Do people with rheumatoid arthritis develop illness-related schemas?

OBJECTIVE: To assess, using both qualitative/inductive and quantitative data, whether people with rheumatoid arthritis (RA) have schemas related to arthritis. METHODS: Themes identified from interview and focus group transcripts were used to develop 1) questionnaire items, and 2) statements participants were asked to recall during home interviews. Two hundred one people with RA completed questionnaires and recall tasks of the type used in cognitive research, followed 10 days later by another recall assessment by telephone. RESULTS: Qualitative methods, item-level questionnaire data, and category-level recall data yielded convergent results supporting 4 final categories: mastery, support, loss of independence, and depression. Regression analyses indicated that category of earlier recollections predicted subsequent recollections assessed via phone. CONCLUSIONS: Results from widely different methods offer at least partial support for arthritis schemas and suggest that the concepts identified are meaningful to patients as well as to researchers.

A randomized trial of physicians and physical therapists as instructors of the musculoskeletal examination.

OBJECTIVE: To evaluate the effectiveness of physicians vs physical therapists as instructors of the musculoskeletal examination to second year medical students. METHODS: A randomized trial conducted over 3 consecutive years in a physical diagnosis course at The University of North Carolina. During the first (baseline) year, medical students received education about the musculoskeletal examination from a lecture and supervision by clinical preceptors. This increased in the second and third (intervention) years where random halves of each class received supplementary clinical instruction which included a structured manual, a videotape, and supervised practice with either general internal medicine physicians or physical therapists. Outcomes were measured from student performance on a practical test of clinical skills, and by written student evaluations of the supplementary instruction. RESULTS: As measured on the clinical examination, performance during the intervention years improved over that during the baseline year in both intervention groups. Measures of medical students' clinical skills did not correlate with measures of academic aptitude. CONCLUSIONS: Clinical education about the musculoskeletal examination should be structured and systematic. Medical students prefer clinical education that is active, provides clear directions, and gives them performance feedback.

Clinical rheumatology training of primary care physicians: the resident perspective.

Because nonspecialized physicians provide care for the vast majority of patients with rheumatic disorders, we surveyed 327 internal medicine and family medicine residents with respect to the nature of their training in rheumatology. Although most internal medicine residents had access to rheumatologists for training and had taken formal rheumatology rotations, this was often not the case for family medicine residents. Deficiencies evident in both types of programs included limited access to rheumatology electives; insufficient exposure to certain major categories of rheumatic disease, e.g., the spondyloarthropathies and systemic autoimmune disorders; and lack of direct participatory experience in orthopedics, rehabilitation, and psychosocial aspects of rheumatology.