Rheumatology: What should all doctors know?

Although training (acquisition of specific skills) may be distinguished from education (an important value base, broader in concept) both are required for medical practice. Undergraduate education should adequately prepare students for their next career stage and lay the foundation upon which postgraduate training and continuing education build. For 'rheumatology' the key essential competencies that all doctors should acquire as an undergraduate are: the ability through appropriate inquiry and examination to differentiate normality from abnormality within the system; accurate recognition of common locomotor conditions and locomotor emergencies; and the ability to outline appropriate investigation and management plans for common or urgent conditions. Linked to these are the understanding of applied anatomy/physiology and basic disease mechanisms, and professional and humanitarian attitudes. Most undergraduate education, therefore, needs to focus on informed holistic patient assessment. Learning objectives need to be clearly stated in the curriculum; the most efficient learning methods then need to be employed; and an assessment that accurately reflects the learning objectives needs to be applied. Each of these three elements needs constant review in the light of learner requirement and performance. Given the primacy of patient assessment in the objectives, clinical competencies should be prominent in the teaching and assessments. Published guidelines on development of a European core curriculum should usefully act as a focus for curriculum development within Europe. Each school can build additional objectives around this core, leading to appropriate diversity of interests and more specialised expertise in young doctors. Medical training from medical school entry onwards ideally should be viewed and organised as a single longitudinal integrated programme rather than as disjointed autonomous units.