Pediatric Rheumatology Curriculum for the Pediatrics Resident: A Case-Based Approach to Learning

Abstract

IntroductionPediatric rheumatologic disease occurs more frequently than several other chronic pediatric diseases but is often underrecognized. It is estimated that in the US, one in 250 children has some form of juvenile arthritis and 300,000 children have a form of rheumatologic disease. However, there are only approximately 400 practicing pediatric rheumatologists nationwide.MethodsKern's six-step method was used to develop a pediatric rheumatology curriculum based on respondents' perceived lack of training and comfort with four key areas: workup, musculoskeletal exam, laboratory interpretation, and referral to rheumatology. These cases were developed for second-year pediatric and second- and third-year internal medicine-pediatric residents rotating with the service. The curriculum was composed of four 30-minute case discussions as well as an observed musculoskeletal exam session.ResultsIn 2017, weekly case study sessions reached 34 trainees. Survey results from these trainees are representative of our overall results and reveal that learners felt the content of the cases helped increase comfort with compiling pertinent history and information of symptoms consistent with autoimmune disease, recognizing physical exam findings of autoimmune disease, ordering and interpreting laboratory studies in children with concerns for autoimmune disease, and referring to pediatric rheumatology.DiscussionThis case-based curriculum exposed residents to presentations of the more common autoimmune diseases encountered in the pediatric population. The curriculum helps fill a gap in pediatric training through increased exposure to this subset of chronic diseases and expands physical examination skills not typically taught in general pediatrics.

Characterization of Pediatric Patients with Rheumatological Diseases Admitted to a Single Tertiary Health Hospital's Pediatric Intensive Care Unit in Latin America

“…sJIA is considered the leading cause of AIDs during childhood, affecting more than eight children (95% CI: 8.2–8.7)/100,000 every year. 16 sJIA is more prevalent during childhood than other chronic diseases, such as sickle cell anemia, but sJIA is frequently underdiagnosed, 17 leading to both higher direct and indirect health care costs. 18 Childhood-onset SLE (cSLE) is another AID of great relevance among the pediatric population, as almost 20% of all SLE cases begin before the age of 16 years.…”

Attitudes toward pediatric rheumatology among residency‐trained pediatricians

“…22 Limited teaching and clinical exposure in PR during undergraduate training and postgraduate training are key issues that have been raised. 8,11,23 Only 77% of registrars recalled receiving formal clinical rheumatology teaching in medical school. 8 Eighty-one percent of pediatric residents specified that their clinical exposure in PR was little.…”

“…8 Eighty-one percent of pediatric residents specified that their clinical exposure in PR was little. 23 Moreover, given the lower proportion of rheumatic diseases compared to others in children, particularly infectious diseases, a lack of interest in PR might be another explanation for individual low self-rated confidence. Freed et al interestingly reported that 74% of general pediatricians seldom care for children who require PR proficiency.…”

“…24 Gillispie et al found a favorable outcome of the levels of comfort with MSK examination, autoimmune laboratory workup and interpretation, and referral following a case-based learning experience. 23 Freed et al found that 21% of general pediatricians felt uncomfortable contributing to the care of pediatric rheumatic patients. 9 Eighty-one percent of residents stated that they felt they had received insufficient exposure to PR.…”

“…9 Eighty-one percent of residents stated that they felt they had received insufficient exposure to PR. 23 Moreover, almost 80% of residency-trained pediatricians working in primary care indicated a need for extra education in PR, especially common diseases and emergency conditions. 13 Our study also showed that most respondents (95.3%) felt that more teaching in PR is essential.…”