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To be or not to be rheumatologist: survey among Belgian medical students and internal medicine trainees: what do certified rheumatologists think about the current rheumatology training program?

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Abstract

In several countries, there have been increasing concerns over the years that fewer medical students or trainees choose rheumatology as a specialty. The aim of this three-step survey is to study the motivational factors for students and trainees in internal medicine to choose for rheumatology as a future career option and the idea among experienced rheumatologists about the needs for changes in the training program. An online survey was distributed among students in medical training (in the final 3 years) and trainees in internal medicine from the Ghent University and University Hospital. Questions concerned the level of clinical exposure to rheumatology and the motivation about becoming rheumatologist. Next, experienced rheumatologists were asked about the needs to change the current training. Descriptive data are shown and chi-squared tests were calculated to assess differences between groups (based on gender and exposure). Logistic regression was performed to study associations between demographic variables and choosing rheumatology as career. Only a minority of students (17%) and about half of trainees (45%) were ever exposed to rheumatology. Only 11% of students and 17% of trainees considered becoming rheumatologist. There was no difference in choice based on gender but previous exposure seemed to play an important role, and especially during the pre-specialty years. Univariate logistic regression identified the year of training and exposure as predictors for choosing rheumatology. Multivariate analysis only retained exposure as significantly associated (odds ratio (95% CI) = 2.88 (1.51–12.58)). Rheumatology is considered to be a fascinating discipline among Belgian students and trainees. Exposure during pre-specialty years is the strongest predictor for choosing rheumatology as future career option.

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Acknowledgements

We would like to thank all students, trainees, and rheumatologists who completed the inquiry. Also thanks to Emily Schaubroeck, Tine Vanlancker, Lara Arnold, and Karen Decaestecker for their support in the data management and analysis.

Author information

Authors and Affiliations

  1. Department Rheumatology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium

    Ruth Wittoek & Herman Mielants

Authors
  1. Ruth Wittoek
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  2. Herman Mielants
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Corresponding author

Correspondence to Ruth Wittoek.

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Appendix A

Appendix A

Medical education program in Belgium

Up to 2013 (at the time of the survey), medical education in Belgium comprised 7 years. Since 2013, the medical training program has reduced to 6 years in order to align more with other programs in Europe. At the time of the survey, the students were all in the 7-year program. During the first 5 years, the focus is on theoretical education. In the 4th and 5th year, 4 weeks of clinical exposure to maximum four different disciplines of choice (including rheumatology) is offered. During the final 2 years (i.e., 6th and 7th year), all students are offered practical training, mainly in a hospital setting, named pre-specialty training. This period corresponds to the Foundation years in the UK. During the 6th year, a compulsory training rotation is foreseen. During the 7th year, several weeks are free to choose according to the interest of the student.

Rheumatology is considered as subspecialty of internal medicine. Therefore, the training program consists of 3 years of basic internal medicine followed by 3 years of specialty in rheumatology.

Questionnaires

The first survey addressed medical students from the 4th till 7th year of the Ghent University Medical School and consisted of eight questions. The first four questions were related to students’ demographics such as (1) gender, (2) age, (3) year of formation, and (4) ethnicity. Exposure was considered as clinical exposure to the discipline. The following five questions were related to their personal educational program and exposure:

  1. (5)

    In which disciplines did you perform an internship during the 4th and 5th year of your training. What was the duration of this internship?

  2. (6)

    In which disciplines did you do an internship in the 6th year of your training. Was it a voluntary internship or compulsory. What was the duration of this internship?

  3. (7)

    How relevant do you consider 37 different disciplines in regards to your future career as a doctor? Indicate on a scale from 0 (not useful and/or relevant) to 10 (very useful and/or relevant).

  4. (8)

    Which discipline(s) (maximum two) was/were chosen as pre-specialty training during the 7th year (8 weeks)?

  5. (9)

    Was rheumatology part of this choice and if so, what was the reason/motivation for it? Open question.

The second survey addressing all trainees in internal medicine from the 1st till the 6th year at the Ghent University Hospital, consisted of 10 questions. The first four questions were related to demographics such as (1) gender, (2) age, (3) year of formation, and (4) ethnicity. The following seven questions were related to their education program:

  1. (5)

    Did you choose rheumatology as a voluntary training during the 5th or 6th year or as pre-specialty training in the 7th year of medical school?

  2. (6)

    Were you a trainee on a rheumatology service during their first 3 years of general internal medicine training?

  3. (7)

    Do you consider becoming a rheumatologist?

  4. (8)

    Did the location where you practiced your internship internal medicine would have influenced your choice/idea about rheumatology?

  5. (9)

    Would the possibility of more practical training on a rheumatic service have influenced your decision to become a rheumatologist?

  6. (10)

    If you consider becoming a rheumatologist, what is the main reason for it? Several reasons can be given (maximum 3). Open question.

  7. (11)

    If they do not consider becoming a rheumatologist, what is the main reason? Several reasons can be given (maximum 3). Open question.

The third survey addressed certified rheumatologists working in Flanders and consisted of 17 questions. The first three questions were related to rheumatologist demographics such as following: (1) gender, (2) year of graduation as a rheumatologist, and (3) professional working environment (academic hospital, private practice and hospital, only private practice, only hospital). Two questions were related to their previous educational program and seven questions were related to their opinion about the need for any changes in the current training program.

  1. (4)

    In which disciplines of internal medicine were you trained during the basic internal medicine training?

  2. (5)

    Did you experienced sufficient training in musculoskeletal disorders during your rheumatology training?

  3. (6)

    Do you think there is a need for change of adaptation in the training program to become a rheumatologist?

  4. (7)

    Which disciplines in internal medicine are essential in the training program to become rheumatologist?

  5. (8)

    Which other disciplines (not included in internal medicine) should be included in the training program to become rheumatology?

  6. (9)

    Which technical skills should be acquired during the training program?

  7. (10)

    What would they want to change in the education program?

  8. (11)

    What is your proposal to change the educational program?

Only one possibility

  1. a.

    No change in the educational program

  2. b.

    More basic internal medicine training

  3. c.

    More specialty training in rheumatology

(12) Where should training take place?

Only one possibility

  1. a.

    Only in academic environment

  2. b.

    Only in non-academic hospital(s)

  3. c.

    A balanced mixture of academic and non-academic environment

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Wittoek, R., Mielants, H. To be or not to be rheumatologist: survey among Belgian medical students and internal medicine trainees: what do certified rheumatologists think about the current rheumatology training program?. Clin Rheumatol 36, 2805–2812 (2017). https://doi.org/10.1007/s10067-017-3673-y

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