Rheumatology Education Research Articles

Undergraduate rheumatology teaching in the UK: a survey of current practice by teachers and students.

The last major UK survey of medical undergraduate rheumatology teaching was 25 years ago. This study aimed to describe current teaching practice, the perceptions of teachers and students and their engagement with Versus Arthritis teaching resources and future challenges and opportunities. Electronic surveys were distributed by e-mail and/or social media to relevant teachers and students identified within all 37 UK medical schools. A total of 34/37 (91%) teacher and 30/37 (81%) student surveys were returned. Compared with the last survey, the proportion of schools delivering rheumatology-identifiable teaching has fallen from 100% to 86% and the mean number of teaching days from 30 to 10. Rheumatology teaching is now more dispersed throughout the curriculum. Students preferred active learning methods such as simulation and expert patient teaching, while teachers preferred small-group teaching, online learning and lectures. The Versus Arthritis resources appeared underutilized by students but were considered useful. Most students thought rheumatology careers were not promoted within their medical school. A decrease in dedicated rheumatology teaching time was noted since the last survey 25 years ago. Greater promotion of rheumatology as a speciality and future career is required to maintain its professional identity and prevent marginalization.

Rheumatological care in Germany : Memorandum of the German Society for Rheumatology and Clinical Immunology 2024

Rheumatology in Germany is facing major challenges. The need for rheumatological care is increasing and can no longer be met in some regions for capacity reasons. Too many people with an inflammatory rheumatic disease (IRD) have to forego appropriate care or receive it too late. The 4thnew edition of the memorandum of the German Society for Rheumatology and Clinical Immunology (DGRh) provides information on rheumatological care in Germany. It was produced under the leadership of the DGRh together with the Professional Association of German Rheumatologists (BDRh), the Association of Acute Rheumatology Clinics (VRA), the German Rheumatism League (DRL) and the German Rheumatism Research Center (DRFZ). The memorandum describes the current state and development of the following areas: number of people with IRD, outpatient, inpatient and rehabilitative care structures, number of specialists in rheumatology, education and training, quality of care, health economic aspects and digital care concepts. Proposals for health policy measures to safeguard rheumatological care are presented. Prevalence: approximately 1.8million adults in Germany have an IRD. The prevalence is increasing, due to changes in the demographic structure of the population, improved diagnostics, treatment and longer survival. Care structures: outpatient specialist care (ASV) for rheumatic diseases is developing as across-sectoral care model for hospital outpatient clinics and rheumatology practices. Hospitals have been able to be certified as rheumatology centers since 2020, which enables structural developments. Specialists in rheumatology: as of 31December 2023, there were 1164 specialists in rheumatology working in Germany. This included 715 physicians accredited to work in practices for national health assurance patients, 39% of whom were employees. In hospitals, 39% of doctors worked part-time. At least 2rheumatology specialists per 100,000 adults are needed, i.e. around 1400, in order to provide adequate care. This means that there is ashortage of around 700 rheumatology specialists in the outpatient sector alone. Of all working specialists, 30% are currently aged60 years old and over. Medical training: only 10 out of38 (26%) state universities have an independent chair in rheumatology. In addition, 11rheumatology departments are subordinate to anonrheumatology chair. In the rheumatology-integration into student training (RISA)III study, only 16 out of 36faculties fulfilled the recommended minimum number of compulsory hours of student rheumatology teaching. Continuing education in rheumatology: the annual postgraduate training qualificationsdo not cover the demand for rheumatology specialists, which isadditionally increasing due to intensified workload, reduced capacities through retirement, and part-time work. Quality of care: since the introduction of highly effective medication patients with IRD have amuch better chance of achieving remission of their disease. With early initiation of targeted therapy, the lives of many patients are hardly restricted at all: however, waiting times for afirst rheumatological visit often last more than 3 months. Quality target is afirst consultation within the first 6 weeks after the onset of symptoms. Models for early consultation, delegation of medical services, structured patient training and digital care concepts have been positively evaluated but are not covered financially. the total annual costs for inflammatory joint diseases alone amount to around 3billion euros. The direct costs have significantly risen since the introduction of biologics, while the indirect costs for sick leave, disability and hospitalization have fallen. The core demands of this memorandum are asignificant and sustainable increase in the number of further training positions in the outpatient and inpatient sector, the creation of chairs or at least independent departments for rheumatology at all universities and the further implementation of new and cross-sectoral forms of care. This will ensure modern needs-based rheumatological care for all patients in the future.

