Background/Purpose
Approximately 1 in 1000 children suffer from a rheumatologic disorder. Despite the relative frequency of these conditions, there is a shortage of pediatric rheumatologists and many children with rheumatologic conditions will present to primary care providers for initial evaluation and management. Unfortunately, there is strong evidence that graduating pediatric residents are ill equipped to recognize and treat these children. In the University of Washington Pediatric Residency Program, exposure to rheumatology occurs through a month long, largely inpatient rotation. The inpatient focus presents an educational challenge to provide residents with fundamental concepts involved in the care of a primarily ambulatory patient population.
Methods
A literature search was conducted to identify previous relevant work. Although there are existing curricula for pediatric rheumatology electives, no curricula were identified to specifically address inpatient based pediatric rheumatology education. A clinical teaching tool was developed based on types of rheumatology admissions commonly available for pediatric resident involvement, as well as a desire to teach broad based concepts involved in evaluation of rheumatologic disorders. An evidence-based literature search identified supporting evidence for relevant clinical questions. The tool consists of a clinical pathway activated by an electronic medical record (EMR) based orderset which guides users through initial assessment and treatment considerations. The orderset is linked to a visual algorithm outlining the recommended approach. An accompanying web-based educational module has been developed along with an assessment tool designed to gauge changes in learner’s knowledge and attitudes after completion of the module. Initial content validity for the assessment tool was developed through peer review by additional pediatric rheumatology providers at our institution.
Results
The Rheumatology New Diagnosis Pathway was implemented in Nov. 2011. The web-based educational module was added in March 2014. EMR derived utilization data reflects high acceptance from pediatric residents with an average of 10 patients on pathway per fiscal quarter (range 2-18). Informal feedback has been positive in terms of facilitation of order entry and appreciation of general concepts presented.
Conclusion
Given the scarcity of pediatric rheumatologists, it is imperative to provide pediatric residents with quality education about rheumatologic conditions. Given the constraints of current residency experiences, novel curricular developments are required to address this educational need. This teaching tool addresses the management of children admitted to the rheumatology service. By focusing on broad concepts involved in initial diagnosis and treatment of childhood rheumatologic disorders, this teaching tool offers a foundational model which can be translated to future patient encounters. Additional work is planned to assess the impact of the tool on trainee knowledge of and comfort with evaluation of children with rheumatologic conditions as well as potential for dissemination to additional institutions.
Disclosure:
K. Hayward,
None;
J. Hrachovec,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/design-and-implementation-of-a-clinical-teaching-tool-for-approach-to-children-with-suspected-new-rheumatologic-diagnosis/