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Abstract

DevelopmentandImplementaEonofaPediatricRheumatologyCurriculumforthePediatricResident

PediatricAllergy,ImmunologyandRheumatology,BaylorCollegeofMedicineandTexasChildren’sHospital

MiriahGillispieandAmandaBrown

•  Duringthisclinicalexperience,residentswereshownthepediatricgait,arms,legs,andspine(pGALS)exambyafelloworaeending

•  AUerallowingforpracEce,theywereobservedperformingtheexamandgivenrealEmefeedbackandevaluaEon

•  TheywerealsoencouragedtodownloadthepGALSappasareference

Methods

OutpaEentExperience

Conclusion/FutureDirecEon

References

Background/IntroducEon Results Results

•  WewereabletoeffecEvelyincreasecomfortlevelwithregardstohistorytaking,physicalexamskills,laboratoryevaluaEon,andrheumatologyreferralsforthosepaEentswhopresentwithconcernsforanautoimmuneprocess

•  WeplantoconEnueusingthiscurriculumforthoseresidentsrotaEngthroughrheumatology

•  WealsoplantoexpandthetopicstoincludeaddiEonallecturesonrheumaEcfever,chronicnonbacterialosteomyeliEs,etc

•  WemayalsointroduceworkshopsforinterestedcommunityPCPsinordertoexpandtheirfundofknowledgeregardingpediatricrheumatologytopics

•  PediatricautoimmunediseasesareamongthemostcommonchronicmedicalcondiEonsafflicEngchildren,evenmorecommonthanbothcysEcfibrosisandsicklecellanemia1,2

•  EsEmatesarethat1in250childrenhaveaformofjuvenilearthriEsorotherautoimmunecondiEon,whichisalmost300,000pediatricpaEentsnaEonwide3Fig1.DistribuEonofpediatricrheumatologistsnaEonwide

•  Despitetheprevalence,thereareonly407pracEcingpediatricrheumatologistsacrossthecountryasof20154

•  EsEmatessuggest10%oftheserheumatologistswillreEreinthenextseveralyearsanddemandalreadyexceedssupplyby25-50%4

•  CurrentlypaEentswhodohaveaccesstocareoUentravel>4hourstoreceivecareandnewpaEentsoUenhavetowaitweekstomonthsforanappointment4

•  ExposuretopediatricrheumatologyteachingforresidentsislimitedandseveralmedicalschoolsandresidencyprogramsdonothaveaccesstothistypeofcurriculumcausingPCPstobeillequippedtodiagnoseandprovidepreliminarytreatment4

•  IninsEtuEonswithpediatricrheumatology,averageexposureandteachingEmeisesEmatedat5hoursfortheenEretyofresidency

•  Astandardcurriculumcovering“breadandbueer”pediatricrheumatologyinacasebasedformatwillhelpincreaseresidentcomfortlevelwithhistorytaking,physicalexaminaEon,workup,andreferralsforpaEentswhopresentwithsignsandsymptomsconcerningforautoimmunediseases

•  Todevelopacurriculumtoincreasecomfortlevelofpediatricsresidentswithregardstohistorytaking,physicalexamskills,laboratoryevaluaEon,andreferralpaeernsperEnenttopaEentswhopresentwithconcernsforautoimmunedisease

•  Allpediatricsandmed-pedsresidentsatourinsEtuEonwereanonymously

surveyedtogettheiropiniononwhichtopicsinrheumatologytheythoughtweremostimportantandalsoontheirpreferenceforcontentdelivery

•  Basedonresponses,aseriesofsixlectureswerecomposedinacasebased,interacEveformat

•  Theprojectincludes30-minutecasebasedlecturesreceivedbysecondyearpediatricsandthirdyearmed-pedsresidentsrotaEngthroughtheinpaEentrheumatologyserviceaswellasrealEmefeedbackonphysicalexamskillsinclinic

•  Preandpostsurveyswereusedtoevaluateimprovementincomfortlevelwithrheumatologytopics

Hypothesis

1.   TheCys0cFibrosisFounda0on.RetrievedonAugust3,2017fromhNps://www.cff.org/About-Us/2.   CenterforDiseaseControlandPreven0on.(August4,2017).SickleCellDiseaseDataandSta0s0cs.Retrievedfrom

hNps://www.cdc.gov/ncbddd/sicklecell/data.html3.   Arthri0sbyNumbers.(2015,December11).RetrievedonJuly15,2017from

hNps://www.arthri0s.org/Documents/Sec0ons/About-Arthri0s/arthri0s-facts-stats-figures.pdf4.   HealthResourcesandServicesAdministra0on(HRSA).ReporttoCongress‘ThePediatricRheumatologyWorkforce:AStudyoftheSupplyand

DemandforPediatricRheumatologists”(February2007)5.   SmithN,JandialS,RaeL,FosterH.pGALs.Educa0on.AppleAppStoreVers1.6.BoxmodelDigitalMediaLimited,2016.Web.Sept2017.