Deepening the Understanding of Inflammatory Conditions Through Rheumatology Education in Family Medicine: An Autoethnography.

Introduction Rheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis, significantly affect quality of life and require comprehensive management, especially where rheumatologists are scarce. Family physicians in rural settings play a crucial role in providing this care. This study aims to elucidate the educational process for family physicians in managing RA within rural hospitals. Methods Using a qualitative autoethnographic approach, we explored the learning experiences of family physicians at Unnan City Hospital in rural Japan. Data were collected through semi-structured interviews, direct observation, reflective field notes, and informal conversations with participants. The study focused on the practical education of RA management facilitated by a family physician with expertise in rheumatology. Results Three main themes emerged: (1) comprehending arthritis as a systemic disease, (2) managing dynamic conditions with prudence, and (3) providing comprehensive and continuous care amid uncertainty. Participants initially viewed arthritis as a localized condition but learned to approach it as part of systemic inflammation. They recognized the fluctuating nature of autoimmune diseases, emphasizing the need for cautious and flexible management. Continuous monitoring and a comprehensive approach to patient care with enduring uncertainty were identified as essential for effective RA management. Conclusion The study highlights the importance of experiential learning and mentorship in educating family physicians about RA in rural settings. Understanding arthritis as a systemic condition, exercising prudence in treatment, and maintaining comprehensive care amid uncertainty are crucial components of effective management. These findings inform the development of targeted educational programs for family medicine residents, ultimately enhancing patient care in rural areas. Future research should include multiple rural settings and quantitative data to validate and expand upon these insights.

E077 Evaluation of group education for patients with large vessel vasculitis prescribed subcutaneous methotrexate

Abstract Background/Aims Patient education in rheumatology is of proven value to educate as well as to reduce demand on health care services. This can be delivered in a multitude of ways, in person and more recently with the use of multi-media modalities. There is limited evidence to specifically demonstrate the benefit of patient education for patients with vasculitis. Education needs to be adapted to meet patient needs. In addition to one-to-one appointments, we have been conducting in-person group education for this patient group. We present our experience. Methods Patients prescribed subcutaneous methotrexate for large vessel vasculitis were given the opportunity to attend a group education session run by the specialist nurse. The sessions were held over a 4-month period, in groups of 3-5 individuals. Patients were provided with written information including the links to online resources prior to attending the group education session which consisted of a verbal presentation and a short video. Patients also had the opportunity to ask questions during the group session. If patients were happy to proceed with the planned treatment, a prescription for the subcutaneous methotrexate was provided and initial blood monitoring commenced. After attending the group session, patients were given an evaluation form to complete Results The responses from the evaluation forms are shown in the following table: Conclusion Group education has proved to be a successful way of providing education to patients with large vessel vasculitis needing to learn about the indications for use, along with the safe handling and administration of subcutaneous methotrexate. Disclosure G. Ducker: None. C.B. Mukhtyar: None.

P033 Online educational resources in paediatric and adolescent rheumatology- what’s new?

