Rheumatology Knowledge Research Articles

Understanding Internal Medicine Residents' Rheumatology Knowledge Base.

Rheumatology is one of the internal medicine subspecialties that residents train to become proficient in during their internal medicine training. Our study sought to understand how residents across all postgraduate year levels felt in terms of comfortability and exposure to rheumatology. We focused on the subjective measurement of resident knowledge and exposure rather than objective data. A five-question survey was distributed to all 75 residents of Lenox Hill Hospital's Internal Medicine categorical residency program, from PGY1 to PGY3. When asked if they get enough exposure or feel confident treating patients with rheumatology diseases, 96% of residents responded no. When asked about their confidence in boards, the average response was a 3/10. The residents at our program voiced a strong concern for lack of exposure and education. Other studies and institutions have shown this to be a problem that has also been seen with poor testperformance on the subject. We explore educational modalities to help improve this gap in education.

An iceberg I can’t handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya

BackgroundDelay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management.PurposeWe evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya.MethodsWe conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software.ResultsA total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31–40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities.ConclusionThere is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.

Rheumatology Image of the Month: A Low Resource Innovation With Measurable Results.

Strategies to increase confidence in rheumatology knowledge are valuable for medical trainees and residents. A web-based teaching innovation was implemented in an attempt to increase rheumatology exposure for internal medicine residents. An Image of the Month webpage was established, where a practicing rheumatologist would post a new image that could be answered online by internal medicine residents. Cumulative data was analyzed to determine the extent and change in rheumatology exposure. The Image of the Month webpage posted images for a total of 76 months between July 2010 to May 2017, with a total of 1326 submitted responses. The proportion of residents who only participated in Image of the Month and only did a rheumatology rotation averaged 36.1% and 16.5%, respectively. The proportion of residents who only participated in Image of the Month was higher than the proportion who only did a rheumatology rotation for all of the 7 time periods assessed. A total of 491 residents participated in Image of the Month, with an average of 54.9% of residents participating each year. Overall, on average, 52 residents had 1 or more submissions, 3.6 entries were submitted per resident, and 17.4 entries were submitted per month. Junior residents (PGY1) participated more often than senior residents (PGY3). The Image of the Month webpage successfully improves internal medicine resident exposure to rheumatology with minimal resources and manpower required. Further study is necessary to determine the impact this exposure may have on the abilities and confidence levels of internal medicine residents.

Development and Test-Item Analysis of a Freely Available 1900-Item Question Bank for Rheumatology Trainees

BackgroundTests composed of multiple-choice questions are an established tool to help evaluate knowledge of medical content. Within the field of rheumatology, there is an absence of free and easily-accessible sets of multiple-choice questions that have been rigorously evaluated and analyzed.ObjectiveTo develop a question bank composed of multiple-choice questions that evaluate trainee knowledge of rheumatology, as well as to investigate the psychometric properties (reliability, discrimination indices, difficulty indices) of items within the question bank.MethodsMultiple-choice questions were drafted according to a strict methodology devised by the investigators. Between January and December 2020, questions were administered in sets of 20-25 questions to test-takers who were either current trainees or had recently graduated from training programs. Performance was evaluated through descriptive statistics (mean, median, range, standard deviation) and test-item statistics (difficulty index, discrimination index, reliability).ResultsInvestigators drafted 1900 multiple choice questions within 45 sections each composed of 20 to 25 questions each. These questions were administered to 32 participants. The mean discrimination index was 0.57 (standard deviation: 0.22) and mean difficulty index was 0.38 (standard deviation: 0.23). Reliability indices for the 45 sections ranged from 0.45 to 0.85 (mean: 0.613, standard deviation: 0.09). The overall reliability index for the entire item bank was greater than 0.95.ConclusionThe investigators developed a 1900-item question bank composed of items that have sufficient difficulty and discrimination indices to be used for low- and moderate-stakes settings. A rigorous methodology was employed to create the first freely-accessible reliable tool for the assessment of rheumatology knowledge. This tool can be purposed for both summative and formative evaluation in multiple settings and platforms.

