Rheumatology Education Research Articles

Education and Professional Development in Rheumatology: Translating Quality Improvement and Education to Clinical Practice.

Academic institutions play an essential role in providing physicians with the necessary skills needed to improve the quality and value of care provided. The Accreditation Council for Graduate Medical Education has several milestones in the curriculum of fellowship programs that prioritize involvement in quality improvement (QI) and patient safety efforts. This article reviews the unique benefits and challenges of involving and teaching fellows to conduct QI initiatives. Strategies and resources available to overcome these challenges and develop a successful quality driven training environment are outlined in this article.

Education and Professional Development in Rheumatology

Education and Professional Development in Rheumatology

Modern Landscapes and Strategies for Learning Ultrasound in Rheumatology.

Ultrasound in rheumatology is gaining increasing acceptance in the field, with its use expanding beyond the musculoskeletal system to image rheumatic disease pathology of the vasculature, salivary glands, and lungs. Fellows in training and practicing clinicians are seeking ways to attain training and competency assessment. These standards are evolving, but no uniform mechanism for training exists. Although clinicians in practice find a wide array of resources available for self-directed education in ultrasound in rheumatology, a consensus-based and publicly available training curriculum can further enhance and standardize learning. This article discusses ultrasound in rheumatology education opportunities, competency assessment, and certification pathways.

Rheumatology capacity building: implementing a rheumatology curriculum for Liberian health-care providers in 2016.

Liberia has no rheumatology providers for the nation's 4.7 million people. We proposed a short course format rheumatology curriculum to educate Liberian providers as an initial step in providing graduate medical education in musculoskeletal health. A 1-week training curriculum in rheumatology encompassing introduction to musculoskeletal exam and approach to rheumatology diagnosis and management was designed. The curriculum used multiple education methods including interactive lectures, bedside training, and hands-on learning. A 1-week rheumatology training curriculum for 24 local physicians was feasible. The execution of the designed rheumatology curriculum in Liberia relied upon a mixed method format that was both didactic and case-based. A survey of the Liberian trainees revealed that the curriculum was salient to care of patients and barriers to optimal learning such as time and space limitations were identified. A 1-week rheumatology training education program is possible and relevant to local providers, but training length and setting may need to be optimized. Future training will aim to minimize barriers to education and expand the cohort of providers with rheumatologic knowledge in Liberia.Key Points• Liberia, like many nations in sub-Saharan Africa, has no trained rheumatologists to serve the nation's population.• Education and capacity building for rheumatologic care in short course format are relevant and feasible to local health-care providers.• Further efforts are needed to develop and evaluate continuing rheumatology education in Liberia.

Social media for research, education and practice in rheumatology.

Online social networking offers numerous opportunities for continuing medical education, professional development, and scholarly collaboration. Available social media channels proved useful for expanding education and research perspectives, particularly in rapidly developing academic disciplines such as rheumatology. Although there are numerous advantages of social media, busy clinicians should be aware of some drawbacks related to misinformation, unethical promotion, and unprofessional behavior in globally expanding platforms. Filtering credible and expert-proven information by skilled users is, therefore, increasingly important. Enforcing ethical norms and advancing professional etiquette in the field is strongly advisable. This article overviews the advantages and shortcomings of social media and reflects on available platforms for education and research in rheumatology.

Using Questions to Enhance Rheumatology Education.

Using Questions to Enhance Rheumatology Education.

Medical education in pediatric rheumatology-unique challenges and opportunities.

Pediatric rheumatology faces workforce shortages in both developed and developing regions of the world resulting in suboptimal care of children with chronic rheumatic diseases. In addition to outlining the structure of formal rheumatology training programs in North America and Europe, we attempt to summarize various strategies being implemented with success in several parts of the world to help close the gap via innovative learning strategies. We discuss the important role of professional organizations in leading this effort.

Harnessing the power of social media: how can it help in axial spondyloarthritis research?

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that is relatively unknown among the general public. Most patients with axSpA are young or middle-aged adults and more likely to use some social media. This review highlights trends in the application of social media and different ways in which these tools do already or may benefit clinical research, delivery of care, and education in rheumatology, particularly in the field of axSpA. This article discusses four areas in the biomedical field that social media has infused with novel ideas: (i) the use of patient-generated health data from social media to learn about their disease experience, (ii) delivering health education and interventions, (iii) recruiting study participants, and (iv) reform, transfer, and disseminate medical education. We conclude with promising studies in rheumatology that have incorporated social media and suggestions for future directions. Rheumatologists now have the opportunity to use social media and innovate on many aspects of their practice. We propose further exploration of multiple ways in which social media might help with the identification, diagnosis, education, and research study enrollment of axSpA patients. However, standardization in study design, reporting, and managing ethical and regulatory aspects will be required to take full advantage of this opportunity.