Abstract Background/Aims Paediatric and adolescent rheumatology (PAR) is a small sub-specialty, and due to the rarity of some conditions, UK trainees find it difficult to access relevant educational materials. Furthermore, due to the wide geographical distribution of paediatric rheumatology centres, regional educational opportunities are limited. A 2022 survey of the UK PAR trainee group confirmed that the creation of more PAR specific online educational materials and signposting of current guidelines/ resources was needed. Survey participants were supportive of a range of delivery methods, including webinars, e-learning, case studies and podcasts. Methods A PAR trainee education team was formed in 2022, with the aim of promoting learning opportunities, by developing and collating educational resources. The PAR trainee education team has been working both independently and in conjunction with the British Society of Rheumatology (BSR) education team and Digital Learning Board (DLB) to achieve this aim. Activities have included the following: a) Creation of a BSR hosted Teams channel to store PAR specific educational information; b) PAR trainee inclusion on the BSR DLB, which creates digital education resources including podcasts and the monthly blended learning Spotlight topic series; c) Creation of PAR focused podcasts within the BSR Talking Rheumatology podcast series; d) Organisation of webinars on PAR relevant topics; e) Creation of a PAR podcast playlist on the Spotify platform; f) Production of a resource list and education newsletter to signpost relevant existing/upcoming learning opportunities and events. Results A 2023 follow up survey of the PAR trainee group (n = 16 respondents), showed the most used resources were podcasts (69%), the newsletter (63%) and resource list (43%). Webinars (38%), the Teams channel (38%) and the BSR Spotlight series (31%) had been accessed less. BSR podcast download data illustrated that PAR relevant podcasts from the Talking Rheumatology/ Talking Rheumatology Spotlight series have a UK and international audience. There have been over 2500 downloads from six PAR relevant podcasts covering myositis guidelines, biologics in PAR, HLH, antiphospholipid syndrome and ultrasound in PAR. Feedback from those who have used the various educational resources has been extremely positive, although comments have indicated a barrier in terms of awareness of the materials and how to access them. Conclusion Good progress has been made, however maximising means and opportunities to disseminate available resources within the PAR community is vital. Work to develop, collate and signpost more PAR educational content is ongoing. A project is in progress to create condition-specific lists of classification criteria, guidelines and key studies. The PAR trainee group are very grateful to all of those who have supported this work including the professionals who have shared their knowledge and expertise via podcasts and webinars, members of the BSR DLB and the education team at BSR. Disclosure J. Lemon: Other; Unpaid member of the BSR Digital Learning Board. R. Close: None. G. Dobson: None. K. Maxey: Other; Works for the BSR as Events and Education Officer. J. May: None. D. McLaughlin: None. I. Rajarathinam: None. S. Saadalla: None. L. Yeo: None. P.A. Watson: Other; Works for the BSR in a paid role (2PA per week ) as digital learning editor.

P037 Rheum for more? A systematic literature review on undergraduate exposure to rheumatology

Abstract Background/Aims Since the introduction of Modernising Medical Careers by the General Medical Council in the United Kingdom (UK) in 2007, newly-qualified doctors are expected to choose their specialty much sooner than previously. A recent report published by the British Society of Rheumatology (BSR) in 2021 demonstrated a lack of exposure to the specialty for medical students. We conducted a systematic literature review on the quantity and quality of rheumatology teaching amongst undergraduate medical students. Methods Articles published until June 2023 were included. Eligible articles were: case reports and series, observational studies, qualitative studies and randomised control trials. Medline, Embase, PyscINFO, Cochrane library and WHO international clinical trial registry were searched, restricted to English language articles only. Articles including postgraduate trainees and those pertaining to a single intervention or single student cohort were excluded. Information was extracted on demographics, method of teaching, hours dedicated to rheumatology and students’ and educators’ feedback where mentioned. Results After deduplication, 1195 article were identified. After screening title and abstract, 1156 papers were excluded, with 39 proceeding to full text screening. Ultimately, seven articles (all cross-sectional surveys) were included. Publication year of included articles ranged from 1981 to 2018. The countries of included studies were UK (3), USA (2), Australian (1) and Pan-European (1). Year of rheumatology teaching at medical school was reported in four studies (3 UK and 1 USA). The three UK studies were all taught in the latter years (4-6), whereas in the USA study the students were taught at every single year. Where reported, data on the number of hours of exposure to rheumatology were variable, ranging from 15 to 96 hours per medical student. Reported method of teaching included lecture-based, rheumatology inpatient service and shadowing consultations. Student feedback was only provided in one (UK-based) study, from 49 students of whom two regarded rheumatology as “fascinating”, four felt that they had limited exposure and eight considered it as “a niche specialty of no interest”. No feedback from educators were collected in any of the included studies. Factors identified by the included studies for overall poor exposure to rheumatology included: lack of having full-time rheumatologists on the school’s faculty, lack of specialty training programme in their local teaching hospital and greater emphasis on general medical/ acute specialties (e.g. general practice and emergency medicine). Conclusion Overall, there are significant limitations in recording the amount and quality of rheumatology teaching amongst undergraduate medical students. Exposure to clinical rheumatology has markedly decreased over time, with variable student awareness of the speciality. Given the ageing UK population and increase in multimorbidity, there is a need to increase exposure and entry to the specialty, which may be partly facilitated by improved incorporation of rheumatology in the undergraduate curriculum. Disclosure K. Kouranloo: None. N. Myall: None. J. Christie: None.

