The system of training resident physicians (MIR) has shown in recent decades to be an extraordinarily effective way to train specialists in Spain. In recent years there has been some debate about the need to reform some aspects of the MIR system access and training routes in different specialties. In this sense, the National Commission of Rheumatology (CNR) has promoted the idea of seeking the views of resident physicians in rheumatology and rheumatologists who had recently completed their MIR training, whereas this information would be useful to identify opportunities for improvement in training in Rheumatology. The objective of this study is to know the opinion of specialists regarding specialized training and labor as well as many aspects, including teaching and research in the Rheumatology residence in Spain.

The CNR designed a survey with a wide range of questions about different aspects of care, teaching and research related to MIR formation in rheumatology. The survey was adapted to the online Survey Monkey utility and sent to the respondents using e-mail addresses contained in a list of residents of the Spanish Society of Rheumatology (SER). In order to determine whether the opinion on different aspects of training MIR varied with the prospect of professional activity in the first years after completing the MIR training, the invitation to participate in the survey was sent to residents and seniors as well as rheumatologists who had finished their MIR training 1 and 2 years before.

Descriptive statistics, such as means and standard deviations (SD), were used, extreme values for continuous variables, and absolute frequency and percentages for categorical variables. To determine whether significant differences existed among respondents in the last years of their residence and the first years of employment, we used χ2 tests and χ2 for linear trend in 2×2 tables. We accepted a significance value less than 0.05 in bilateral contrast.

65 of the 176 guests (37%) responded to the survey. Their mean age was 30 years with a standard deviation (SD) of 3.5 years and a range of 26–49. 70% were women. Excluding a respondent from Colombia, the rest were of Spanish nationality. Only 2 respondents had a previous specialty (immunology and internal medicine). 25% were third-year residents, 25% fourth-year, 34.6% had completed their residency one year before and 15.4% 2 years prior.

The MIR system has meant a breakthrough in the education of medical specialists with an appropriate level of technical training. However, in recent years some opportunities for improvement related primarily to a more solid structure or training pathway systems for supervision and more effective evaluation have been identified. The CNR is an advisory body of the Ministries of Education and Health. Its composition, powers and operation are regulated by Article 28 of the Profession Health Planning Act.1 Among other functions, the CNR should develop specialty training program, establish evaluation criteria for training specialists to propose the creation of specific training areas, establish criteria for the evaluation of teaching and training unit, prepare the report on programs and criteria for continuing professional training or participate in the design of comprehensive plans within the scope of rheumatology.1

Certainly, knowing the opinion of the main protagonists of the MIR training in rheumatology, residents, it is of utmost importance to detect problems, limitations and deficiencies related to the program. Therefore, the CNR conducted this survey, directed to third and fourth year residents of Rheumatology and specialists who have finished the residency in the one or two years before. The survey looked at many aspects of care, teaching and research in the rheumatology residency.

In the field of health care activity, respondents were mostly satisfied or very satisfied on its influence in training. In fact, only 12% were dissatisfied or very dissatisfied. In contrast, a significant proportion of respondents felt that supervision was not enough, feeling dissatisfied or very dissatisfied in 38%. In the same vein, nearly half of respondents felt that the level of responsibility required in relation to knowledge of the resident was excessive. Likewise, the organization of the unit of rheumatology and the division of tasks were unsatisfactory for 50% of respondents. Together, these responses suggest that residents feel the lack of oversight by the medical staff.

While respondents overwhelmingly expressed their satisfaction with the learning of joint puncture techniques and infiltration, it is worrying to note that training of a basic technique such as the examination of synovial fluid under polarized light microscopy was considered suboptimal by almost 40% of respondents, or that learning an emerging technique of extraordinary value as a diagnostic musculoskeletal ultrasound was considered very unsatisfactory or unsatisfactory by 57% of respondents. It should also move to reflect that almost 8% of residents had no access to the polarized light microscope and 12.7% had access difficulties. It should be remembered that the analysis of synovial fluid under polarized light microscopy is considered an essential technique in training guide2 and the availability of a polarized light microscope is a prerequisite for accreditation of teaching units.3,4

The degree of satisfaction with the training received in different diseases and the use of immunosuppressants or biological agents was generally high. One might note that the highest level of dissatisfaction existed in systemic lupus erythematosus, systemic vasculitis and other connective tissue diseases, osteoporosis and other metabolic bone diseases as well as regional pain syndromes and fibromyalgia.

In the field of educational structure, the lowest level of satisfaction is due to the absence or scarcity of structured and effective assessments of the itinerary. It should be remembered that both points are a formal requirement of the 183/20085 royal decree and that efforts should be made so that the resident tutors have enough time available to perform these essential tasks in their process of formation.

In terms of research training, a small number of residents and former residents graduated with a dissertation completed and 8% had not yet begun their graduate academic project. Also worth taking into consideration is the fact that 39% of respondents were very dissatisfied or dissatisfied with respect to the facilities offered to them by teaching unit to publish articles during the residency.

Our study has some limitations. First, the response rate did not reach 40% of individuals contacted. Moreover, demographic data were not collected and some medical professionals invited to participate refused to do so, so we cannot be assured that the group of participants was truly representative of the rest. On the other hand, the survey also asked specifically about the distribution of rotations outside the rheumatology service or the convenience in homogenizing them.

In summary, residents of rheumatology of our country are reasonably satisfied with respect to their classroom training but it would be desirable to improve relevant aspects of their training such as the supervision of their daily work, their responsibility in the advancement of their professional skills, improvement in their training in particular techniques and conditions, progress in monitoring and evaluation of more structured learning and providing better opportunities for research, publication and development of graduate studies.