Rheumatology training in Poland vs. United Kingdom.
ABSTRACT: When evaluating the quality of Rheumatology specialty training, it can be useful to explore similarities and differences between countries. In this article we compare the training in the UK and Poland. The two training programmes are similar in length and in the competencies that must be achieved, although they do have significant differences in the way the training is structured. The UK-based system is more out-patient based, which can be advantageous, as after completion of training the doctor is more confident in treating common rheumatological problems. On the other hand, having exposure to paediatric rheumatology and orthopaedics like one has in Polish-based training, despite a short placement time, is definitely beneficial for the trainee in gaining all-round knowledge. In conclusion, each system has its merits and can be further enhanced by observing how junior doctors are sub-speciality trained in different countries.
Project description:This editorial accompanies the launch of BMC Rheumatology, a new open access, peer-reviewed journal within the BMC Series portfolio, which considers studies on all aspects of rheumatological diseases. The Journal will also place a special emphasis on manuscripts reporting systemic and inflammatory conditions and connective tissue diseases, along with related comorbidities, including cardiovascular disease, malignancy and infection. Through the publication of a variety of article types, including Research articles, Case reports, Study protocols and Debates, BMC Rheumatology will provide the rheumatology community with an open access avenue to disseminate research into rheumatological diseases, with the ultimate aim of improving patient care.
Project description:Background:There is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work-life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK. Methods:We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine. Results:There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality. Conclusion:This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.
Project description:Objectives:Rheumatology-related diseases remain a significant burden worldwide. However, little is known about the comparative status of rheumatology research between Mainland China (MC) and the world's leading countries. The aim of this study is to compare the quantity and quality of research output in the field of rheumatology that were written by researchers from MC, the USA, the UK, the Netherlands and France. Methods:Between 2007 and 2017, all articles published in 30 rheumatology journals were identified via Science Citation Index Expanded database. The number of total and annual articles, article types (randomized controlled trials (RCTs), reviews, case reports, clinical trials and meta-analysis), impact factor (IF), citations, h-index and articles in the high-impact journals were collected for quantity and quality comparisons. The correlation of socioeconomic factors and annual publications was also analyzed. Results:From 2007 to 2017, there were 53,439 articles published in rheumatology journals, of which researchers from the USA published 13,391 articles, followed by the UK, the Netherlands, France and MC with 6,179, 4,310, 4,066 and 2,898 articles, respectively. Publications from MC represented the ninth, but the number is growing rapidly. For total and average citations, MC still lags behind the other four countries in the study. Similar trends were observed in average IF, h-index and articles in the high-impact journals. In terms of article types, the USA occupies the dominant place, except for meta-analysis. The annual numbers of articles from MC and the USA were positively correlated with gross domestic product (p < 0.05). Conclusions:The USA has played predominant role in rheumatology research for the last 11 years. The annual number of published articles from MC has increased notably from 2007 to 2017. Although MC has made progress in the number of published articles over the past decade, it still lags far behind the highly developed countries in most bibliometric indicators. Thus, the general quality of publications from MC needs further improvement.
Project description:Pharmacist participation in chronic disease management benefits patients in many ambulatory settings. We explored the attitudes and perceptions among multidisciplinary members of a rheumatology team towards the skills and responsibilities of a pharmacist joining their practice.The physicians, nurse, physiotherapist and staff of a rheumatology clinic were invited to participate in focus group and semistructured interviews. Practice members also completed an inventory of perceived health professional roles in the medication use process.Discussions with 2 physicians, a nurse, physiotherapist and 1 office administrator were conducted. Concepts related to 3 key themes included positively viewed pharmacist roles broadly related to activities that encompass provision of medication-related services for the patients, the providers and the practice. Examples of such care included educational tasks related to therapies (rheumatological and otherwise) and maintenance of accurate drug histories. These findings were reflected in high scores for perceived pharmacist roles in education and medication review responsibilities using the Medication Use Processes Matrix instrument. Most members were not comfortable with pharmacists conducting physical assessments and emphasized the need for a team member who could adapt to variations in workflow preferences across rheumatologists in the practice.Perceived pharmacist roles expressed by existing rheumatology team members were largely consistent with the scope of pharmacist knowledge, skills and responsibilities in primary care.Overall, existing multidisciplinary staff exhibited favourable attitudes towards a pharmacist joining their practice setting. Data from this job analysis exercise were used to inform the development of a job description for a rheumatology clinical pharmacist.
