development and implementaon of a pediatric … · hnps://¬gures.pdf 4. health resources and...
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Abstract
DevelopmentandImplementaEonofaPediatricRheumatologyCurriculumforthePediatricResident
PediatricAllergy,ImmunologyandRheumatology,BaylorCollegeofMedicineandTexasChildren’sHospital
MiriahGillispieandAmandaBrown
• Duringthisclinicalexperience,residentswereshownthepediatricgait,arms,legs,andspine(pGALS)exambyafelloworaeending
• AUerallowingforpracEce,theywereobservedperformingtheexamandgivenrealEmefeedbackandevaluaEon
• TheywerealsoencouragedtodownloadthepGALSappasareference
Methods
OutpaEentExperience
Conclusion/FutureDirecEon
References
Background/IntroducEon Results Results
• WewereabletoeffecEvelyincreasecomfortlevelwithregardstohistorytaking,physicalexamskills,laboratoryevaluaEon,andrheumatologyreferralsforthosepaEentswhopresentwithconcernsforanautoimmuneprocess
• WeplantoconEnueusingthiscurriculumforthoseresidentsrotaEngthroughrheumatology
• WealsoplantoexpandthetopicstoincludeaddiEonallecturesonrheumaEcfever,chronicnonbacterialosteomyeliEs,etc
• WemayalsointroduceworkshopsforinterestedcommunityPCPsinordertoexpandtheirfundofknowledgeregardingpediatricrheumatologytopics
• PediatricautoimmunediseasesareamongthemostcommonchronicmedicalcondiEonsafflicEngchildren,evenmorecommonthanbothcysEcfibrosisandsicklecellanemia1,2
• EsEmatesarethat1in250childrenhaveaformofjuvenilearthriEsorotherautoimmunecondiEon,whichisalmost300,000pediatricpaEentsnaEonwide3Fig1.DistribuEonofpediatricrheumatologistsnaEonwide
• Despitetheprevalence,thereareonly407pracEcingpediatricrheumatologistsacrossthecountryasof20154
• EsEmatessuggest10%oftheserheumatologistswillreEreinthenextseveralyearsanddemandalreadyexceedssupplyby25-50%4
• CurrentlypaEentswhodohaveaccesstocareoUentravel>4hourstoreceivecareandnewpaEentsoUenhavetowaitweekstomonthsforanappointment4
• ExposuretopediatricrheumatologyteachingforresidentsislimitedandseveralmedicalschoolsandresidencyprogramsdonothaveaccesstothistypeofcurriculumcausingPCPstobeillequippedtodiagnoseandprovidepreliminarytreatment4
• IninsEtuEonswithpediatricrheumatology,averageexposureandteachingEmeisesEmatedat5hoursfortheenEretyofresidency
• Astandardcurriculumcovering“breadandbueer”pediatricrheumatologyinacasebasedformatwillhelpincreaseresidentcomfortlevelwithhistorytaking,physicalexaminaEon,workup,andreferralsforpaEentswhopresentwithsignsandsymptomsconcerningforautoimmunediseases
• Todevelopacurriculumtoincreasecomfortlevelofpediatricsresidentswithregardstohistorytaking,physicalexamskills,laboratoryevaluaEon,andreferralpaeernsperEnenttopaEentswhopresentwithconcernsforautoimmunedisease
• Allpediatricsandmed-pedsresidentsatourinsEtuEonwereanonymously
surveyedtogettheiropiniononwhichtopicsinrheumatologytheythoughtweremostimportantandalsoontheirpreferenceforcontentdelivery
• Basedonresponses,aseriesofsixlectureswerecomposedinacasebased,interacEveformat
• Theprojectincludes30-minutecasebasedlecturesreceivedbysecondyearpediatricsandthirdyearmed-pedsresidentsrotaEngthroughtheinpaEentrheumatologyserviceaswellasrealEmefeedbackonphysicalexamskillsinclinic
• Preandpostsurveyswereusedtoevaluateimprovementincomfortlevelwithrheumatologytopics
Hypothesis
1. TheCys0cFibrosisFounda0on.RetrievedonAugust3,2017fromhNps://www.cff.org/About-Us/2. CenterforDiseaseControlandPreven0on.(August4,2017).SickleCellDiseaseDataandSta0s0cs.Retrievedfrom
hNps://www.cdc.gov/ncbddd/sicklecell/data.html3. Arthri0sbyNumbers.(2015,December11).RetrievedonJuly15,2017from
hNps://www.arthri0s.org/Documents/Sec0ons/About-Arthri0s/arthri0s-facts-stats-figures.pdf4. HealthResourcesandServicesAdministra0on(HRSA).ReporttoCongress‘ThePediatricRheumatologyWorkforce:AStudyoftheSupplyand
DemandforPediatricRheumatologists”(February2007)5. SmithN,JandialS,RaeL,FosterH.pGALs.Educa0on.AppleAppStoreVers1.6.BoxmodelDigitalMediaLimited,2016.Web.Sept2017.