P086 Rheum to improve: a study on rheumatology knowledge amongst medical students

Abstract Background/Aims Medical students are tomorrow’s doctors and rheumatology seems to be losing its status in school curricula despite its rise in importance. The aim of this study is to determine the knowledge of common rheumatic diseases amongst Year 3 graduate-entry medical students (GEMS) before and after a session of rheumatology tutorial. Methods 19 GEMS who were soon to sit for Year 3 final examination were asked to complete questionnaires pre and post rheumatology tutorial regarding their knowledge and confidence in examining/managing rheumatic diseases namely rheumatoid arthritis(RA), psoriatic arthritis(PsA), osteoarthritis(OA), gout, systemic lupus erythematosus (SLE), scleroderma and ankylosing spondylitis (AS). Knowledge and confidence were measured using a 5-point Likert scale. Results Students were aged 21-30 years. None had previous rotation in rheumatology but 2 (10.5%) had attended a rheumatology clinic before. All were not completely confident in examining the seven rheumatic conditions. >50% were somewhat or fairly confident in examining patients with RA, PsA, OA and gout. The majority found themselves either slightly or not confident in examining SLE, scleroderma and AS patients. Only one stated to have excellent knowledge on the treatment/management of one rheumatic condition, which was gout. 80% or more have above average knowledge on treatment/management of RA, OA and gout. 47.4% rated their knowledge to be poor in the treatment/management of PsA and SLE. Knowledge on treatment/management of scleroderma and AS was below average in > 84%. Following a rheumatology tutorial, everyone had confidence in examining all seven rheumatic diseases. 78.9% and above were either fairly or completely confident in examining patients with RA, PsA, OA, gout, scleroderma and AS versus 52.6% for SLE. All were above average in treating/managing RA, PsA, OA and gout. 78.9% or more have above average knowledge in treatment/management conditions like SLE, scleroderma and AS. Everyone who attended the tutorial felt that it contributed positively in their preparation towards examination and would like to have similar tutorials in future. Conclusion Knowledge in examining, treating and managing common rheumatic diseases is very poor amongst medical students. Rheumatology tutorials are beneficial to increase their knowledge and confidence. Attendance in rheumatology clinics should also be encouraged. P086 Table 1:Confidence in examining patients with common rheumatic conditions pre and post rheumatology tutorialNot confident at all (Pre, Post)Slightly confident (Pre, Post)Somewhat confident (Pre, Post)Fairly confident (Pre, Post)Completely confident (Pre, Post)Rheumatoid Arthritis0, 00, 110, 09, 110, 7Psoriatic Arthritis3, 02, 110, 14, 130, 4Osteoarthritis0, 00, 18, 011, 110, 6Gout1, 03, 18, 17, 120, 5Systemic Lupus Erythematosus5, 07, 45, 52, 90, 1Scleroderma11, 03, 24, 11, 150, 1Ankylosing Spondylitis10, 05, 13, 31, 120, 3 Disclosure W. Ng: None. J. Devlin: None. A. Fraser: None.

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This article arose within the framework of the EMEUNET peer review mentoring program.1 This project allows mentees to independently review articles submitted to Annals of the Rheumatic Diseases and RMD...

Core Curriculum to Facilitate the Expansion of a Rheumatology Practice to Include Nurse Practitioners and Physician Assistants

