P037 Rheum for more? A systematic literature review on undergraduate exposure to rheumatology
Authors: Kouranloo Koushan , Myall Nikki , Christie Jennifer 
Published: April 2024

Abstract

Background/Aims
Since the introduction of Modernising Medical Careers by the General Medical Council in the United Kingdom (UK) in 2007, newly-qualified doctors are expected to choose their specialty much sooner than previously. A recent report published by the British Society of Rheumatology (BSR) in 2021 demonstrated a lack of exposure to the specialty for medical students. We conducted a systematic literature review on the quantity and quality of rheumatology teaching amongst undergraduate medical students.

Methods
Articles published until June 2023 were included. Eligible articles were: case reports and series, observational studies, qualitative studies and randomised control trials. Medline, Embase, PyscINFO, Cochrane library and WHO international clinical trial registry were searched, restricted to English language articles only. Articles including postgraduate trainees and those pertaining to a single intervention or single student cohort were excluded. Information was extracted on demographics, method of teaching, hours dedicated to rheumatology and students’ and educators’ feedback where mentioned.

Results
After deduplication, 1195 article were identified. After screening title and abstract, 1156 papers were excluded, with 39 proceeding to full text screening. Ultimately, seven articles (all cross-sectional surveys) were included. Publication year of included articles ranged from 1981 to 2018. The countries of included studies were UK (3), USA (2), Australian (1) and Pan-European (1). Year of rheumatology teaching at medical school was reported in four studies (3 UK and 1 USA). The three UK studies were all taught in the latter years (4-6), whereas in the USA study the students were taught at every single year. Where reported, data on the number of hours of exposure to rheumatology were variable, ranging from 15 to 96 hours per medical student. Reported method of teaching included lecture-based, rheumatology inpatient service and shadowing consultations. Student feedback was only provided in one (UK-based) study, from 49 students of whom two regarded rheumatology as “fascinating”, four felt that they had limited exposure and eight considered it as “a niche specialty of no interest”. No feedback from educators were collected in any of the included studies. Factors identified by the included studies for overall poor exposure to rheumatology included: lack of having full-time rheumatologists on the school’s faculty, lack of specialty training programme in their local teaching hospital and greater emphasis on general medical/ acute specialties (e.g. general practice and emergency medicine).

Conclusion
Overall, there are significant limitations in recording the amount and quality of rheumatology teaching amongst undergraduate medical students. Exposure to clinical rheumatology has markedly decreased over time, with variable student awareness of the speciality. Given the ageing UK population and increase in multimorbidity, there is a need to increase exposure and entry to the specialty, which may be partly facilitated by improved incorporation of rheumatology in the undergraduate curriculum.

Disclosure
K. Kouranloo: None. N. Myall: None. J. Christie: None.