Cases
ObjecEveFig7.WordcloudpresenEngmostcommonlyusedwordsinfreetextresponseonsurveyasking
StronglyAgree
Agree
Neutral
Disagree
StronglyDisagree
0
Case66yearoldwitharash
Case25yearoldwith“T-Rex”arms
Case316yearoldwithjointpain
Case13yearoldwithfevers
Case412yearoldwithweakness
Case55yearoldwithredeyes
a. b. c.
f.e.d.
Fig2.a)IniEalslideforperiodicfever,adeniEs,pharyngiEs,aphthousstomaEEs(PFAPA)case;b)IniEalslideforthejuvenileidiopathicarthriEs(JIA)casewithpediatricsgait,arms,legs,andspine(pGALS)exam;c)IniEalslideforthesystemiclupuserythematosus(SLE)case;d)IniEalslideforthejuveniledermatomyosiEs(JDMS)case;e)IniEalslidefortheKawasakiDisease(KD)case;f)IniEalslidefortheHenoch-Schönleinpurpura(HSP)case
Fig3.pGALSappavailablefreeforiPhone5
PreRotaEonAssessmentofResidentComfortwithWorkUp
PostRotaEonAssessmentofResidentComfortwithWorkup
PreRotaEonAssessmentofResidentComfortwithMusculoskeletalExam
PostRotaEonAssessmentofResidentComfortwithMusculoskeletalExam
PreRotaEonAssessmentofResidentComfortwithLaboratoryInterpretaEon
PostRotaEonAssessmentofResidentComfortwithLaboratoryInterpretaEon
PreRotaEonAssessmentofResidentComfortwithRheumatologyReferral
PostRotaEonAssessmentofResidentComfortwithRheumatologyReferral
LecturesDeliveredtoResidentsByMonth
Feb March April May June July Aug
Fig5b.AJtudesofresidentswithregardtocomfortlevelwithmusculoskeletalexamsaUerinpaEentrheumatologyrotaEonandclinicexperience
0
2
4
6
Re
siden
ts
FebMarchAprilMayJuneJulyAug0
2
4
6
Fig6b.AJtudesofresidentswithregardtocomfortwithlaboratoryinterpretaEoninapaEentwhopresentswithconcernforautoimmunediseaseaUertheinpaEentrheumatologyrotaEon
Re
siden
ts
Fig8a.AJtudesofresidentsregardingcomfortwithrheumatologyreferralpriortoinpaEentandclinicexperiencewithrheumatology
FebMarchAprilMayJuneJulyAug0
2
4
6
Resid
ents
PFAPA
SLE
HSP
JIAwithpGALS
JDMS
KD
Fig9.Lecturesbrokendownbyfrequency
Feb March April May June July Aug
2
6
10
14
18
Resid
ents
FebMarchAprilMayJuneJulyAug
Fig4b.AJtudesofresidentswithregardtocomfortlevelwithautoimmunediseaseworkupaUerinpaEentrheumatologyrotaEon
0
2
4
6
Re
siden
ts
FebMarchAprilMayJuneJulyAug0
2
4
6
Fig8b.AJtudesofresidentsregardingcomfortwithrheumatologyreferralaUerinpaEentandclinicexperiencewithrheumatology
Resid
ents
Fig5a.AJtudesofresidentswithregardtocomfortwithmusculoskeletalexamspriortoinpaEentrheumatologyrotaEonandclinicexperience
FebMarchAprilMayJuneJulyAug0
2
4
6
Resid
ents
FebMarchAprilMayJuneJulyAug
Fig4a.AJtudesofresidentswithregardtocomfortlevelwithautoimmunediseaseworkuppriortoinpaEentrheumatologyrotaEon
0
2
4
6
2
4
6
FebMarchAprilMayJuneJulyAug
Fig6a.AJtudesofresidentswithregardtocomfortwithlaboratoryinterpretaEoninapaEentwhopresentswithconcernsforautoimmunediseasepriortotheinpaEentrheumatologyrotaEon
Resid
ents
Residen
ts