Due to an aging population, increasing prevalence of rheumatic disease, and a growing supply and demand gap of rheumatology providers, innovative solutions are needed to meet the needs of persons with rheumatic conditions. Nurse practitioners (NPs) and physician assistants (PAs) have been identified as a group of health professionals who could help address the workforce shortage. The Executive Committee of the Association of Rheumatology Health Professionals (ARHP), a division of the American College of Rheumatology (ACR), charged a task force to facilitate the preparation of NPs/PAs to work in a rheumatology practice setting. The task force, consisting of private practice and academic rheumatologists, and NPs and PAs, from both adult and pediatric settings, conducted a needs assessment survey of current NPs and PAs to identify mechanisms for acquiring rheumatology knowledge. Through face-to-face and webinar meetings, and incorporating stakeholder feedback, the task force designed a rheumatology curriculum outline to enrich the training of new NPs and PAs joining rheumatology practice. Informed by the needs assessment data and stakeholders, an NP/PA rheumatology curriculum outline was developed and endorsed by the ACR Board of Directors for use by community-based and academic rheumatology practices, whether pediatric or adult, who desire to add NPs and PAs to their practice setting. As rheumatology is facing workforce shortages, the ACR/ARHP rheumatology curriculum outline can be utilized to train NPs and PAs and create more efficient integration of NPs and PAs into rheumatology practice.

Rheumatologic skills development: what are the needs of internal medicine residents?

Given the burden of rheumatic disease in our society and the anticipated future shortage of rheumatologists, all internal medicine (IM) residencies need to train internists who are capable of caring for patients with rheumatic diseases. The objective of this study was to perform a targeted needs assessment of the self-confidence of IM residents in the evaluation and care of patients with rheumatologic diseases. A 16-item, web-based, self-assessed confidence survey tool was administered to participating post graduate year (PGY)1 (N = 83) and PGY3 (N = 37) residents. The categories of questions included self-confidence in performing a rheumatologic history and exam, performing common rheumatologic procedures, ordering and interpreting rheumatologic laboratory tests, and caring for patients with common rheumatologic diseases. Resident demographics, prior rheumatology exposure, and career plans were also queried. PGY3 residents had higher self-assessed confidence than PGY1 residents in all categories. Self-assessed confidence in joint procedures was consistently low in both groups and when compared to other categories. Prior exposure to a rheumatology course or elective was not consistently associated with higher self-assessed confidence ratings across all categories. PGY3 residents showed less interest in rheumatology as a career than PGY1 residents, although the interest in the topic of rheumatology was not statistically different. Our needs assessment shows a low level of self-assessed confidence in rheumatology knowledge and skills among IM residents. Despite improvement with PGY year of training, self-assessed confidence remains low. To improve resident's skills and self-confidence in rheumatology, more curricular innovations are needed. Such innovations should be assessed for overall effectiveness.

Knowledge sources for evidence-based practice in rheumatology nursing.

As rheumatology nursing develops and extends, knowledge about current use of knowledge in rheumatology nursing practice may guide discussions about future knowledge needs. To explore what perceptions rheumatology nurses have about their knowledge sources and about what knowledge they use in their practice, 12 nurses working in specialist rheumatology were interviewed using a semi-structured interview guide. The data were analyzed using conventional qualitative content analysis. The analysis yielded four types of knowledge sources in clinical practice: interaction with others in the workplace, contacts outside the workplace, written materials, and previous knowledge and experience. Colleagues, and physicians in particular, were important for informal learning in daily rheumatology practice. Evidence from the medical arena was accessed through medical specialists, while nursing research was used less. Facilitating informal learning and continuing formal education is proposed as a way toward a more evidence-based practice in extended roles.

AB1134 Reumeval: Online System for Teacher Evaluation of Rotation in Rheumatology Mir. Results of the Pilot

ObjectivesAnalyze the results of a pilot study to measure the functionality of a new online evaluation system of knowledge in Rheumatology MIR rotating units for this specialty.MethodsIt has been developed...

AB1409 Confidence levels of internal medicine trainees in rheumatological skills and diagnosis: A singapore perspective

BackgroundMusculoskeletal (MSK) disease is one of the most common problems encountered in primary care and specialist consultations. Clinical assessment is essential to approaching MSK complaints and central to management. However...

Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solutions

Objectives. Rheumatological conditions are common, thus nurses (Ns) occupational therapists (OTs) and physiotherapists (PTs) require at least basic rheumatology knowledge upon qualifying. The aim of this study was to develop a core set of teaching topics and potential ways of delivering them.Methods. A modified Delphi technique was used for clinicians to develop preliminary core sets of teaching topics for each profession. Telephone interviews with educationalists explored their views on these, and challenges and solutions for delivering them. Inter-professional workshops enabled clinicians and educationalists to finalize the core set together, and generate methods for delivery.Results. Thirty-nine rheumatology clinicians (12N, 14OT, 13PT) completed the Delphi consensus, proposing three preliminary core sets (N71 items, OT29, PT26). Nineteen educationalists (6N, 7OT, 6PT) participated in telephone interviews, raising concerns about disease-specific vs generic teaching and proposing many methods for delivery. Three inter-professional workshops involved 34 participants (clinicians: N12, OT9, PT5; educationalists: N2, OT3, PT2; Patient 1) who reached consensus on a single core set comprising six teaching units: Anatomy and Physiology; Assessment; Management and Intervention; Psychosocial Issues; Patient Education; and the Multi-disciplinary Team, recommending some topics within the units receive greater depth for some professions. An innovative range of delivery options was generated plus two brief interventions: a Rheumatology Chat Show and a Rheumatology Road Show.Conclusions. Working together, clinicians and educationalists proposed a realistic core set of rheumatology topics for undergraduate health professionals. They proposed innovative delivery methods, with collaboration between educationalists, clinicians and patients strongly recommended. These potential interventions need testing.

Exchange of information in rheumatology between east and west: FromMan'yo-shu to the future

The most ancient record of rheumatoid arthritis (RA) in Japan is found in the Man’yo-shu, the oldest of the imperial anthologies of Japanese poetry published in the 8th century (AD 759), the Nara era of Japan’s history. Man’yo-shu is composed of 20 volumes, including 4,500 poems. One of the authors, Yamonoueno Okura (Figure 1), who died in AD 733, had progressive destructive polyarthropathy. He wrote many elegant and beautiful poems in the Man’yo-shu and also one article, entitled “Lament for my life with the disease” in the fifth volume. In the article, he expressed the thought that none of the treatments could release his pain and he would not mind turning into a mouse from a human being if somebody could remove the symptoms from his body. Those descriptions lead us to think that he was suffering from rheumatoid arthritis. If only at that time he had the possibility to receive some of the current treatments for RA, now, 1,300 years later, we could enjoy much more his beautiful poems. Several years ago, one of the authors of this article traveled to Tours in France and found in a tiny bookshop an ancient edition of a medical book titled Traite des principaux objets de Medecine, printed in 1762 (Figure 2A). Only one chapter of this book is dedicated to arthritis, chapter V, in the second volume entitled “De la Goutte” (Figure 2B). There is no description of RA, as all arthritis was classified as gout. The first paragraph in chapter V reads, “Is Moxa effective for arthritis?” The author writes “Moxa is used in Japan.” Moxa is a Japanese dried leaf of mugwort used for cautery. Therefore, ancient oriental treatment was performed in France before the French Revolution, showing that there was exchange of rheumatology knowledge between the East and the West before the 18th century. How the exchange of clinical information occurred at that time is not known, but it is likely that knowledge circulated using the ancient trade route called The Silk Road that linked East with West and carried active trade of goods and ideas between two great civilizations. Nowadays, communication and exchange of information between East and West is much easier. In the field of rheumatology, the American College of Rheumatology (ACR) and international journals, in particular Arthritis & Rheumatism (AR Tsuneyo Mimori MD, PhD: Graduate School of Medicine, Kyoto University, Kyoto, Japan. Address correspondence to Tatsuya Atsumi, MD, PhD, Department of Medicine II, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan. E-mail: at3tat@med.hokudai.ac.jp. Submitted for publication September 12, 2007; accepted September 12, 2007.

Core knowledge in rheumatology: what does a general physician need to know?

Le medecin generaliste doit pouvoir diagnostiquer cliniquement les maladies rhumatologiques aigues susceptibles d'etre a l'origine de pathologies diverses infectieuses ou virales

Development and evaluation of a coordinated, ambulatory rheumatology experience for internal medicine residents.