Cases

ObjecEveFig7.WordcloudpresenEngmostcommonlyusedwordsinfreetextresponseonsurveyasking

StronglyAgree

Agree

Neutral

Disagree

StronglyDisagree

0

Case66yearoldwitharash

Case25yearoldwith“T-Rex”arms

Case316yearoldwithjointpain

Case13yearoldwithfevers

Case412yearoldwithweakness

Case55yearoldwithredeyes

a. b. c.

f.e.d.

Fig2.a)IniEalslideforperiodicfever,adeniEs,pharyngiEs,aphthousstomaEEs(PFAPA)case;b)IniEalslideforthejuvenileidiopathicarthriEs(JIA)casewithpediatricsgait,arms,legs,andspine(pGALS)exam;c)IniEalslideforthesystemiclupuserythematosus(SLE)case;d)IniEalslideforthejuveniledermatomyosiEs(JDMS)case;e)IniEalslidefortheKawasakiDisease(KD)case;f)IniEalslidefortheHenoch-Schönleinpurpura(HSP)case

Fig3.pGALSappavailablefreeforiPhone5

PreRotaEonAssessmentofResidentComfortwithWorkUp

PostRotaEonAssessmentofResidentComfortwithWorkup

PreRotaEonAssessmentofResidentComfortwithMusculoskeletalExam

PostRotaEonAssessmentofResidentComfortwithMusculoskeletalExam

PreRotaEonAssessmentofResidentComfortwithLaboratoryInterpretaEon

PostRotaEonAssessmentofResidentComfortwithLaboratoryInterpretaEon

PreRotaEonAssessmentofResidentComfortwithRheumatologyReferral

PostRotaEonAssessmentofResidentComfortwithRheumatologyReferral

LecturesDeliveredtoResidentsByMonth

Feb March April May June July Aug

Fig5b.AJtudesofresidentswithregardtocomfortlevelwithmusculoskeletalexamsaUerinpaEentrheumatologyrotaEonandclinicexperience

0

2

4

6

Re

siden

ts

FebMarchAprilMayJuneJulyAug0

2

4

6

Fig6b.AJtudesofresidentswithregardtocomfortwithlaboratoryinterpretaEoninapaEentwhopresentswithconcernforautoimmunediseaseaUertheinpaEentrheumatologyrotaEon

Re

siden

ts

Fig8a.AJtudesofresidentsregardingcomfortwithrheumatologyreferralpriortoinpaEentandclinicexperiencewithrheumatology

FebMarchAprilMayJuneJulyAug0

2

4

6

Resid

ents

PFAPA

SLE

HSP

JIAwithpGALS

JDMS

KD

Fig9.Lecturesbrokendownbyfrequency

Feb March April May June July Aug

2

6

10

14

18

Resid

ents

FebMarchAprilMayJuneJulyAug

Fig4b.AJtudesofresidentswithregardtocomfortlevelwithautoimmunediseaseworkupaUerinpaEentrheumatologyrotaEon

0

2

4

6

Re

siden

ts

FebMarchAprilMayJuneJulyAug0

2

4

6

Fig8b.AJtudesofresidentsregardingcomfortwithrheumatologyreferralaUerinpaEentandclinicexperiencewithrheumatology

Resid

ents

Fig5a.AJtudesofresidentswithregardtocomfortwithmusculoskeletalexamspriortoinpaEentrheumatologyrotaEonandclinicexperience

FebMarchAprilMayJuneJulyAug0

2

4

6

Resid

ents

FebMarchAprilMayJuneJulyAug

Fig4a.AJtudesofresidentswithregardtocomfortlevelwithautoimmunediseaseworkuppriortoinpaEentrheumatologyrotaEon

0

2

4

6

2

4

6

FebMarchAprilMayJuneJulyAug

Fig6a.AJtudesofresidentswithregardtocomfortwithlaboratoryinterpretaEoninapaEentwhopresentswithconcernsforautoimmunediseasepriortotheinpaEentrheumatologyrotaEon

Resid

ents

Residen

ts