Rheumatology training and awareness among undergraduates in Indian medical schools: a multicenter observational study

Rheumatic and musculoskeletal diseases, which are prevalent in nearly 25-30% of the Indian population, pose a significant burden on public health. However, the field is often overlooked in undergraduate medical curricula, leading to a shortage of adequately trained healthcare professionals to address these conditions, especially at the primary health care level. Enhancing rheumatology training for undergraduates in India is imperative. Symptoms of rheumatological diseases are nonspecific and often overlap with those of degenerative joint diseases, neurological conditions, vascular issues, and dermatological problems. As a result, early diagnosis is challenging. A lack of knowledge and skills results in delayed diagnosis and leads to long-term disability and reduced quality of life for patients. Adequate training at the undergraduate level can facilitate early detection and management. At present, rheumatology is taught as part of the internal medicine curriculum through lectures and training during clinical ward postings. We conducted this study to assess the awareness and knowledge of rheumatological diseases among final-year undergraduate medical students and interns.

This was a questionnaire-based cross-sectional study. The anonymized, self-administered, semi structured questionnaire with 9 questions across various domains was designed to gauge participants' exposure to rheumatological illnesses during undergraduate training. Questions 1 and 2 pertained to their duration of training in Medicine and Orthopedics. Question 3 addressed the perceived prevalence of rheumatic diseases. Questions 4, 5, and 6 focused on the cases encountered during clinical rotation, the approach to rheumatological complaints, and joint examination, respectively. Question 7 aimed to assess the difficulties in learning rheumatology. Question 8 provided an objective evaluation of knowledge using 12 true/false questions and a score 65% or more was deemed satisfactory. Question 9 was designed to gauge their confidence regarding rheumatological conditions compared to other conditions. The questionnaire was administered to both undergraduates (UGs) and those undergoing internship (Interns).

A survey of 459 students revealed that the students frequently encountered patients with rheumatoid arthritis (83.5%), osteoarthritis (66.9%) and gout (55.4%) where as less encountered conditions were dermatomyositis (6.6%, 26/390), Sjogren syndrome, antiphospholipid antibody syndrome, and systemic sclerosis (7.9%, 31/390). They remembered being taught to examine large joints, mostly the knee joint (68.2%) whereas less emphasis was placed on the small joints of the hands (34.5%, 127/368), feet (22.5%, 83/368), and ankles (29.8%, 110/368). Only 20% students scored more than 65% in the knowledge score. There was a significant lack of confidence for rheumatological conditions when compared with other conditions (P < 0.001). Interns performed better than final-year students in terms of knowledge confidence level of Rheumatological conditions (P < 0.01).

This study highlights a significant knowledge gap about musculoskeletal conditions among students, with interns showing greater confidence than final-year students. The confidence in examining rheumatological conditions was lower than other conditions indicating inadequate training. These findings suggest revising medical curricula to include more comprehensive teaching in rheumatology and practical training in joint examination. Addressing these gaps is crucial for improving medical education and patient care.