Identifying educational and resource needs of general internal medicine physicians in sickle cell disease management. Free

Background: Sickle cell disease (SCD) presents with a wide spectrum of acute and chronic complications that require timely recognition and multidisciplinary management. General internal medicine (GIM) physicians frequently care for patients with SCD across inpatient, outpatient, and consultative settings, yet often lack formal training or tools to support high-quality care. Despite increasing SCD prevalence and known knowledge-gaps in non-specialist management, there are no structured educational resources or clinical tools available at our centre to assist GIM physicians. This study aimed to evaluate GIM physicians' comfort in recognizing and managing SCD-related complications, and to explore their preferences for educational and clinical decision-making supports.

Methods: We conducted a cross-sectional needs assessment using a web-based survey developed with input from hematologists and GIM physicians. The survey included a mix of Likert scale, multiple choice, and open-ended questions to assess self-reported comfort in identifying and managing common and rare SCD-related complications. It also explored participants' preferences for educational resources, clinical decision tools, and institutional supports. The survey was distributed via internal email. Data was analyzed descriptively.

Results: We received 18 responses from physicians within the Division of General Internal Medicine, which includes approximately 85 members.Most respondents reported encountering exacerbations of chronic pain (83.3%), acute vaso-occlusive pain crises (66.7%), and acute chest syndrome (44.4%). Comfort in identifying complications varied, with highest discomfort reported for aplastic crisis (38.9% extremely uncomfortable) and hepatic sequestration (50.0% somewhat uncomfortable). Notably, no respondents reported being “extremely comfortable” with recognizing any SCD complication. The most preferred clinical tools were pre-formulated pain management protocols (66.7%), standardized order sets (55.6%), and clinical pathways or decision support tools (55.6%). Educational resources of interest included quick reference guides, access to protocols, and e-learning modules. Free-text responses revealed key themes: (1) Limited exposure to SCD and rare complications; (2) Uncertainty in distinguishing acute vs. chronic pain presentations; (3) Need for early involvement of hematology; (4) Desire for educational materials that promote understanding, not just checklist-driven care. As one respondent noted, “Order sets make me nervous when I don't know WHY I'm doing something… I am just checking boxes rather than making decisions.”

Conclusion: GIM physicians at our center report low comfort with recognizing and managing SCD complications, particularly less common presentations. While there is strong interest in structured decision tools and educational supports, participants also expressed a desire for resources that enhance clinical reasoning and promote confidence in decision-making. This single-institution study provides valuable insight to guide the co-development of targeted local interventions by hematology and internal medicine. Future work should consider expanding the survey to other academic centres to explore variation in GIM experience. Differences in institutional models—such as hematology-led admissions for SCD at some centres—may significantly influence educational and resource needs.