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Pediatric Rheumatology Curriculum for the Pediatrics Resident: A Case-Based Approach to Learning
Miriah Gillispie1, Eyal Muscal2,3, Jennifer Rama4
1Fellow, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital.
Insights
A new pediatric rheumatology curriculum improved resident confidence in diagnosing and managing autoimmune diseases in children. This training addresses a critical gap, enhancing skills for early detection and referral of pediatric rheumatologic conditions.
Area of Science:
- Pediatric Rheumatology
- Medical Education
- Autoimmune Diseases
Background:
- Pediatric rheumatologic diseases are common yet underrecognized, affecting approximately 1 in 250 children with juvenile arthritis.
- A shortage of pediatric rheumatologists nationwide exacerbates diagnostic and treatment challenges.
- Gaps exist in resident training regarding the workup, examination, and management of pediatric autoimmune conditions.
Purpose of the Study:
- To develop and evaluate a case-based curriculum to enhance pediatric residents' skills in rheumatologic disease management.
- To improve resident comfort and competence in diagnosing and referring pediatric autoimmune diseases.
Main Methods:
- A six-step curriculum development method was employed, focusing on workup, musculoskeletal exam, lab interpretation, and referral.
- The curriculum consisted of case discussions and an observed musculoskeletal exam session for pediatric and internal medicine-pediatric residents.
Main Results:
- The curriculum successfully increased resident comfort in identifying symptoms, physical exam findings, and appropriate laboratory studies for autoimmune diseases.
- Trainees reported improved confidence in managing and referring pediatric rheumatologic cases.
- Weekly sessions in 2017 reached 34 trainees, with survey results indicating significant learning gains.
Conclusions:
- The case-based curriculum effectively addresses a critical gap in pediatric training for rheumatologic diseases.
- Enhanced exposure to common autoimmune conditions and improved physical examination skills were key outcomes.
- This program better prepares residents to manage children with potential rheumatologic conditions.
Introduction:
Pediatric rheumatologic disease occurs more frequently than several other chronic pediatric diseases but is often underrecognized. It is estimated that in the US, one in 250 children has some form of juvenile arthritis and 300,000 children have a form of rheumatologic disease. However, there are only approximately 400 practicing pediatric rheumatologists nationwide.
Methods:
Kern's six-step method was used to develop a pediatric rheumatology curriculum based on respondents' perceived lack of training and comfort with four key areas: workup, musculoskeletal exam, laboratory interpretation, and referral to rheumatology. These cases were developed for second-year pediatric and second- and third-year internal medicine-pediatric residents rotating with the service. The curriculum was composed of four 30-minute case discussions as well as an observed musculoskeletal exam session.
Results:
In 2017, weekly case study sessions reached 34 trainees. Survey results from these trainees are representative of our overall results and reveal that learners felt the content of the cases helped increase comfort with compiling pertinent history and information of symptoms consistent with autoimmune disease, recognizing physical exam findings of autoimmune disease, ordering and interpreting laboratory studies in children with concerns for autoimmune disease, and referring to pediatric rheumatology.
Discussion:
This case-based curriculum exposed residents to presentations of the more common autoimmune diseases encountered in the pediatric population. The curriculum helps fill a gap in pediatric training through increased exposure to this subset of chronic diseases and expands physical examination skills not typically taught in general pediatrics.
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