Patient education in rheumatology

In Switzerland, patient education in rheumatology faces challenges, despite national advances following the development of the concept of self-management support by the Federal Office of Health. Yet it is a fundamental pillar of rheumatic disease management, meeting the needs of both patients and healthcare professionals. It helps to improve the overall quality of care and is recommended by the European Alliance of Associations for Rheumatology (EULAR). Training in PE needs to be strengthened, as does the evaluation of programmes, which must take account of the specific nature of rheumatic diseases. An integrated, patient-centered approach is essential to overcome these obstacles and promote PE in rheumatology.

Assessing Pediatric Rheumatology Fellow Competence in the Milestone Era: Past, Present, and Future.

Starting in 2015, pediatric rheumatology fellowship training programs were required by the Accreditation Council for Graduate Medical Education to assess fellows' academic performance within 21 subcompetencies falling under six competency domains. Each subcompetency had four or five milestone levels describing developmental progression of knowledge and skill acquisition. Milestones were standardized across all pediatric subspecialties. As part of the Milestones 2.0 revision project, the Accreditation Council for Graduate Medical Education convened a workgroup in 2022 to write pediatric rheumatology-specific milestones. Using adult rheumatology's Milestones 2.0 as a starting point, the workgroup revised the patient care and medical knowledge subcompetencies and milestones to reflect requirements and nuances of pediatric rheumatology care. Milestones within four remaining competency domains (professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice) were standardized across all pediatric subspecialties, and therefore not revised. The workgroup created a supplemental guide with explanations of the intent of each subcompetency, 25 in total, and examples for each milestone level. The new milestones are an important step forward for competency-based medical education in pediatric rheumatology. However, challenges remain. Milestone level assignment is meant to be informed by results of multiple assessment methods. The lack of pediatric rheumatology-specific assessment tools typically result in clinical competency committees determining trainee milestone levels without such collated results as the foundation of their assessments. Although further advances in pediatric rheumatology fellowship competency-based medical education are needed, Milestones 2.0 importantly establishes the first pediatric-specific rheumatology Milestones to assess fellow performance during training and help measure readiness for independent practice.

Rheumatoid arthritis knowledge gap and intervention in Nigeria study.

