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Factors that influence Canadian internal medicine residents’ choice to pursue a rheumatology career

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Abstract

In Canada, little is known about residents’ self-confidence to diagnose/treat musculoskeletal (MSK) disease and factors affecting pursuit of a rheumatology career. Our study explored these factors. An online survey (descriptive cross-sectional design) was distributed to Canadian postgraduate year (PGY) 1 and 2 internal medicine (IM) residents. Questions probed self-confidence in rheumatology and factors influencing subspecialty career choice. Frequencies were determined and responses compared between PGY-1 and PGY-2 using univariate statistical analyses. Fifty-four IM residents completed the survey. PGY-2 residents were statistically more certain in subspecialty decidedness and had higher levels of self-confidence to diagnose/treat MSK disease and perform a physical exam. “Quality of life” was the most encouraging factor for a rheumatology career choice followed by “job opportunities” and “previous clinical exposure.” Although 50% of PGY-1 residents had completed a rheumatology clinical rotation, 76% indicated that increased knowledge would affect rheumatology career choice. Only 38% were interested in novel rheumatology education. No difference in rheumatology exposure, rheumatology clinical rotation completion year, or rheumatology career choice was observed. Our research confirms findings from similar United States (US) and United Kingdom (UK) studies that suggest that increased MSK knowledge positively influences residents’ confidence to diagnose/treat MSK disease. Our study differs with Canadian PGY-1 and PGY-2 IM residents by evaluating self-confidence to diagnose/treat MSK disease separately from self-confidence to perform a physical exam. Significant differences between first and second year trainees suggest types/quality of rheumatology experiences (e.g., case complexity, diagnostic problem-solving competency) may affect self-confidence to diagnose/treat MSK disease factors and rheumatology career choice.

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References

  1. Briggs AM, Cross MJ, Hoy DG et al (2016) Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization world report on ageing and health. The Gerontologist 56(S2):43–55

    Google Scholar 

  2. Horton R (2012) GBD 2010: understanding disease, injury, and risk. Lancet 15:2053–2054

    Article  Google Scholar 

  3. Badley EM, Davis AM (2012) Meeting the challenge of the ageing of the population: issues in access to specialist care for arthritis. Best Pract Res Clin Rheumatol 26:599–609

    Article  PubMed  Google Scholar 

  4. MacKay C, Canizares M, Davis AM, Badley EM (2010) Health care utilization for musculoskeletal disorders. Arthritis Care Res 62(2):161–169

    Google Scholar 

  5. Widdifield J, Paterson JM, Bernatsky S, et al (2014) The epidemiology of rheumatoid arthritis in Ontario, Canada. Arthritis Rheum 66(4):786–793

  6. Zhang W, Anis AH (2011) The economic burden of rheumatoid arthritis: beyond health care costs. Clin Rheumatol 30(1):25–32

    Article  Google Scholar 

  7. Badley E, DesMeules M (2003) Arthritis in Canada-an ongoing Challenge. Ottawa: Health Canada (Cat.# H39–4/14-2003E)

  8. Barber CE, Jewett L, Badley EM et al (2016) Stand up and be counted: measuring and mapping the rheumatology workforce in Canada. J Rheumatol 44(2):248–257

    Article  PubMed  Google Scholar 

  9. Cividino A, Bakowsky V, Barr S et al (2016) How to attract trainees, a pan-Canadian perspective: phase 1 of the “training the rheumatologists of tomorrow” project. J Rheumatol 43(4):788–798

    Article  PubMed  Google Scholar 

  10. Deal CL, Hooker R, Harrington T, Birnbaum N, Hogan P (2007) Bouchery. The United States rheumatology workforce: supply and demand, 2005-2025. Arthritis Rheum 56:722–729

    Article  PubMed  Google Scholar 

  11. Hanly JG (2001) Manpower in Canadian academic rheumatology units: current status and future trends. Canadian council of academic rheumatologists. J Rheumatol 28:1944–1951

    CAS  PubMed  Google Scholar 

  12. Brophy J, Marshall DA, Badley EM et al (2016) Measuring the rheumatology workforce in Canada: a literature review. J Rheumatol 43(6):1121–1129

    Article  PubMed  Google Scholar 

  13. Johnston C (2015) Rheumatology an in-demand career choice. CMAJ 187(10):E298

    Article  PubMed Central  PubMed  Google Scholar 

  14. McDougall C, Hurd K, Barnabe C (2017) Systematic review of rheumatic disease epidemiology in the indigenous populations of Canada, the United States, Australia, and New Zealand. Semin Arthritis Rheum 46(5):675–686

    Article  PubMed  Google Scholar 

  15. Loyola-Sanchez A, Hurd K, Barnabe C (2017) Healthcare utilization for arthritis by indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic review. Semin Arthritis Rheum 46(5):665–674

    Article  PubMed  Google Scholar 

  16. Watmough S, Taylor D, Ryland I (2007) Using questionnaires to determine whether medical graduates’ career choice is determined by undergraduate or postgraduate experiences. Med Teach 29:830–832

