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Abstract Number: 1896

Variation in US Pediatric Rheumatology Fellowship Training

Anjali Patwardhan1, Michael Henrickson2, Sandy D. Hong3, 'Laura Laskosz4 and Charles H. Spencer5, 1Pediatric Rheumatology, Nationwide Childrens Hospital, Columbus, OH, 2MLC 4010, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 3Pediatrics-Rheumatology, U of Iowa Children's Hosp, Iowa City, IA, 4Manager, Sections on Endocrinology, Pulmonology, and Rheumatology, 5Rheumatology, Nationwide Childrens Hospital, Columbus, OH

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Assessment, practice guidelines and rheumatologic practice

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Session Information

Title: Medical Education

Session Type: Abstract Submissions (ACR)

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.

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