Family physicians are often the first healthcare providers to encounter patients with rheumatoid arthritis (RA) in Nigeria, given the paucity of rheumatology services nationwide. This study aimed to assess and address the knowledge gap regarding RA among family physicians in Nigeria. A cross-sectional survey involving 609 family physicians from all six geopolitical zones of Nigeria was conducted in October 2022. Pre-intervention questionnaires were administered to assess the participants' knowledge of RA. An investigator-led PowerPoint presentation on RA was then delivered as an intervention, followed by the same participants completing post-intervention questionnaires to evaluate knowledge improvement. Data were analyzed using the Statistical Package for Social Science, version 25. The mean age of participants was 42 ± 15 years, predominantly male (63.9%). The median pre-intervention knowledge score was 3.2 (IQR: 2.0-4.5), with 77.0% scoring <5. After the intervention, the median score significantly improved to 7.1 (IQR: 4.3-8.6) (p = .001), with 62.6% scoring >7. Significant improvements were observed in several knowledge areas where gaps existed pre-intervention, including the understanding that NSAIDs are not the mainstay of management (p < .001), the effectiveness of glucosamine and chondroitin sulfate (p < .001), confidence in diagnosing RA (p = .016), the recognition of joint deformities as a characteristic feature (p < .001), and the understanding that rheumatoid factor is not definitive for diagnosis (p < .001). This study highlights the importance of interventions in closing the knowledge gap about RA diagnosis and management. We recommend the implementation of a comprehensive approach to rheumatology education and services by policymakers.

Exploring Methotrexate Route of Administration Decisions for Adults with Rheumatoid Arthritis

Methotrexate is a common first-line treatment for rheumatoid arthritis, yet its widespread and habitual usage often leads physicians to overlook the choice of administration route when planning management strategies. A recent survey involving 30 consultant rheumatologists from France, Germany, Italy, Poland, Spain, and the UK, identified variation in the utilisation and perceptions regarding oral versus subcutaneous delivery for methotrexate. In November 2023, EMJ interviewed Roberto Caporali, Professor of Rheumatology at the University of Milan, and Head of the Department of Rheumatology and Medical Sciences at Gaetano Pini Hospital, Milan, Italy. Caporali’s expertise is in clinical practice, teaching, and research in rheumatology, mainly rheumatoid arthritis and other immune-mediated inflammatory diseases, with a focus on prognostic factors, biomarkers, and treatment for patients with moderate-to-severe active rheumatoid arthritis. During this interview, Caporali discussed the decision-making process for treating rheumatoid arthritis, with a particular focus on the use of methotrexate. The purpose was to gain insights from a rheumatology expert regarding the prevalence and management goals of the disease, and available treatment options. The interview considered key decision-making drivers and barriers to healthcare professionals when selecting the route of administration. Caporali suggested that the efficacy and safety profile of methotrexate when delivered subcutaneously may be the optimal choice for patients, often resulting in higher adherence compared to oral dosing. Caporali recommended education and re-evaluation of local guidelines to improve patient outcomes by better understanding the optimal use and efficacy of methotrexate.

Harnessing ChatGPT and GPT-4 for evaluating the rheumatology questions of the Spanish access exam to specialized medical training

The emergence of large language models (LLM) with remarkable performance such as ChatGPT and GPT-4, has led to an unprecedented uptake in the population. One of their most promising and studied applications concerns education due to their ability to understand and generate human-like text, creating a multitude of opportunities for enhancing educational practices and outcomes. The objective of this study is twofold: to assess the accuracy of ChatGPT/GPT-4 in answering rheumatology questions from the access exam to specialized medical training in Spain (MIR), and to evaluate the medical reasoning followed by these LLM to answer those questions. A dataset, RheumaMIR, of 145 rheumatology-related questions, extracted from the exams held between 2010 and 2023, was created for that purpose, used as a prompt for the LLM, and was publicly distributed. Six rheumatologists with clinical and teaching experience evaluated the clinical reasoning of the chatbots using a 5-point Likert scale and their degree of agreement was analyzed. The association between variables that could influence the models’ accuracy (i.e., year of the exam question, disease addressed, type of question and genre) was studied. ChatGPT demonstrated a high level of performance in both accuracy, 66.43%, and clinical reasoning, median (Q1–Q3), 4.5 (2.33–4.67). However, GPT-4 showed better performance with an accuracy score of 93.71% and a median clinical reasoning value of 4.67 (4.5–4.83). These findings suggest that LLM may serve as valuable tools in rheumatology education, aiding in exam preparation and supplementing traditional teaching methods.

