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CURRENT COMMENT

DO MEDICAL STUDENTS IN THE UNITED STATES LEARN CLINICAL

RHEUMATOLOGY?

MICHAEL D. LOCKSHIN

Do medical students in the United States learn clinical rheumatology? Because most patients with rheu- matic 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 sev- eral committees and task forces of the American Rheu- matism 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 in- dicated that one-fourth of American medical schools have little or no capability for teaching clinical rheuma- tology, “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 rheumatolo- gists 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 de-

From the Division of Rheumatic Diseases. Hospital for Spe- cial Surgery. affiliated with the New Y ork Hospital-Cornell Univer- sity 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.

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 ) com- petition for patients-usually inpatients with collagen diseases-and patient-derived laboratory income by es- tablished specialty groups within the hospital complex; b) relegation of the rheumatologist to the role of out- patient physician; and c) reduction of his or her teaching time by forcing very large clinical, i.e. income-produc- ing, 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 rheuma- tology 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 i f there is a strong one at the major teaching hospital. Second, rheumato- logic experience within the departments of pediatrics, orthopedics, and rehabilitation medicine is often nonex- istent. Third, some programs confidently described as adequate by respondents were, on close review of mate- rial taught and students reached, considered by the task force to be unsatisfactory.

These surveys reveal several desiderata. High pri- ority should be assigned to establishing a rheumatology

Arthritis and Rheumatism, Vol. 20, No. 2 (March 1977)

760 LOCKSHIN

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 ap- proach deficient schools to encourage removal of dis- incentives, t o aid in recruiting personnel, and in some cases to convince responsible personnel of the need for rheumatology training. Financial support from the A F and from the federal government, i f available, may assist this effort.

the United States clinical experience under the guidance of a physician knowledgeable in rheumatology should be an achievable aim.

ACKNOWLEDGMENTS Members of the task forte were Michael Lockshin

(Chairman). Gordon Sharp (ex-officio), Gerson Bernhard, Janice Pigg, Ralph Hinckley, and Owen Pollard. John Baum and J o h n Calabro contributed valuable advice.

A second, larger, and longer range goal will be to

taught, how much is he or she taught, and what is the content of the material taught? A third goal will be t o remove the deficiencies that will likely be found. Cer- tainly, the objective of giving every medical student in

assess the quality of rheumatology teaching: who is REFERENCES 1 . The Arthrit is Foundation: Professional Manpower in

2. The Arthritis Foundation: Professional Education Com- Rheurnatology. January, 1975 (unpublished)

mittee Survey. June, 1975 (unpublished)