the Problem. Sports Med. 1993;15:328–37.CrossRefGoogle Scholar
  22. 22.
    Curriculum 2020. King’s College school of Medicine. (
  23. 23.
    AAMC. Report VII contemporary issues in medicine: musculoskeletal medicine education, medical school objectives project no. VII. Washington, DC: Association of American Medical Colleges; 2005.Google Scholar
  24. 24.
    Wise EM, Walker DJ, Coady DA. Musculoskeletal education in general practice: a questionnaire survey. Clin Rheumatol. 2014;33:989–94.CrossRefGoogle Scholar
  25. 25.
    Queally JM, Kiely PD, O’Daly BJ, O’Byrne JM. Design and implementation of a system-based course in musculoskeletal medicine for medical students. J Bone Joint Surg Am. 2009;91:1276–7.PubMedGoogle Scholar
  26. 26.
    Bilderback K, Eggerstedt J, Sadasivan KK, Seelig L, Wolf R, Barton S, Mccall R, Chesson AL Jr, Marino AA. Design and implementation of a system-based course in musculoskeletal medicine for medical students. J Bone Joint Surg. 2008;90:2292–300.CrossRefGoogle Scholar
  27. 27.
    Al-Nammari SS, James BK, Ramachandran M. The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom. Bone Joint J. 2009;19:1413–8.Google Scholar
  28. 28.
    Nottidge TE, Ekrikpo U, Ifesanya AO, Nnabuko RE, Dim EM, Udoinyang CI. Pre-internship Nigerian medical graduates lack basic musculoskeletal competency. Int Orthop. 2012;36:853–6.CrossRefGoogle Scholar
  29. 29.
    Goldenberg DL, Dehoratius JK, Mason J, Meenan R, Perlman SG, Winfield JB. Rheumatology training at internal medicine and family practice residency programs. Arthritis Rheum. 1985;28:471–6.CrossRefGoogle Scholar
  30. 30.
    Clawson DK, Jackson DW, Ostergaard DJ. It’s past to reform the musculoskeletal curriculum. Acad Med. 2001;76:709–10.CrossRefGoogle Scholar
  31. 31.
    Katz SJ, Oswald AE. How confident are internal medicine residents in rheumatology versus other common internal medicine clinical skills: an issue of training time or exposure? Clin Rheumatol. 2011;30:1081–93. Matzkin E, Smith MEL, Freccero CD, Richardson AB. (2005). Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. 87:310–4.CrossRefGoogle Scholar
  32. 32.
    Freedman KB, Bernstein J. Educational deficiencies in musculoskeletal medicine. J Bone Joint Surg. 2002;84(4):604–8.CrossRefGoogle Scholar
  33. 33.
    Oswald AE, Bell MJ, Snell L, Wiseman J. The current state of musculoskeletal clinical skills teaching for preclerkship medical students. J Rheumatol. 2008;35(12):2419–26.CrossRefGoogle Scholar
  34. 34.
    Thompson AE. Improving undergraduate musculoskeletal education: a continuing challenge. J Rheumatol. 2008;35(12):2298–9.CrossRefGoogle Scholar
  35. 35.
    Garneau KL, Iversen MD, Tsao H, Solomon DH. Primary care physicians’ perspectives towards managing rheumatoid arthritis: room for improvement. Arthritis Res Ther. 2011;13(6):R189.CrossRefGoogle Scholar
  36. 36.
    Harrold LR, Mazor KM, Negron A, Ogarek J, Firneno C, Yood RA. Primary care providers’ knowledge, beliefs and treatment practices for gout: results of a physician questionnaire. Rheumatology. 2013;52(9):1623–9.CrossRefGoogle Scholar
  37. 37.
    Almeida C, Clarke B, O’Brien A, Hammond A, Ryan S, Kay L, Hewlett S. Current provision of rheumatology education for undergraduate nursing, occupational therapy and physiotherapy students in the UK. Rheumatology. 2006;45(7):868–73.CrossRefGoogle Scholar
  38. 38.
    Hewlett S, Clarke B, O’Brien A, Hammond A, Ryan S, Kay L, Richards P, Almeida C. Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solution s. Rheumatology. 2008;47(7):1025–30.CrossRefGoogle Scholar
  39. 39.
    Henrickson M. Policy challenges for the pediatric rheumatology workforce: part I. Educ Econ Pediatr Rheumatol Online J. 2011;9:23. Scholar
  40. 40.
    Louthrenoo W. An insight into rheumatology in Thailand. Nat Rev Rheumatol. 2014.
  41. 41.
    Gibson T. Rheumatology in India and Pakistan today. Rheumatology. 2014;keu306.Google Scholar
  42. 42.
    Li Z, Yang Y. Rheumatology in China: challenges and development. Rheumatology. 2012;51(10):1733–4.CrossRefGoogle Scholar
  43. 43.
    Lau C, Feng P. Rheumatology without borders. Nat Clin Pract Rheumatol. 2007;3(6):305.CrossRefGoogle Scholar
  44. 44.
    Chipeta J, Njobvu P, McGill PE, Bucala R. Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project. Clin Rheumatol. 2014:1–6.Google Scholar
  45. 45.
    Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001;83:1317–20.CrossRefGoogle Scholar
  46. 46.
    Williams JR. The teaching of trauma and orthopaedic surgery to the undergraduate in the United Kingdom. J Bone Joint Surg Br. 2000;82:627–8.CrossRefGoogle Scholar
  47. 47.
    Rasker JJ. Rheumatology in general practice. Br J Rheumatol. 1995;34:494–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yasser El Miedany
    • 1
    • 2
  1. 1.King’s College London, Darent Valley HospitalDartfordUK
  2. 2.Rheumatology and RehabilitationAin Shams UniversityCairoEgypt

Personalised recommendations