To develop a compulsory ambulatory rotation in rheumatology for internal medicine residents and to evaluate the educational effect of this rotation. All year 2 residents in the program participated in the rotation. The perceived quality of the learning experience was assessed by resident self-evaluation using a visual analog scale. Residents used a similar scale to rate their confidence in managing common rheumatologic problems. A validated multiple choice test was used to measure pre- and post-rotation knowledge of rheumatology and skill in interpreting bone radiographs. On a 1 (no learning) to 5 (superior learning) scale, the mean rating of the rheumatology learning experience was 4.7 +/- 0.5. Residents' confidence in clinical skills significantly increased as well. Scores on the post-rotation rheumatology knowledge test increased 15% compared with pre-rotation scores (P < 0.0001). Confidence and skills in interpreting bone radiology films also significantly improved (P < 0.0001 for both items). A relatively brief, subspecialty ambulatory rotation can be developed to expose all residents to a rheumatology curriculum. Such a rotation can increase their confidence, knowledge, and skills in important domains of outpatient rheumatology.

Development and validation of an exercise performance support system for people with lower extremity impairment.

To identify innovative strategies to support appropriate, self-directed exercise that increase physical activity levels of people with arthritis. This article reports on one interactive, multimedia exercise performance support system (PSS) for people with lower extremity impairments in strength or flexibility. An interdisciplinary team developed the PSS using self-report of lower extremity musculoskeletal impairments (flexibility and strength) to produce an individualized exercise program with video and print educational materials. Initial evaluation has investigated the validity and reliability of program assessments and recommendations. PSS self-report and professional assessments were similar, with more impairments indicated by self-report. PSS exercise recommendations were similar to those made by 3 expert physical therapists using the same exercise data base. Results of PSS impairment assessments were stable over a 1-week period. PSS exercise recommendations appear to be reliable and a valid reflection of current exercise knowledge in rheumatology. Furthermore, users were able to complete the computer-based program with minimal assistance and reported it to be enjoyable and informative.

Does curriculum make a difference? A comparison of family physicians with and without rheumatology training during residency.

To assess the long-term effect of an extensive rheumatology curriculum on graduates of family practice residencies. Cohort analytic study using a mailed survey and a multiple-choice test based on clinical vignettes that were administered 3 to 7 years after graduation from residency training. Practicing family physicians who had graduated from a community hospital family practice residency with an extensive rheumatology curriculum (trained) were compared with graduates from a similar program without specific rheumatology training (untrained). Total test scores, results of individual test questions, practice style, and attitudes toward rheumatology training and practice. We received 39 (85%) responses from 46 potential respondents in the trained group and 25 (89%) responses from 28 potential respondents in the untrained group. Physicians in the two groups had similar backgrounds and practice styles. The trained physicians scored higher on the multiple-choice test (mean +/- SD, 25 +/- 5 vs 22 +/- 6; P < .03). The clinical significance of these differences is a matter of individual interpretation. One hundred percent of the trained physicians believed that the quality of their rheumatology training was good to excellent compared with 25% of the untrained physicians. Seventy-six percent of the untrained physicians wished that they knew more about rheumatology. No variables other than rheumatology training accounted for the differences between the two groups. The difference in rheumatology knowledge, evident during and soon after residency between trained and untrained physicians, persists for 3 to 7 years.

Automatic knowledge base refinement: Learning from examples and deep knowledge in rheumatology

MESICAR is a second generation expert system which contains very general descriptions of rheumatological disorders in the primary medical care field. With the help of a detailed hierarchical description of the human anatomy the system is able to support diagnostic decisions. The paper describes how machine learning techniques are used to automatically construct more specific disease descriptions for common, frequently occurring cases. The system MESICAR-LEARN implements a learning method which integrates analytical and empirical learning techniques. Cases diagnosed by MESICAR form the training examples, and MESICAR's knowledge base is used as domain theory. The leamed concepts are integrated into a hierarchy of disease descriptions. They support efficient and fast reasoning on common cases in addition to the general diagnostic support afforded by MESICAR's deep knowledge.