Our study examines the rheumatology knowledge and skills of trainees in internal medicine and family practice residency programs. Site visits were made to 15 programs in the eastern half of the United States. Eighty-one trainees participated in the study, 53 in internal medicine and 28 in family practice. Each completed a 50-item rheumatology quiz and performed a clinical assessment of a trained patient evaluator. Trainees in internal medicine had quiz and clinical assessment scores of 52.4% and 72.9%, respectively, while scores for family practice trainees were 43.4% and 61.6% (p less than 0.004 for both). Regression analysis showed that having had a rheumatology elective had a significant effect on knowledge and skills. Trainees in family practice programs were 3 times less likely than internal medicine trainees to have taken a rheumatology elective. Family practice trainee scores in our study were comparable to scores previously documented in 4th year medical students. These results confirm the importance of a specific rheumatology experience for the development of rheumatology knowledge and skills in internal medicine and family practice trainees, and suggest that the rheumatology content of these training programs needs to be enhanced.