Background/Purpose: The purpose of this project was to develop a curriculum to teach residents these skills. Due to a paucity of pediatric rheumatologists and the growing patient population, pediatricians must be able to recognize and begin a basic work up for suspected autoimmune disease. The project includes 30-minute case based lectures on the topics of systemic lupus erythematosis (SLE), juvenile idiopathic arthritis (JIA), periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), Kawasaki Disease (KD), juvenile dermatomyositis (JDMS), and Henoch Schonlein purpura (HSP).

There are 300,000 children in the US with rheumatic conditions and the incidence is increasing with better recognition of this subset of chronic diseases. This makes rheumatic disease one of the most common chronic illnesses in pediatrics. Most recent estimates from 2015 show that there are 407 pediatric rheumatologists in the country and of those, many have very little clinical time are involved more heavily in research. Sadly, most recent estimates suggest that up to 10% of pediatric rheumatologists will be retiring within the next several years and that demand exceeds supply by 25-50%. Many children who do have access to a pediatric rheumatologist travel >4 hours to see a subspecialist and wait times at many centers are several weeks to months. As a result, the practicing pediatric rheumatologists often must rely heavily on generalists and those in other subspecialties to help manage these patients. However, 40% of residency programs do not have access to an onsite pediatric rheumatologist and 11 states are still without a board certified/eligible pediatric rheumatologist. Even within institutions who have access to a pediatric rheumatologist, exposure is limited with estimates of approximately 5 hours of teaching time for the residents who do not rotate with rheumatology as an elective at our institution. This is similar to exposure in other institutions who have pediatric rheumatology.

Methods: All pediatrics and med-peds residents at our institution were anonymously surveyed to get their opinion on which topics in rheumatology they thought were most important and also on their preference for content delivery. Based on responses, a series of six lectures were composed in a case based, interactive format. Second year pediatrics and third year med-peds residents rotate through the inpatient rheumatology service and received this curriculum. Pre and post surveys were used to evaluate improvement in comfort level with rheumatology topics.

Results: Per self-assessment from the residents’ comfort level with laboratory work up, musculoskeletal exam, and referrals improved after working through cases in the curriculum while on the inpatient rotation.

Conclusion: Although exposure to pediatric rheumatology is limited in our institution, we were able to effectively increase comfort level with regards to work up and diagnosis of autoimmune diseases. Ideally, exposure to patients in both the inpatient and outpatient setting would also help increase comfort level with this subset of patients, but ACGME guidelines for residency training do not require exposure to pediatric rheumatology during residency training.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/developing-a-pediatric-rheumatology-curriculum-for-pediatric-residents/