Project description:BACKGROUND: There is concern about the adequacy of operative exposure in surgical training programmes, in the context of changing work practices. We aimed to quantify the operative exposure of all trainees on the National Basic Surgical Training (BST) programme in Ireland and compare the results with arbitrary training targets. METHODS: Retrospective analysis of data obtained from a web-based logbook (http://www.elogbook.org) for all general surgery and orthopaedic training posts between July 2007 and June 2009. RESULTS: 104 trainees recorded 23,918 operations between two 6-month general surgery posts. The most common general surgery operation performed was simple skin excision with trainees performing an average of 19.7 (± 9.9) over the 2-year training programme. Trainees most frequently assisted with cholecystectomy with an average of 16.0 (± 11.0) per trainee. Comparison of trainee operative experience to arbitrary training targets found that 2-38% of trainees achieved the targets for 9 emergency index operations and 24-90% of trainees achieved the targets for 8 index elective operations. 72 trainees also completed a 6-month post in orthopaedics and recorded 7,551 operations. The most common orthopaedic operation that trainees performed was removal of metal, with an average of 2.90 (± 3.27) per trainee. The most common orthopaedic operation that trainees assisted with was total hip replacement, with an average of 10.46 (± 6.21) per trainee. CONCLUSIONS: A centralised web-based logbook provides valuable data to analyse training programme performance. Analysis of logbooks raises concerns about operative experience at junior trainee level. The provision of adequate operative exposure for trainees should be a key performance indicator for training programmes.
Project description:OBJECTIVE: In Rheumatology, non-steroidal anti-inflammatory drugs (NSAIDs) has been widely prescribed and used. However, despite their clinical benefits in the management of inflammatory and degenerative joint disease, NSAIDs have considerable side effects, mostly affecting the upper gastrointestinal system, which therefore, limit their use. This study was conducted to determine the patients' knowledge and perception regarding the used of NSAIDS. METHODS: A total of 120 patients who attended the rheumatology clinic Hospital, Raja Permaisuri Bainun, Malaysia, and received NSAIDs more than 3 months were interviewed irrespective of their rheumatological conditions. Patient's knowledge and perception on the side effects of NSAIDs were recorded. RESULT: Fifty-four percent of the patients obtained information regarding the side effect of NSAIDs either from the rheumatologist, rheumatology staff nurse or other medical staffs (75.4%). The remaining 45.8% were naive of such knowledge. Fifteen percent obtained the information by surfing the internet and 9.2% from printed media. Twenty-four (24.2%) patients, experienced indigestion and/or stomach discomfort attributed to NSAIDs used. Two patients (1.7%) had hematemesis and malena once. CONCLUSION: This study shows that half of the patients who attended the rheumatology clinic were unaware of the side effect of NSAIDs. Available data showed that most of the knowledgeable patients are more conscience and self-educated. This study also reveals the important roles of clinicians, trained staff nurses as well as the pharmacist in providing the guidance and knowledge of any medication taken by patients.
Project description:We undertook a needs assessment exercise using questionnaire survey of junior doctors' knowledge and beliefs concerning evidence-based medicine (EBM) and critical literature appraisal, as this is a core competence in postgraduate medical education.We surveyed 317 junior doctors in various specialities in the UK West Midlands Deanery. Using validated questionnaires we compared the needs of different trainee groups. Results overall were internally consistent (Cronbach's alpha 0.929).Respondents' generally felt that they had poor training in EBM (Mean score 2.2, possible range 1-6) and that they needed more education (Mean score 5.3, possible range 1-6). Male trainees felt more confident at evaluating statistical tests than females (p = 0.002). Female trainees considered patient choice above the evidence more often than males (p = 0.038). Trainees from surgical speciality felt more confident at assessing research evidence (p = 0.009) whereas those from medical speciality felt more confident at evaluating statistical tests (p = 0.038) than other specialities. However, non-surgical specialities tended to believe that EBM had little impact on practice (p = 0.029). Respondents who had been qualified for 11 years or over felt overall more confident in their knowledge relating to EBM than those who had been qualified less than 10 years. In particular, they felt more confident at being able to assess study designs (p = < 0.001) and the general worth of research papers (p = < 0.001). Trainees with prior research experience were less likely to find original work confusing (p = 0.003) and felt more confident that they can assess research evidence (p = < 0.001) compared to those without previous research experience. Trainees without previous research experience felt that clinical judgement was more important than evidence (p = < 0.001).There is a perceived deficit in postgraduate doctors' EBM knowledge and critical appraisal skills. Learning needs vary according to gender, place of basic medical qualification, time since graduation, prior research experience and speciality. EBM training curricular development should take into account the findings of our needs assessment study.
