Introduction

With the implementation of the revision of the model training regulations for German physicians (Musterweiterbildungsverordnung, MWBO) in 2018, the area of each field in internal medicine was redefined and a restructuring of the training period for specialists in internal medicine and rheumatology took place [2].

The minimum training time requires 72 months, divided into two parts of 36 months each, which include both the common contents of the training as a specialist in internal medicine (“basic training”) as well as the specific contents of the specialist training in internal medicine and rheumatology.

The basic training period in “internal medicine” requires acquisition of at least two specialist competences which do not belong to the specializing field. This training consists of 24 months and is complemented by 6 months of training in both an emergency department and an intensive care unit. The specialized training period in internal medicine and rheumatology also extends over 36 months, of which at least 24 months are completed in inpatient rheumatologic care as defined by the MWBO [2]. Exemptions from this regulation were introduced by individual State Medical Chambers (Landesärztekammern) to allow for a longer period of specialized training in outpatient rheumatologic care.

Based on the MWBO of 2018, a model curriculum was developed by the Commission for Education and Training of the German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie, DGRh) on behalf of the board of the DGRh with regard to core competences in specialized training in internal medicine and rheumatology. This model curriculum focuses on advanced training competences which should be acquired within the 36 months of specialized training in internal medicine and rheumatology and does not include competences relevant to the general part of internal medicine training (basic training).

In this review article, the model curriculum of the DGRh for specialized training in internal medicine and rheumatology is presented.

The model training regulations (MWBO)

The MWBO 2018 provides “cognitive and methodological competences” (knowledge) and “action competences” (experience and skills) for the specialty of internal medicine and rheumatology [1, 2], which includes the recognition, diagnosis, differential diagnosis, treatment, long-term care, and rehabilitation of inflammatory rheumatic joint diseases, inflammatory or immunologic systemic diseases (especially connective tissue diseases and vasculitides), auto-inflammatory syndromes, immunodeficiencies, and their associated comorbidities [2]. Based on the MWBO 2018, the model curriculum was developed by the Commission of Education and Training of the DGRh.

The model curriculum

The aim of the model curriculum is to establish a guideline for trainers and trainees in rheumatology, in which the training competencies of the 36-month training period in the specialty of internal medicine and rheumatology based on the MWBO 2018 are provided in a structured and synchronized manner [2]. The model curriculum is also intended to serve as a basis for all postgraduate trainers in the development of their own rheumatology training plan, which must be submitted to the State Medical Chambers with the new application for training authorization, as is mandatory with the implementation of the MWBO.

The defined examination and treatment procedures listed in the MWBO 2018 serve as the basis for this model curriculum [2]. The aim of the model curriculum is the structured learning of physical examination, diagnosis, differential diagnosis, treatment algorithms, long-term care, and rehabilitation of inflammatory rheumatic joint diseases, inflammatory or immunologic systemic diseases (especially connective tissue diseases, vasculitides, and auto-inflammatory syndromes), and their associated comorbidities.

Structure of the model curriculum

The competences to be provided and acquired were divided into 3 years of training. These competences are minimum requirements, which should be adapted to the respective training institution, so that corresponding activities or knowledge can be learned or performed at an earlier (but also later) point in time. Of course, a more in-depth teaching of competences beyond the present model curriculum is possible and desirable and can be included accordingly in the individual specialized training plan of the training institution. The structure of the specialized training competences as demonstrated here was developed by the Commission of Education and Training and consented by the board of the DGRh and is intended to enable the acquisition of competences to be coordinated over time. In addition, variable training content is also included, which is not assigned to a training section and can be acquired according to the level of knowledge in the first to third year of training.

The acquisition of competences follows the structure of the curriculum with regard to learning of leading symptoms; examination; laboratory, radiology, rheumatologic diagnostics; physical therapy; and therapeutic measures. In addition, interventions (e.g., joint aspiration) are dedicated to the second and third year of training (for details, see Table 1).

Table 1 Minimum requirements for the acquisition of competences, whereby the activities and knowledge can be learned or performed at an earlier or later point in time than indicated
Full size table

Variable contents, which are not assigned to any further training section, are osteology, training programs, and issues of radiation safety (see Table 2).

Table 2 Further education contents with a variable assignment to the further education section
Full size table

Adaptation of the model curriculum

The model curriculum reflects the minimum requirements of the MWBO. In this context, it is not to be regarded as an optimal and binding training option for every rheumatology training center in Germany, but rather provides the framework for successful training as a specialist in internal medicine and rheumatology. Adaptation of the curriculum to the respective situation of the specialized training location is possible or may be necessary at any time. This includes changes in the chronologic sequence of the competence transfer, a more in-depth training in individual aspects, and addition of further training content.

For a continuous development of the curriculum, the Commission for Education and Training asks particularly for feedback from the trainers and trainees regarding the content, topics, and structure of the curriculum. Thus, the curriculum is to be seen as a “work in progress,” which is why comments or suggestions for improvement to the commission are explicitly desired.

In summary, the model curriculum is intended to ensure standardized and structured training and continuing education for specialists in internal medicine and rheumatology.

Conclusion for clinical practice

  • The model curriculum enables the standardized teaching of core competences as part of specialist training in internal medicine and rheumatology.

  • The core competences to be acquired and the variably assignable training contents are provided in three training sections over 36 months.

  • An adaptation of the curriculum to the requirements of the respective institutions of specialized training is reasonable or may be necessary.