Survey of rheumatologists in Saxony, Saxony-Anhalt and Thuringia regarding the occupational situation and activities in further education: no way out of the undersupply of rheumatological care

Many regions in the middle of Germany have adeficit in specialized rheumatological care. Asurvey was undertaken to investigate whether the regional capacities for rheumatological advanced training are sufficient to provide an adequate number of rheumatologists in the future. All 91 rheumatologists registered in Saxony, Saxony-Anhalt and Thuringia received aquestionnaire that was sent back by 66% of the recipients (23responses from Saxony, 19 from Saxony-Anhalt, 18 from Thuringia). Of the rheumatologists 41 were in private practice, 19 worked in an inpatient department and the mean duration of professional activity was 18years. Over the last decade the number of patients treated by rheumatologists in private practices increased from 1200 to 1500 per quarter year (p < 0.001), whereas the number of first consultations rose from 100 to 130 per quarter year (p = 0.06). The waiting time for afirst consultation rose from 8 to 11weeks (p = 0.01), 32% of the responders indicated that the conditions for outpatient treatment had either improved or had remained constant during the last 10years, whereas 60% reported amild or marked deterioration and 48% stated that the number of rheumatologists had decreased within the same time frame. Only 20% indicated that they had adefinite successor in the practice after retirement. All inpatient departments also had an outpatient office. During the last 10years, the number of consultations per quarter year decreased from 1100 to 700 (not significant), while the waiting time doubled from 6 to 12weeks (rounded mean). Of the rheumatologists in private practice eight are currently entitled to provide advanced education in rheumatology, with amedian training period of 18months; however, none of the responding physicians had actually brought assistant doctors to the final examination during the last decade and only one prospective rheumatologist was currently completing training in aprivate practice setting. Only 6 out of 12 inpatient rheumatological facilities are entitled to educate rheumatologists over the whole training period, 5facilities were not involved in training at all and 7indicated that they lacked applications for rheumatology training. During the last 10years, 37rheumatologists completed the training of which 18went into private practice, 8worked as general practitioners and 29remained in the region of their initial training. Given the increase in the number of outpatients served, the volume of training activities in rheumatology is hardly sufficient to improve the deficit of rheumatological care in the middle of Germany.

027 Stakeholder evaluation of an ambulatory rheumatology teaching day

027 Stakeholder evaluation of an ambulatory rheumatology teaching day

Rheumatology teaching and training in India – From procrastination to implementation!

Rheumatology teaching and training in India – From procrastination to implementation!

Flipped Learning: Can Rheumatology Lead the Shift in Medical Education?

To 1. implement flipped classroom rheumatology teaching for undergraduate education. 2. Evaluate outcomes of teaching using OSCE assessment and student perceived effectiveness and satisfaction survey. The flipped classroom education, 55-students, was conducted in 3 phases. Phase 1: Carried out in the students' own time. Web links were emailed to assist exposure of the instructional part of the lesson online. Phase 2: Interactive in-class activity to share personal reflection and reinforce the key aspects. Phase 3: A simulated OSCE assessment. A cohort of 56-students, who were taught in the last educational year on the same topics according to standard teaching protocols, were included as control group. The clinical Outcomes were assessed using the scores of the OSCE examination model. Academic outcomes included the engagement measure as well as the students' answers to perceived effectiveness and satisfaction survey. There was no significant difference regarding demographics between the 2 students' groups. There was a significant improvement (p< 0.05) in the flipped learning, in contrast to the control group, in terms of clinical (OSCE score) as well as communication skills. Student perceived effectiveness and satisfaction was significantly higher among the flipped learning (p< 0.05). Scores from the flipped learning cohort showed a state of engagement significantly higher than the control group (p< 0.01). Flipped learning implementation musculoskeletal learning successfully demonstrated a promising platform for using technology to make better use of the students' time, and for increasing their satisfaction. Active learning increases student engagement and can lead to improved retention of knowledge.

Factors that influence Canadian internal medicine residents' choice to pursue a rheumatology career.