Project description:OBJECTIVE:To produce recommendations for patients with rheumatological diseases receiving immunomodulatory and immunosuppressive therapies (conventional drugs, biologicals, and small molecules) during the COVID-19 pandemic. MATERIALS AND METHODS:The recommendations were determined using the Delphi method as an agreement tool. A panel of experts was formed, with academic backgrounds and research experience in rheumatology. A literature search was conducted and 42 questions were generated. The level of agreement was made with 80% of approval by the participants. RESULTS:A group of eleven rheumatologists from 7 cities in the country participated. The response rate was 100% for the three consultation rounds. In the first round, agreement was reached on 35 questions, on 37 in the second round, and on 42 questions in the third round. CONCLUSION:The recommendation for the majority of the pharmacological treatments used in rheumatology is to continue with immunomodulatory or immunosuppressive therapies in patients who do not have the infection, and to suspend it in patients with a diagnosis of SARS-CoV-2/COVID-19.
Project description:Background:Exercise has proven benefits in rheumatologic disease including reducing inflammation and improving symptoms. A Group Strength Training (GST) program design has improved adherence to exercise in primary care patients but the effect is unknown in rheumatology patients. We examined the interest of rheumatology patients with different diagnoses and the effect of comorbidities in pursuing an organized GST program. Methods:We conducted a cross-sectional survey of patients from a rheumatology practice in central Pennsylvania in February and April 2017. This survey assessed self-reported interest of patients in a GST program in addition to demographics, comorbidities, and quality of life measures. Primary care data from a previous survey were used for comparative analysis for the primary outcome: interest in a GST program. Results:Fifty percent of rheumatology patients were interested in a GST program and there was no difference of interest compared to primary care patients (X2 = 2.04, p = 0.15). There was no difference in interest in a GST program for rheumatology patients with poor health compared to patients with good health (OR = 0.9, p = 0.8). Female patients were more interested in a group strength training program than male patients (OR = 3.7, p = 0.001). Patients with a BMI of 25-30 (OR = 2.2, p = 0.04) or > 30 (OR = 1.7, p = 0.12) were more interested compared to those with a normal BMI. There was no difference in interest in group strength training regardless of rheumatology diagnosis or comorbidities. Conclusion:Our data suggest that rheumatology patients are interested in a GST program regardless of disease, medical comorbidities, perceived mental or physical health, or education level. Further study is needed to determine the effects of GST on rheumatologic diseases.
Project description:AIM:To understand the impact of COVID-19 on radiology trainee experience and well-being. MATERIALS AND METHODS:A questionnaire designed to capture the impact of COVID-19 on radiology training, working patterns, and well-being was sent to all speciality trainees in a regional UK radiology school. The survey was distributed at the beginning of May 2020 and responses collected over 2 weeks. Trainees were questioned about changes that had occurred over a time period starting at the beginning of the COVID-19 pandemic. All survey responses (n=29) were anonymised and the results were subsequently analysed. RESULTS:Sixty-two percent (29 of 47) of trainees within the deanery, who were spread across seven different hospital sites, responded to the questionnaire. All trainees felt that overall radiology workload had decreased in response to COVID-19. Seventy-two percent (21/29) stated that their workload had significantly decreased. Seventy percent (19/27) reported decreased subspecialty experience, and 19% (5/27) reported a complete lack of subspecialty training. Twenty-four percent (7/29) of trainees were redeployed from radiology to clinical ward-based work. Forty-eight percent reported experiencing a worsening in their well-being compared to before the pandemic. CONCLUSION:The first wave of the COVID-19 pandemic had a significant impact on training and well-being. Lessons learnt from this report should help prepare for a second-wave of COVID-19 or future pandemics.