Methods:  : At Texas Children’s Hospital, a cadaver workshop was implemented in July 2016 to teach joint injection techniques to pediatric rheumatology trainees. Six pediatric rheumatology fellows participated. A tutorial on anatomy and technique was given by a faculty member or senior fellow. Fellows practiced injecting large and small joints with immediate feedback. Ultrasound was used to define landmarks and evaluate proper needle placement. Pre and post surveys assessing comfort level of performing intra-articular injections were administered. A six month follow up survey was given to reassess comfort in performing joint injections.

Results:  The pre-survey showed that prior to participating in the workshop, comfort with joint injections ranged from “Nervous, but able to take it on” to “comfortable”. Mode was “comfortable” with four participants. The post-survey showed comfort ranged from “nervous but able to take it on” to “comfortable”. The mode was “comfortable” from five participants showing an overall increased comfort level. At 6 month follow up, comfort ranged from “nervous, but able to take it on” to “comfortable” with a mode of “comfortable” with 4 participants. Three trainees attempted injecting new sites not previously tried subsequent to the workshop. Each of them felt “nervous but able to take it on”. Trainees felt the workshop was a favorable experience. Comments were “this was very helpful, good, no pressure environment to review/point out landmarks and technique, learned common pitfalls”, “definitely more comfortable after today”, and “became more comfortable with the approach and actual procedure”. Five trainees wanted review material prior to the workshop.

Conclusion:   Post workshop surveys showed improvement in comfort level. At 6-month follow up the comfort level was identical to the pre-cadaver workshop survey. This could reflect insufficient practice with live patients. Only 3 fellows performed untried joint injections after the workshop. Trainee comments were favorable. They appreciated the lower stress environment, practicing various approaches to joint injection and reviewing anatomy. Joint injections are a key therapy for children with arthritis. It is important to give trainees opportunities to improve their proficiency. Hands on workshops can provide practice for injections. This is necessary in the era of biologics, as fewer injections are performed. There is no published curriculum for teaching joint injections on cadavers. Our ultimate goal is to create a multi-modal curriculum incorporating simulation lab, cadaver workshop, and ultrasound education for proficiency in intra-articular injection training. This could be generalized for other pediatric programs, as well as adult rheumatology programs, or other specialties.