Chance and the Prepared Mind — Attracting Trainees into Rheumatology

Abstract

> In the fields of observation, chance favors only the prepared mind. > > — Louis Pasteur, University of Lille, December 7, 1854 What is the influence of a chance encounter in a training program? As the Rheumatology community grapples with the average age of practitioners in the mid-50s and a flat rate of already low recruitment of rheumatology trainees (RT) from internal medicine (IM) training programs, does type and timing of exposure to rheumatology have a predictive value? In an intriguing article in this issue of The Journal 1, Drs. Katz and Yacyshyn have data-mined the Canadian Post-MD Education Registry (CAPER) (which enables anonymous tracking of RT based on their IM residency training site), and examined the relationship of mere availability of a rheumatology rotation in each postgraduate year to the number of eventual RT generated. Curriculum information was obtained from the Canadian Residency Matching Service over a 3-year period; because programs were under major review during this period, no changes were likely to be implemented, assuring homogeneous atomic data. Using advanced logistic regression techniques, Katz and Yacyshyn assigned the availability of a rheumatology elective a numeric value from 0 (no chance of completing a rotation over a given month) to 1 (mandatory completion). They address program restrictions in selectivity (a choice between rheumatology and another rotation would be 0.5), and accordingly, if rheumatology were one choice among 10 rotations, the score would be 0.1. While statistical purists might argue the validity of this construct, it is an attempt to quantify existing data, as the number of rheumatology electives would not be considered a normally distributed value across IM training sites and in each postgraduate year, due to local variations in curriculum, full-time faculty equivalents, or participating community rheumatologists, as they ably demonstrate in their Table 1. There was a positive relationship (Figure 1) between postgraduate year 1 rheumatology opportunities … Address correspondence to Dr. McCarty. E-mail: gmccarty{at}mainehospital.org