Variations in the Adult Rheumatology Fellowship Training in the United States: Opportunities and Challenges.

Abstract

Adult rheumatology fellowship training programs in the United States exhibit considerable curricular diversity while staying within the framework provided by American College of Rheumatology (ACR) and Accreditation Council for Graduate Medical Education (ACGME). This study aims to characterize the variation in key training components across programs, providing a descriptive overview of current practices. We developed a set of survey questions using Qualtrics to capture curricular elements among ACGME-accredited adult rheumatology fellowship programs in the United States. One current trainee from each program was invited to participate. We received responses from 91 out of 126 programs available at the time of study, leading to a response rate of 72.2%. Although most programs incorporate core elements recommended by ACGME and ACR, substantial variability was observed in areas such as ambulatory and inpatient training, elective offerings, procedural experience, didactic structure, interdisciplinary exposure, mentorship, and research opportunities. Our findings highlight the diverse approaches taken by rheumatology fellowship programs in structuring their curricula. Rather than advocating for uniformity, this variability may reflect the adaptability of programs to local resources and institutional strengths. Further exploration of how these differences influence educational outcomes could inform future efforts to enhance rheumatology training.