Background/Purpose: Pediatric rheumatology (PR) became an American Board of Pediatrics subspecialty in 1990. This is the first survey to examine training differences between the 31 US PR fellowship programs. We hypothesize that there is infinite variation in the Pediatric Rheumatology Fellowship Training across North America
Methods: Members of the American Academy of Pediatrics (AAP) Section of Rheumatology and its Executive Committee conducted this cross-sectional study. We developed the survey instrument through extensive literature research and the Delphi consensus technique. Following institutional human subjects research review and approval, we distributed the survey to PR trainees (n=82)
Results: We obtained a 57% response rate (n=47). Respondents’ training level followed a normal distribution: initial (8%); completion of 1st year (16%), 2nd year (34%), 3rd year (37%) and 4th year (5%). Their clinical commitments involved the following half-day sessions per week: 1 (28%), 2 (43%), 3 (13%), 5 (11%), and 6 (4%). Sixty percent provided care for either 4 (30%) or 5 (30%) patients per session. Procedural experience included joint injections and musculoskeletal ultrasound. Respondents’ average number of joint injections per month comprised 0-1 (55%), 2-4 (37%), and ≥ 5 (7%); 20% received formal ultrasound training. On-call experience at home involved nights and weekends; the latter also included inpatient rounds for 98% of respondents. The range of nights on-call was 0-15, distributed as: 0 (2%), 3 (16%), 7 (27%), 10 (14%) and 15 (7%). The range of weekends on-call was 1-4, distributed as: 1 (37%), 2 (39%), 3 (9%) and 4 (9%). Educational session hours attended varied among trainees: 2 (13%), 3 (35%), 4 (29%) and ≥ 5 (22%). Sessions included journal club presentations (range=1-8/year), trainee-presented PR lectures (97%), resident education (88%), and attendance at specialty conferences with adult rheumatology (81%), radiology (59%), nephrology (48%) and histopathology (43%). Respondents’ research activity hours per week (range= 20 to > 60) varied: ≤ 20 (43%), 21-40 (43%), 41-60 (11%), > 60 (2%). Respondents presented abstracts at regional or national academic meetings in a range of 1 (32%) to 8 (6%). Regarding published papers, 41% had one, while 59% had none
Conclusion: Both clinical and research experience varies widely between US PR fellowship programs. Our survey data may identify areas for programmatic improvements, best practice benchmarks, and policy development for future training recommendations & workforce development. We hope programs will accomplish similar standards of excellence through the use of comparison data
Table1:
|
Please indicate the average number of patients you have seen in each group during your fellowship |
|||||||
|
Disease Groups |
‘Number of patients seen’ subgroup (numbers in italics denote % of responders) |
Range of exposure |
|||||
|
0-5 |
6-10 |
11-20 |
>20 |
Never observed/treated |
Response Count |
||
|
Existing Diagnosis of SLE |
11.3 |
13.6 |
31.8 |
43.1 |
0 |
44 |
43.1% of responders see >20 & Only 11.3% responders saw less than 5 of previously diagnosed SLE patients |
|
SLE Nephritis |
20.4 |
25 |
27.2 |
27.2 |
0 |
44 |
27.2% of responders saw >20 while 20.4% responders saw <5 patients with SLE nephritis |
|
New Case of SLE |
29.5 |
34 |
31.8 |
4.5 |
0 |
44 |
29.5% responders saw <5 cases while only 4.5% responders saw >20 cases of newly diagnosed SLE |
|
Existing Diagnosis of WG |
68.1 |
22.7 |
4.5 |
0 |
4.5 |
44 |
68.1% of responders saw < 5 patients while 4.5% responders never saw a patients with previously diagnosed WG |
|
New WG |
86.3 |
6.8 |
0 |
0 |
6.8 |
44 |
86.3% of responders saw < 5 patients while 6.8% responders never saw a patients with newly diagnosed WG |
|
Scleroderma |
47.7 |
29.5 |
20.45 |
5 |
0 |
44 |
47.7% of responders saw < 5 patients while no one saw <20 patients with scleroderma |