The Impact of COVID-19 on Education and Training in Rheumatology: A Narrative Review.

The Impact of COVID-19 on Education and Training in Rheumatology: A Narrative Review.

Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial.

The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student's perspective using a questionnaire with 16 questions covering six subject areas. The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.

"Rheuma (be-)greifen"- Amultimodal teaching concept to improve rheumatology education for medical students

The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future. To assess whether acombination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as adiscipline. Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3Dprinting of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students. The evaluation of the teaching concept with 93students of medicine showed aconsistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3Dprinting and virtual reality. Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.

Educational readiness among health professionals in rheumatology: low awareness of EULAR offerings and unfamiliarity with the course content as major barriers—results of a EULAR-funded European survey

BackgroundOngoing education of health professionals in rheumatology (HPR) is critical for high-quality care. An essential factor is education readiness and a high quality of educational offerings. We explored which factors...

P032 Starting work as a rheumatology doctor: how to do it well

Abstract Background/Aims Starting work in a specialty for the first time can be extremely challenging. This has implications for patient care, junior and supervising doctor enjoyment and future career choices. A focus group was established to explore what resources junior doctors would want when starting Rheumatology. This determined that a blended learning package with podcasts, webinars and eLearning with topics including history and examination skills, understanding investigations and prescribing disease modifying drugs (DMARDs) would be ideal. Furthermore, it would be well placed to include resources to help junior doctors consider a career in Rheumatology. Methods The focus group results were used to design online ‘how to’ resources guiding doctors through tasks that they might be expected to do as a Rheumatology doctor. These were created by teams of junior doctors alongside Consultant Rheumatologists with creative support from the British Society for Rheumatology (BSR) education team. Content was pitched at an introductory level to help doctors when they first start working in Rheumatology. The most appropriate delivery modalities were selected for each topic e.g. a podcast for ‘how to talk to patients about DMARDs’ and eLearning including a video for ‘how to do disease activity scoring’. The resources are hosted on the BSR eLearning site and are free for anyone to use (no membership required) https://www.rheumatology.org.uk click eLearning. BSR communications and twitter were used to advertise the launch of the ‘how to’ series prior to junior doctor rotations in August. Results Since the ‘how to’ eLearning site was launched there have been 258 users. All content has been accessed. To date the most popular topics have been ‘how to’ - Interpret antibodies-Use DMARDs safely-Interpret x-rays-Score disease activity Feedback has been extremely positive with an overall satisfaction of 4/5. An example of written feedback from a user “ … it was a good overview, I would recommend to new IMT doctors starting in departments, or those considering Rheumatology as a career, I like how you have incorporated different modalities for learning e.g. mixture of lectures, podcasts, reading.” Conclusion The response to the resources created so far have been extremely positive. 258 users is a good start but increasing awareness of the resources should allow many more doctors to benefit from these resources. The authors plan to develop and improve content and welcome any feedback or suggestions for future topics. Disclosure R. Benson: None. E. Appleby: None. C. Gledhill-Flynn: None. K. Maxey: Other; Kate is a member of the Education team at the British Society for Rheumatology. D. Southam: Other; Daisy is employed by the British Society for Rheumatology as Head of Education. J. Little: None. P.A. Watson: Other; I am employed by the British Society for Rheumatology as eLernaing Editor.

Virtually Speaking: The Impact of a Nationwide Synchronous and Asynchronous Learning Forum.