    Article  PubMed  Google Scholar 

  17. Horn L, Tzanetos K, Thorpe K, Straus SE (2008) Factors associated with the subspecialty choices of internal medicine residents in Canada. BMC Med Educ 8(1):37

  18. Hale A, Glassman R, Fessler D, Mukamal KJ, Stead W (2016) Meeting the needs of the resident trainee during an elective subspecialty rotation. Int J Med Educ 7:115–118

    Article  PubMed Central  PubMed  Google Scholar 

  19. Katz SJ, Yacyshyn EA (2009) Attracting internal medicine trainees to rheumatology: where and when programs should focus efforts. J Rheumatol 36(12):2802–2805

    Article  PubMed  Google Scholar 

  20. Zborovski S, Rohekar G, Rohekar S (2010) Strategies to improve recruitment into rheumatology: results of the workforce in rheumatology issues study (WRIST). J Rheumatol 37(8):1749–1755

    Article  PubMed  Google Scholar 

  21. Hague M, Shenker N (2014) How to investigate: chronic pain. Best Pract Res Clin Rheumatol 28(6):860–874

    Article  PubMed  Google Scholar 

  22. Alyn N (2009) The diagnostic challenge of joint pain—part 1. GM: Midlife Beyond 39(6):349–355

    Google Scholar 

  23. Katz SJ, Oswald AE (2011) How confident are internal medicine residents in rheumatology versus other common internal medicine clinical skills: an issue of training time or exposure? Clin Rheumatol 30(8):1081–1093

    Article  PubMed  Google Scholar 

  24. Truntzer J, Lynch A, Kruse D, Prislin M (2014) Musculoskeletal education: an assessment of the clinical confidence of medical students. Perspect Med Educ 3(3):238–244

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kroop SF, Chung CP, Davidson MA, Horn L, Damp JB, Dewey C (2016) Rheumatologic skills development: what are the needs of internal medicine residents? Clin Rheumatol 35(8):2109–2115

    Article  PubMed  Google Scholar 

  26. Goff I, Wise EM, Coady D, Walker D (2016) Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice? Clin Rheumatol 35(2):507–511

    Article  PubMed  Google Scholar 

  27. Nadesalingam K, Ntatsaki E, Hull D, Hughes R (2016) Musculoskeletal training in rheumatology-what the trainees think. Br J Med Pract 9(2):29–32

    Google Scholar 

  28. Ofoma UR, Lehman EE, Haidet P, Yacht AC (2011) Associations between subspecialty fellowship interest and knowledge of internal medicine: a hypothesis-generating study of internal medicine residents. BMC Med Educ 11(1):5

    Article  PubMed Central  PubMed  Google Scholar 

  29. Button JH, Bruel BM, Francisco GE (2007) Assessment of musculoskeletal examination skills: physiatry residents as evaluators and models. Am J Phys Med Rehabil 86(11):926–934

    Article  PubMed  Google Scholar 

  30. DiGiovanni BF, Chu JY, Mooney CJ, Lambert DR (2012) Maturation of medical student musculoskeletal medicine knowledge and clinical confidence. Med Educ Online 17(1):17092

    Article  Google Scholar 

  31. Beretta B. Top ten common problems in designing effective survey questions. Best Practices, Customer Satisfaction. 2014. Retrieved from: http://www.satrixsolutions.com/blog/top-ten-common-problems-designing-effective-survey-questions/

  32. Del Greco L, Walop W, McCarthy RH (1987) Questionnaire development: 2. Validity and reliability. CMAJ: Can Med Assoc J 136(7):699–700

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Rheumatology, McMaster University, Hamilton, ON, Canada

    Mark Matsos, Mary-Clair Yelovich & Karen A. Beattie

  2. Faculty of Education, Brock University, St. Catharines, ON, Canada

    Susan Maureen Docherty-Skippen

Authors
  1. Mark Matsos
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  2. Susan Maureen Docherty-Skippen
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  3. Mary-Clair Yelovich
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  4. Karen A. Beattie
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Corresponding author

Correspondence to Karen A. Beattie.

Ethics declarations

The study was approved by the Hamilton Integrated Research Ethics Board (a jointly instituted board of St. Joseph’s Healthcare Hamilton, Hamilton Health Sciences and McMaster University’s Faculty of Health Sciences).

Conflict of interest

The authors have no financial relationship with The Arthritis Society who funded Dr. Matsos with a career award. The authors confirm they have full control of all primary data and allow the journal to review their data if requested.

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Matsos, M., Docherty-Skippen, S.M., Yelovich, MC. et al. Factors that influence Canadian internal medicine residents’ choice to pursue a rheumatology career. Clin Rheumatol 38, 229–234 (2019). https://doi.org/10.1007/s10067-018-4222-z

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  • DOI: https://doi.org/10.1007/s10067-018-4222-z

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