In Canada, little is known about residents' self-confidence to diagnose/treat musculoskeletal (MSK) disease and factors affecting pursuit of a rheumatology career. Our study explored these factors. An online survey (descriptive cross-sectional design) was distributed to Canadian postgraduate year (PGY) 1 and 2 internal medicine (IM) residents. Questions probed self-confidence in rheumatology and factors influencing subspecialty career choice. Frequencies were determined and responses compared between PGY-1 and PGY-2 using univariate statistical analyses. Fifty-four IM residents completed the survey. PGY-2 residents were statistically more certain in subspecialty decidedness and had higher levels of self-confidence to diagnose/treat MSK disease and perform a physical exam. "Quality of life" was the most encouraging factor for a rheumatology career choice followed by "job opportunities" and "previous clinical exposure." Although 50% of PGY-1 residents had completed a rheumatology clinical rotation, 76% indicated that increased knowledge would affect rheumatology career choice. Only 38% were interested in novel rheumatology education. No difference in rheumatology exposure, rheumatology clinical rotation completion year, or rheumatology career choice was observed. Our research confirms findings from similar United States (US) and United Kingdom (UK) studies that suggest that increased MSK knowledge positively influences residents' confidence to diagnose/treat MSK disease. Our study differs with Canadian PGY-1 and PGY-2 IM residents by evaluating self-confidence to diagnose/treat MSK disease separately from self-confidence to perform a physical exam. Significant differences between first and second year trainees suggest types/quality of rheumatology experiences (e.g., case complexity, diagnostic problem-solving competency) may affect self-confidence to diagnose/treat MSK disease factors and rheumatology career choice.

Confidence amongst Multidisciplinary Professionals in Managing Paediatric Rheumatic Disease in Australia.

Objective Interprofessional collaboration is a crucial component of care for children with rheumatic disease. Interprofessional care, when delivered appropriately, prevents disability and improves long-term prognosis in this vulnerable group. Methods The aim of this survey was to explore allied health professionals' and nurses' confidence in treating paediatric rheumatology patients. Results Overall, 117 participants were recruited, 77.9% of participants reported being “not confident at all,” “not confident,” or “neutral” in treating children with rheumatic diseases (RD) despite 65.1% of participants reporting having treated >1 paediatric rheumatology case in the past month. Furthermore, 67.2% of participants felt their undergraduate education in paediatric rheumatology was inadequate. “Journals” or “texts books” were used by 49.3% of participants as their primary source of continuing professional development (CPD) and 39.3% of participants indicated that they did not undertake any CPD related to paediatric rheumatology. Small group and online education were perceived to be potentially of “great benefit” for CPD. Conclusion This paper highlights allied health professionals' and nurses' perceived inadequacy of their undergraduate education in paediatric RD and their low confidence in recognising and treating RD. Undergraduate and postgraduate education opportunities focusing on interprofessional collaboration should be developed to address this workforce deficiency.

Therapeutic Education in rheumatology: example of both programs "Fibromyalgia" and "Osteoarthritis" set up in the spa center of Dax (France)

The thermal urban area of Grand Dax had the authorization by its administration of supervision (the ARS) to deliver two programs of Therapeutic Education of Patient (ETP) intended for patients reached of chronic pathology : one on the fibromyalgia, the program Fibr' Eau and another on the degenerative osteoarthritis of the members, the program Educ' Arthrose. These two programs were thought and built by the CNETH then gave to the spa center having a multidisciplinary team trained in the ETP. The dispensation of a program ETP is made according to a quite particular dynamics, namely : a shared educational assessment or educational diagnosis shared realized generally by a nurse, the participation of the patients in therapeutic activities then finally an assessment in order to evaluate the competences acquired by the patient. It is on this plan that the programs Fibr' Eau and Educ' arthrose are delivered during the 18 days of water cure in a spa center.

The effect of an educational intervention, based on clinical simulation, on the diagnosis of rheumatoid arthritis and osteoarthritis.