To address significant disruptions in didactic education precipitated by the COVID-19 pandemic, a group of rheumatology program directors collaborated with the American College of Rheumatology to create a virtual fellows-in-training (V-FIT) program. A working group was composed to develop the virtual didactic program comprising live virtual sessions of core curricular rheumatology topics that were recorded to permit asynchronous learning. Nationally recognized educators were invited to lead sessions to fill the void in didactic education occurring on a broad scale across US rheumatology fellowship training programs. Demographic information, live and asynchronous participation data, and feedback surveys were collected from participants in the program. There were 3 components to V-FIT: the Virtual Rheumatology Learning (ViRL) series, the Virtual Rheumatology Practicum (ViP), and the Virtual Rheumatology Teaching Lessons (ViTLs). The ViRL program had global impact with more than 2,000 learners from more than 55 countries. ViP provided a standardized curriculum of rheumatology topics for incoming first-year fellows. ViTLs addressed advanced and interdisciplinary rheumatic disease topics for learners at all stages. With collaboration, adaptation, and innovation, the V-FIT program not only maintained but also enhanced education for rheumatology trainees, was enriched by national and international participation, and provided standardized, broadly accessible content with interdisciplinary learning.

The Development of Online Resources to Support Medical Trainees in Providing Virtual Rheumatology Care.

The musculoskeletal (MSK) physical examination is one of the core components of the rheumatologic clinical assessment for trainees. The pandemic has restricted in-person assessments, and as such, rheumatologists have found themselves having to adapt their clinical skills in the virtual setting while dealing with the restrictions of such an approach to "hands-on" rheumatology education.

Validity and Reliability of Four Parent/Patient-Reported Outcome Measures for Juvenile Idiopathic Arthritis Remote Monitoring.

The aim of this work was to provide evidence of validity and reliability for 4 parent/child-reported outcome measures included in the Outcome Measures in Rheumatology juvenile idiopathic arthritis core domain set: the evaluation of the child's pain and level of disease activity, the assessment of morning stiffness duration, and an active joint count for proxy/self-assessment. Patients were included in the multinational study Epidemiology Treatment and Outcome of Childhood Arthritis. Criterion validity was assessed by examining the correlation of the 4 tested measures with physician measures and the clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10) in the whole sample and after grouping patients by International League of Associations for Rheumatology (ILAR) category, geographic area, and education level. Reliability was assessed comparing 2 visits 7-14 days apart with intraclass correlation coefficients (ICCs). A total of 8,643 parents and 6,060 patients had all the evaluations available. Correlations of tested measures were moderate (0.4-0.7) with physician-reported measures. The level of correlation with the cJADAS10 remained stable after grouping patients by ILAR category, geographic areas, and level of education of the parent filling the questionnaire. In 442 parents and 344 children, ICCs ranged between 0.79 and 0.87 for parents and 0.81 and 0.88 for children. The 4 tested parent/child-reported outcomes showed good criterion validity and excellent reliability. These tools can be considered for remote patient assessment, when in-person evaluation might not be possible.

Race, Ethnicity, and Disparities in Rheumatology Educational Materials.

To characterize the representation of dark skin color in clinical images across 4 major rheumatology training resources. We gathered images of patients with rheumatic diseases from the American College of Rheumatology Image Library, UpToDate, the New England Journal of Medicine Images in Clinical Medicine and Clinical Cases filtered by "Rheumatology," and the 9th edition of Kelley's Textbook of Rheumatology. Investigators used Fitzpatrick's skin phototypes to independently code images depicting visible skin as "light" (skin types I to IV), "dark" (skin types V to VI), or "indeterminate." The representation of dark skin in clinical images was compared to the representation of Asian, Native American, and Black individuals within the US Census population and within lupus cases nationally. Of the 1,043 patient images included in the study, 13.4% had dark skin, 84.0% light skin, and 2.6% indeterminate skin color. Dark skin was underrepresented significantly in rheumatology educational materials and lupus images when compared with the representation of Asian, Native American, and Black individuals within the US Census population (13.4% versus 20.6%; χ2 =32.8, P < 0.001) and in published studies of patients with systemic lupus erythematous (22.6% versus 44.2%; χ2 =20.0, P < 0.001). Darker skin tones are significantly underrepresented in major rheumatology clinical image banks. Improving representation of racial and ethnic minorities in rheumatology education materials can better equip trainees to recognize and diagnose cutaneous manifestations of rheumatic diseases in these groups.