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© 1995 British Society for Rheumatology

research-article

ASSESSING CLINICAL COMPETENCE: RECOGNITION OF CASE DESCRIPTIONS OF RHEUMATIC DISEASES BY GENERAL PRACTITIONERS

A. A. M. BLAAUW*,, L. W. T. SCHUWIRTH{dagger}, C. P. M. VAN DER VLEUTEN{dagger}, F. SMITS{ddagger} and SJ. VAN DER LINDEN*

*Department of Internel Medicine, Division of Rheumatology, University Hospital Maastricht Maastricht
{dagger}Department of Educational Development and Research, University of Limburg Maastricht
{ddagger}General Practitioner Maastricht, The Netherlands

Correspondence to: Correspondence to: A.A.M. Blaauw, University Hospital Utrecht, Department of Rheumatology F02.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.

The objective of this study was to detect strengths and weaknesses in the diagnosis of rheumatic diseases by general practitioners in order to set up post-graduate training accordingly and to assess whether open-ended questions give results comparable with multiple choice-type questions. Fifty-one general practitioners were given eight written cases: rheumatoidarthritis (RA), ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis (PsA), systemic lupus erythematosus (SLE), gout, polymyalgia rheumatica and pseudogout. Only signs and symptoms were provided. All cases were derived from realpatients with a definite diagnosis. Each case was presented in both types of question formats. The cases were also presented to 23 rheumatologists. We found that in the open-ended question format 57.1% of the general practitioners gave the correct answers. Cases of RA, AS, gout and PsA were correctly diagnosed by >70% of the general practitioners. Cases of polymyalgia rheumatica and reactive arthritis were correctly diagnosed by 55 and 39% of the general practitioners, respectively. The cases of pseudogout and SLE were correctly diagnosed by less than 11% of the general practitioners. Fifty-two per cent of the general practitioners gave the correct answers to the multiple choice-type questions. There was no statistical difference in the correct answers between the open-ended questions and the multiple choice-type questions. We concluded that assuming generalization of the results, training of general practitioners should include polymyalgia rheumatica, reactive arthritis, SLE and pseudogout.

KEY WORDS: Clinical competence, Rheumatic diseases, General practitioners, Quality assurance, Health care


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