Nurse Practitioner & Physician Assistant Rheumatology Curriculum Outline Released

A note from ARP President Hazel L. Breland, PhD, OTR/L, FAOTA: Some time has passed since the ACR first published its NP/PA Rheumatology Curriculum Outline. Originally developed to serve as a guide for rheumatologists to onboard a nurse practitioner (NP) or physician assistant (PA) into the rheumatology practice setting, the ACR has realized this valuable resource has a broader benefit. Not only does the curriculum address a gap identified by  rheumatologists, but it also serves the interprofessional members of the Association of Rheumatology Professionals (ARP).

The curriculum maps a path to continued professional development as our NPs and PAs graduate or transition from another specialty. In keeping with the curriculum outline, a concerted effort to ensure resources are readily available to meet our collective needs continues to evolve. The curriculum, in addition to wrap-around products, includes the ARP’s newly relaunched Advanced Rheumatology Course (ARC), new Advanced eBytes and an upcoming unique collaboration initiated between the ACR and the American Academy of Physician Assistants, titled The Training Rheum, all of which provides a well-rounded foundation on essential rheumatology topics.

Whether you are a rheumatologist or an NP/PA seeking guidance, we re-introduce the NP/PA Rheumatology Curriculum Outline and encourage you to use the entire product package to meet your needs.

Originally published Oct. 18, 2018

Rheumatology is the first specialty to develop a specialty-specific curriculum for nurse practitioners (NPs) and physician assistants (PAs). Now available online, the Rheumatology Curriculum Outline (RCO) is designed as a tool or guide for rheumatologists to use when adding an NP or PA to their practice.

“The NP/PA Rheumatology Curriculum Outline provides a structured and organized approach that can be utilized in adult and pediatric rheumatology, as well as private practice and academic settings, to facilitate the NP/PA’s efficient integration into a rheumatology practice,” says Benjamin J. Smith, PA-C, director of didactic education, School of Physician Assistant Practice, Florida State University, College of Medicine, Tallahassee, Fla.

Mr. Smith was the first co-lead author of a recently published study detailing the impetus for and development of the curriculum.¹ As part of a task force created by the ARHP Executive Committee, he and a group of rheumatologists, NPs and PAs at academic institutions and in private practice were charged with developing the curriculum. The task force worked with and was supported by a number of ACR committees, including the ACR Executive Committee and Board of Directors.

It is hoped the RCO will fill a gap that currently exists in the training of NPs and PAs who wish to practice rheumatology, as well as encourage the expansion of rheumatology providers. The sidebar, right, lists a number of advantages to implementing the RCO.

Citing a workforce study published in April that showed huge gaps between projected supply and demand for rheumatologists, Marcy B. Bolster, MD, associate professor of medicine, Harvard Medical School, and director of the Rheumatology Fellowship Training Program in the Division of Rheumatology, Allergy and Immunology at Massachusetts General Hospital, Boston, says current projections for the next decade again predict a tremendous gap between the supply of rheumatology providers and demand for rheumatology care.

These data are not new. Data going back to 2007 predicted a shortage of rheumatology providers.² These data prompted the ACR in 2007 to include expanding the rheumatology workforce in its strategic approach, a plan that aimed to increase the number of physicians training to become rheumatologists and laid the foundation on which to expand practices and improve access to care by adding NPs and PAs.

More than 10 years later, the RCO builds on this foundation. “What we hope, with this curriculum, is that it will facilitate the rheumatologist to be able to more quickly and compre­hensively integrate an NP or PA into their practice,” says Dr. Bolster, a member of the task force and the second co-lead author of the study.

Closer Look at the RCO

In developing the RCO, the task force undertook a rigorous process to identify the needs for rheumatology training for NPs and PAs by obtaining input from published data and survey responses, and gathering feedback from stakeholders.

Through this process the task force collected data showing the important role played by NPs and PAs in a rheumatology practice, including managing a number of rheumatic diseases, as well as prescribing an array of drugs. Survey data from NPs and PAs highlighted what they deemed most important in terms of training. At the top of the list was a colleague mentor physician, NP or PA, followed by, in order, the ACR/ARHP, a textbook and online resources.

The content of the RCO is built around core competencies for NPs and PAs that parallel the core competencies established for physicians by the Accreditation Council for Graduate Medical Education Core Competencies.¹ These include competencies in patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal/communication skills.

Dr. Bolster emphasizes the curriculum is designed to be an outline that covers important topics in adult and pediatric rheuma­tology needed to establish a solid knowledge base for NPs and PAs. The online modules include case studies, resource materials and a rheumatology toolbox.

The outline design makes it a flexible training curriculum that can be adapted to the specific needs of any given rheumatology practice. The curriculum is not meant to be a one-size-fits-all training tool. Mr. Smith refers to it as a model. “Similar standardized curricula can be applied broadly, but also be flexible [to fit] the specific needs of a practice,” he says.

No certification accompanies the curriculum, and NPs and PAs work through the curriculum at their own pace. “The curriculum is not a supervised activity; it is meant to provide a resource for physicians to integrate an NP or PA into their practice,” says Dr. Bolster.

Dr. Bolster says the task force suggests an evaluation period after six months by a supervising physician to provide performance feedback to the NP or PA and obtain input from the NP or PA on areas of needed focus. The curriculum outline can be used as a guide for continued study.

As an NP who started to practice in rheuma­tology 15 years ago, Christine Stamatos, DNP, director, Fibromyalgia Wellness Center, Northwell Health, Division of Rheumatology, Great Neck, N.Y., says the RCO provides a needed focused training for NPs and PAs that previously was lacking.

“Rheumatology is a complex specialty and requires knowledge that is not obtained in any graduate program,” she says. “This curriculum forms a road map to guide the learning process. It provides both the NP and the MD mentor a specific and comprehensive plan to follow in the first year of practice.”

Ms. Stamatos, who is also a member of the task force and co-author of the study, says the greatest challenge going forward is to get information about the RCO out to NPs and PAs, as well as to practicing rheumatologists. “We need to educate physicians about the program and help them understand that with proper training [available], they will be much more likely to train and retain an NP or PA,” she says.

She stresses the importance of education on the rheumatology specialty for NP and PA students to gain their interest in pursuing a career in rheumatology. “I can’t imagine anyone new to rheumatology not interested in using a curriculum to guide their learning and training,” she says.

Endorsed by the ACR Board of Directors in February 2017, the RCO is now available online.

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Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.

References

1. Smith BJ, Bolster MB, Slusher B, et al. Core curriculum to facilitate the expansion of a rheumatology practice to include nurse practitioners and physician assistants. Arthritis Care Res (Hoboken). 2018 May;70(5):672–678.
2. Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology workforce study: Supply and demand projections of adult rheumatology workforce, 2015–2030. Arthritis Care Res (Hoboken). 2018 April;70(4):617–626.