Background/Purpose: Microvascular damage is an intrinsic and early pathological event in Systemic Sclerosis (SSc) and can be observed using nailfold capillaroscopy (NFC). NFC can be performed using different techniques, including dermoscopy, widefield microscopy, and videocapillaroscopy. Abnormal nailfold capillaries are part of the 2013 diagnostic criteria for systemic sclerosis and may be observed in other connective tissue diseases (CTD) as well. With the support of our Academy of Medical Educators, we developed and assessed an educational curriculum to teach adult and pediatric rheumatology fellows the techniques and skills required for NFC.
Methods: Our curriculum had three programmatic elements. First, the fellows were provided with dermatoscopes and were given the opportunity to learn both the normal exam and abnormal capillary patterns. They were then given a one-hour didactic session and workshop where they used dermoscopy and widefield microscopy to examine the normal and abnormal patterns on themselves and an SSc patient. The third part of the curriculum involved a full-day course given by two experts in NFC that incorporated videocapillaroscopy and patient cases. Tests of usage and interest were taken at three time points – prior to giving the dermatoscopes, following the one-hour didactic session, and following the full-day course. Tests of knowledge were given to attendees of the full-day course before and after and included fellows, rheumatology attendings, and others. Comparisons were made using Fischer Exact Tests.
Results: In our institution there are 12 pediatric and adult rheumatology fellows. Response rates were 100%, 83% and 75% at the 1st, 2nd and 3rdtimepoints- respectively. At all time points 100% of fellows noted interest or strong interest in learning NFC techniques. After the course 67% felt confident in their ability to perform NFC while before the course only 17% felt confident, p = 0.03. Prior to the completion of the curriculum 25% of fellows responded that they used NFC frequently when they performed rheumatologic consultation compared to 67% after the course, p= 0.09.
Before and after the one-day course participants were asked to look at photographs of normal and abnormal NFC using a web-based application via SurveyMonkey. Response rates were 36/70 (51%) prior and 19/70 (27%) after. In the pre-test 74% answered all questions correctly and 95.5% answered all questions correctly in the post-test. Improved identification of normal NFC was observed: 18/36 (50%) before the course and (18/18) 100% after the course on one question, p<0.001. Improved identification of neoangiogenesis was observed, 18% pre versus 77% post, p <0.001.
Conclusion: NFC is an area of interest for rheumatology trainees and attendings. This curriculum was feasible and led to improved ability of learners to distinguish normal from abnormal and to recognize and describe SSc-specific NFC changes that identify validated patterns of disease progression. This curriculum also led to improved confidence in examining nailfold capillaries and increased use of this skill in rheumatologic consultation.
Disclosure:
D. Lerner,
None;
S. A. Paget,
None;
M. Cutolo,
None;
V. Smith,
None;
R. F. Spiera,
None;
J. K. Gordon,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/integration-of-nailfold-capillary-microscopy-and-dermoscopy-into-the-rheumatology-fellows-curriculum/