Attitudes toward pediatric rheumatology among residency-trained pediatricians

Abstract

Background: Pediatric rheumatology (PR) is a relatively new and rare subspecialty in emerging countries. This study aimed to investigate physicians' attitudes toward and real-life clinical practice in PR among residency-trained pediatricians in Thailand. Methods: An electronic questionnaire was developed and sent via email to pediatricians from Thailand who completed their residency training between 2007 and 2015. Confidence in treating and managing children with rheumatic diseases was rated using a 5-point Likert scale. Results: The response rate was 281 out of 902 (31%), and the mean ± standard deviation age of respondents was 33.8 ± 2.7 years. Confidence was rated as adequate for history taking of children with rheumatic diseases (mean 2.76, 95% confidence interval [CI]: 2.66–2.91), but low for musculoskeletal (MSK) examination (2.42, 95% CI: 2.29–2.54), arthrocentesis (2.01, 95% CI: 1.91–2.11), and rheumatology investigation (2.49, 95% CI: 2.39–2.60). Confidence was high for diagnosis and management of Henoch-Schönlein purpura (3.83, 95% CI: 3.74–3.92) and Kawasaki disease (3.46, 95% CI: 3.38–3.55), but low for juvenile idiopathic arthritis (JIA) (2.41, 95% CI: 2.30–2.52) and chronic systemic vasculitis (1.97, 95% CI: 1.85–2.08). Confidence to perform an MSK examination and arthrocentesis was significantly higher in respondents who had a full-time pediatric rheumatologist working in their pediatric residency training center (P = 0.02, P = 0.01, respectively), and in those who had experienced a PR rotation (P < 0.001, P = 0.01, respectively). Most respondents agreed that more teaching in PR is essential (95.3%) and that case-based discussion was the preferred teaching method. Conclusion: The self-rated confidence of pediatricians was low in MSK examination, arthrocentesis, and rheumatology investigation and therefore, teaching on PR is needed.