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

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 ope n-ended questions give results comparable with multiple choice-type qu estions. Fifty-one general practitioners were given eight written case s: rheumatoid arthritis (RA), ankylosing spondylitis (AS), reactive ar thritis, psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) , gout, polymyalgia rheumatica and pseudogout. Only signs and symptoms were provided. All cases were derived from real patients with a defin ite diagnosis. Each case was presented in both types of question forma ts. 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 3 9% of the general practitioners, respectively. The cases of pseudogout and SLE were correctly diagnosed by less than 11% of the general prac titioners. Fifty-two per cent of the general practitioners gave the co rrect answers to the multiple choice-type questions. There was no stat istical difference in the correct answers between the open-ended quest ions and the multiple choice-type questions. We concluded that assumin g generalization of the results, training of general practitioners sho uld include polymyalgia rheumatica, reactive arthritis, SLE and pseudo gout.