|
Sjogren’s Syndrome |
62.7 |
23.2 |
4.6 |
0 |
9.3 |
43 |
62.7% of responders saw < 5 patients while 9.3% responders never saw a patients with Sjogren's |
|
Existing Diagnosis of JDM |
56.8 |
29.5 |
25 |
13.6 |
2.2 |
44 |
56.8% of responders saw < 5 patients while 2.2% responders never saw a patients with previously diagnosed JDM |
|
New JDM |
56.8 |
29.5 |
4.5 |
2.2 |
6.8 |
44 |
56.8% of responders saw < 5 patients while 6.8% responders never saw a newly diagnosed JDM patients |
|
CNS Vasculitis |
72.7 |
18.1 |
0 |
0 |
9 |
44 |
72.7% of responders saw < 5 patients while 9% responders never saw a patients with CNS Vasculitis |
|
PAN |
65.9 |
2.2 |
0 |
0 |
31.8 |
44 |
65.9% of responders saw < 5 patients while 31.8% responders never saw a patients with PAN |
|
MPA |
68.1 |
6.8 |
0 |
0 |
25 |
44 |
68.1% of responders saw < 5 patients while 25% responders never saw a patients with PAN |
|
Poly JIA |
4.5 |
6.8 |
13.6 |
75 |
0 |
44 |
4.5 % of responders saw < 5 patients while 75% saw >20 Poly JIA patients |
|
Oligo JIA |
5 |
0 |
15.9 |
81.8 |
0 |
44 |
5% of responders saw < 5 patients while 81.8% saw >20 patients with Oligo JIA |
|
Spondyloarthropathies/ERA |
6.8 |
15.9 |
25 |
52.2 |
0 |
44 |
6.8% responders saw <5 cases while 52.2% responders saw >20 cases of Spondyloarthropathies/ERA |
|
SOJIA |
15.9 |
46.5 |
27.9 |
9.3 |
0 |
43 |
15.9% responders saw <5 cases while only 9.3% responders saw >20 cases of SOJIA |
|
MAS |
61.3 |
29.5 |
2.3 |
2.3 |
0 |
43 |
61.3% of responders saw less than 5 cases while 2.3 % saw >20 cases of MAS |
|
Other ANCA related Vasculitic |
75 |
9 |
27.7 |
0 |
13.5 |
44 |
75% of responders saw less than 5 cases while 13.5 % saw >20 cases of Other ANCA related Vasculitic |
|
Churg-Strauss syndrome |
52.2 |
0 |
0 |
0 |
47.7 |
44 |
52.2% of responders saw less than 5 cases while 47.7% never saw a cases of Churg-Strauss syndrome |
|
Behcet’s syndrome |
77.4 |
13.6 |
2.2 |
0 |
6.8 |
44 |
77.4% of responders saw less than 5 cases while 6.8% never saw a cases of Behcet’s syndrome |
|
Streptococcal Syndromes/RF/Reactive arthritis/PANDA |
20.4 |
38.6 |
36.6 |
4.5 |
0 |
44 |
20.4% of responders saw less than 5 cases while 4.5 % saw >20 cases of Streptococcal Syndromes |
|
Kawasaki Disease |
20.4 |
45.4 |
18.1 |
13.6 |
2.2 |
44 |
20.4% of responders saw less than 5 cases while 13.6% saw >20 cases while 2.2% never saw a case of Kawasaki Disease |
|
Resistant to treat HSP |
53.4 |
29.5 |
9.3 |
0 |
6.9 |
43 |
53.4% of responders saw less than 5 cases while 6.9% never saw a Resistant to treat case of HSP |
|
Chronic Recurrent multifocal Osteomyelitis (CRMO) |
59 |
29.5 |
4.5 |
2.2 |
4.5 |
44 |
59% of responders saw less than 5 cases while 2.2 % saw >20 cases of CRMO. 4.5% responders never saw a case of CRMO |
|
Pain Enhancement Syndrome |
2.2 |
15.9 |
18.1 |
59 |
4.5 |
44 |
2.2% of responders saw less than 5 cases while 59% saw >20 cases of Pain Enhancement Syndrome. White interestingly 4.5% never saw such case |
|
Sarcoidosis |
60.4 |
23.2 |
4.6 |
0 |
11.6 |
43 |
60.4% of responders saw less than 5 cases while 11.6% never saw a case of Sarcoidosis |
|
Periodic Fever Syndromes |
29.5 |
31.8 |
27.2 |
11.3 |
0 |
44 |
29.5% of responders saw less than 5 cases while 11.3% saw >20 cases of Periodic Fever Syndromes |
|
Antiphospholipid Antibody Syndrome (APLS) |
63.6 |
25 |
6.8 |
2.2 |
2.2 |
44 |
63.6% of responders saw less than 5 cases while 2.2% saw >20 cases of APLS while 2.2% responders never saw a case of APLS |
|
Other (please specify) Others: Neonatal SLE -4.5% MCTD- 6.8% Neurosarcoid -2.2% Takayasu arteritis – 2.2% |
2 |
|
|||||
|
answered question |
44 |
|
|||||
|
skipped question |
3 |
|
|||||
Disclosure:
A. Patwardhan,
None;
M. Henrickson,
None;
S. D. Hong,
None;
Laskosz,
None;
C. H. Spencer,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/variation-in-us-pediatric-rheumatology-fellowship-training/