Rheumatology education in United States medical school

Although rheumatology manpower in United States medical schools has dramatically increased in the past decade, 13% of medical schools did not have a full-time staff rheumatologist in 1980. Thirty-eight percent of medical schools had 2 or less full-time rheumatologists. Staff rheumatologists and rheumatology fellows provided the majority of medical student education in the clinical aspects of rheumatic disease; however, rheumatologists in less than 50% of medical schools taught in the basic science curriculum or in related fields such as collagen biochemistry, metabolic bone disease, and orthopedic intervention in arthritis. The staff rheumatologists' time commitment to medical student education was inversely proportional to the rheumatology faculty size. At medical schools with no rheumatologists, however, there was little, if any, formal education in the rheumatic diseases. Most subjects are taught in systems-oriented lectures. Education is currently limited to the common rheumatic conditions such as bursitis and back pain. Only 62% of medical schools provide a structured course on the musculoskeletal examination. Elective rotations in rheumatology, usually offered in the third or fourth year, are currently being provided to only 15% of U.S. medical students.