Yukiko Kimura, MD, has been interested in medical education for a long time, so when the ACR REF awarded her the ACR REF Clinician Scholar Educator Award in 2008, she knew what she wanted to do.
“My original plan was relatively simple: to develop a web-based program that could use video and multimedia to teach primary care physicians, residents, and trainees how to do joint exams in children,” says Dr. Kimura, who is chief of pediatric rheumatology at Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center in Hackensack, N.J.
“There’s such a shortage of specialists to teach this sort of skill. Learning by doing a hands-on exam is the best way, but there aren’t enough specialists to be able to teach everyone this way,” she says.
Dr. Kimura says that several problems can contribute to children not being diagnosed or treated effectively when they develop rheumatic disease: a lack of specialists in the field, a lack of awareness about these diseases, and a lack of appropriate training for those who treat children with musculoskeletal issues.
“There are less than 300 pediatric rheumatologists in the country, and up to a third of U.S. medical schools don’t even have one on faculty,” she says. “This leads to poor general knowledge and awareness about arthritis and other pediatric rheumatic diseases, even though arthritis is one of the most common chronic diseases in children. Kids often get referred first to orthopedists instead of rheumatologists when they develop swollen joints and pain, because pediatricians don’t think about arthritis as a possibility. As a result, diagnosis and treatment may be delayed. Because musculoskeletal examination skills are not taught in medical schools, primary care providers often have poor confidence in conducting them.”
Dr. Kimura says that pediatric rheumatologists and orthopedists can learn from each other. “There should be more collaboration in teaching and management,” she believes. “We see many patients who have a lot of similarities in their presentations.”
In order to develop a program that would provide better and more far-reaching education in this area, Dr. Kimura first looked at the resources that were available. Since she didn’t have the technical expertise to create an online multimedia learning platform on her own, she contacted the pediatric rheumatology section at the American Academy of Pediatrics (AAP). The AAP already has a feature called PediaLink, which is an online learning center for pediatric healthcare professionals.
“They realized the section on pediatric orthopedics was also interested in having modules on musculoskeletal diseases,” Dr. Kimura says. Since they were already exploring some of the same themes that Dr. Kimura planned to focus on, it was a good fit. “Interestingly, their module outline didn’t even touch on the fact that children can get arthritis,” she says.
That’s when she realized that collaboration between the specialties would be vital to developing a program that would get at the core of what pediatricians need to know to understand the differential diagnosis, examination, and workup of a child who has limb pain. Bringing together expertise from both pediatric rheumatology and pediatric orthopedics, Dr. Kimura and her colleagues created a program called “Pediatric Musculoskeletal Medicine.”
Based on the positive feedback the project has received so far, she is looking to expand the program so that it is available to more people, especially in countries where there is an even greater shortage of specialists. In addition, the experience has fed her interest in learning about education.
“It has changed my thinking about the scholarship of education. It has exposed me to a whole world of teachers,” she says. “The award helped me grow as a person and as a teacher. Educating physicians and other healthcare professionals is an activity that medical schools and universities need to take seriously as an important academic activity.”
Dr. Kimura also believes that teaching about rheumatology and exposing students and trainees to the subspecialty is a key to leading more physicians to choose it as their field of specialization.
“Rheumatologists tend to be great teachers, so if we can develop ways to expose young people to the field, more will be inspired to become rheumatologists. It’s a very intellectual specialty,” she says.