The aim of the present study was to evaluate the effectiveness of an educational tool for general physicians, based on rheumatological clinical simulation, for the diagnosis of rheumatoid arthritis and osteoarthritis. A randomized clinical study was carried out, in which the physician research subjects were assigned to one of two groups: the experimental group (educational intervention for rheumatoid arthritis with clinical simulation) or the control group (educational intervention for the basic aspects of the diagnosis and treatment of osteoporosis). Four weeks after the educational intervention, the members of both groups completed an examination that included four clinical cases with real patients, two clinical cases with two clinical simulation models and six virtual clinical cases. In this examination, the participants noted clinical findings, established a diagnosis and defined the complementary tests they would request, if necessary, to corroborate their diagnosis. A total of 160 doctors participated (80 in the active educational intervention for rheumatoid arthritis and 80 in the control group), of whom 89 were women (56%). The mean age was 35 (standard deviation 7.7) years. Success was defined as a physician correctly diagnosing at least 10 of the 12 cases presented. A significant difference of 81.3% (95% confidence interval 72-90%; p < 0.001) in success was found in favour of the active group (88.8% versus 7.5%). A greater number of correct answers was found in the active group compared with the control group in the detection of clinical findings and in the number of complementary tests requested (p < 0.001). The study showed the effectiveness of an educational intervention based on clinical simulation to improve the diagnostic approach to rheumatoid arthritis and osteoarthritis. The results open a new horizon in the teaching of rheumatology.

Educational needs of health professionals working in rheumatology in Europe

ObjectiveTo explore the availability of postgraduate education for health professionals (HPs) working in rheumatology in Europe, and their perceived educational needs and barriers for participation in current educational offerings.MethodsStructured interviews...

Status of rheumatology practice and professional training courses in rural areas of China-an ILAR project.

With the financial support from International League of Associations for Rheumatology (ILAR), we held a rheumatologic care education project in Xishuang Ban'na, a remote district in southern China. During 2014-2015, our project devoted to improve rheumatologic care skills of local clinical practitioners and basic rheumatologic knowledge tothe public. This paper summarizes the undeveloped conditions of rheumatology and our effort in Xishuang Ban'na.

Rheumatology Research Foundation Clinician Scholar Educator Award: Fifteen Years Promoting Rheumatology Educators and Education.

The Rheumatology Research Foundation's Clinician Scholar Educator (CSE) award is a 3-year career development award supporting medical education research while providing opportunities for mentorship and collaboration. Our objective was to document the individual and institutional impact of the award since its inception, as well as its promise to strengthen the subspecialty of rheumatology. All 60 CSE Award recipients were surveyed periodically. Fifty-six of those 60 awardees (90%) responded to requests for survey information that included post-award activities, promotions, and further funding. Data were also collected from yearly written progress reports for each grant. Of the total CSE recipients to date, 48 of 60 (80%) are adult rheumatologists, 11 of 60 (18%) are pediatric rheumatologists, and 1 is an adult and pediatric rheumatologist. Two-thirds of survey respondents spend up to 30% of their total time in educational activities, and one-third spend greater than 30%. Thirty-one of the 60 CSE recipients (52%) have published a total of 86 medical education papers. Twenty-six of 52 (50%) had received an academic promotion following the award. Eleven awardees earned advanced degrees. We describe the creation and evolution of a grant program from a medical subspecialty society foundation and the impact on producing education research, individual identity formation, and ongoing support for educators. This community of rheumatology scholar educators now serves as an important resource at the national level for the American College of Rheumatology and its membership. We believe that this grant may serve as a model for other medical societies that want to promote education scholarship and leadership within their specialties.

A survey of anatomical items relevant to the practice of rheumatology: upper extremity, head, neck, spine, and general concepts.

This study aimed to identify the anatomical items of the upper extremity and spine that are potentially relevant to the practice of rheumatology. Ten rheumatologists interested in clinical anatomy who published, taught, and/or participated as active members of Clinical Anatomy Interest groups (six seniors, four juniors), participated in a one-round relevance Delphi exercise. An initial, 560-item list that included 45 (8.0%) general concepts items; 138 (24.8%) hand items; 100 (17.8%) forearm and elbow items; 147 (26.2%) shoulder items; and 130 (23.2%) head, neck, and spine items was compiled by 5 of the participants. Each item was graded for importance with a Likert scale from 1 (not important) to 5 (very important). Thus, scores could range from 10 (1×10) to 50 (5×10). An item score of ≥40 was considered most relevant to competent practice as a rheumatologist. Mean item Likert scores ranged from 2.2±0.5 to 4.6±0.7. A total of 115 (20.5%) of the 560 initial items reached relevance. Broken down by categories, this final relevant item list was composed by 7 (6.1%) general concepts items; 32 (27.8%) hand items; 20 (17.4%) forearm and elbow items; 33 (28.7%) shoulder items; and 23 (17.6%) head, neck, and spine items. In this Delphi exercise, a group of practicing academic rheumatologists with an interest in clinical anatomy compiled a list of anatomical items that were deemed important to the practice of rheumatology. We suggest these items be considered curricular priorities when training rheumatology fellows in clinical anatomy skills and in programs of continuing rheumatology education.