From initial interviews, researchers learned that three major factors influence a fellow’s decision to choose pediatric rheumatology: their perception of life as a pediatric rheumatologist, their interest in the field and their personal experiences working with pediatric rheumatology patients. Researchers also found the fellows were influenced by mentorship; external persuasive influences, such as research; dissuasive practice limitations; and the geographic location of areas with the greatest need for pediatric rheumatologists, including rural locations.
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Explore This IssueDecember 2020
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As the team completes its final year of the study, Dr. Mehta is looking at benefits to pediatric rheumatology that can be gleaned from study interviews and leveraged for recruitment. Such benefits include job satisfaction and reasonable work hours, interest in complex immunopathology and the ability to form long-term relationships with patients.
To meet the study’s second target, researchers have followed six pediatric rheumatology fellows through their first two years of fellowship. They’ve identified common challenges, such as transitioning from a primarily inpatient residency to a primarily outpatient fellowship, the presence of impostor syndrome and going from being a highly knowledgeable senior resident to learning a new field all over again. Recognition of these challenges may help fellowship directors better prepare new fellows for the challenges they will face.
Educating Fellows about the Transition from Pediatric to Adult Care
Although the physical transition from pediatric to adult rheumatology care may seem as simple a move to a new office down the hall, the young adult patients—and their families—who are transferring to adult care may feel it’s a giant leap, according to Rebecca Sadun, MD, PhD, an adult and pediatric rheumatologist at Duke University School of Medicine, Durham, N.C.
“We know that about 50% of pediatric rheumatology patients are lost to care at the time of transfer,” Dr. Sadun says. She notes that less than 25% of graduate medical education trainees feel competent performing core transition skills for pediatric to adult care, such as providing orientation and expectations, placing the patient in the primary role, performing a confidential social history, assessing self-management skills and assessing barriers to transition.2
To boost transition competence and confidence among providers, Dr. Sadun and her team are testing three educational interventions aimed at rheumatology fellows: a standalone lecture, a series of workshops with practical training experience and a web-based education program that delivers training through a team-based setting, with hypothetical scenarios and applied homework for fellows to practice in the clinic.3