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Barriers to Learning Rheumatology

  • Yasser El Miedany
Chapter

Abstract

Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up to date about the developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of evidence-based knowledge in healthcare. Implementation of evidence-based practice requires a great deal of learning on the part of practitioners. Similar to healthcare professionals working in other medical specialities, it is likely that practitioners in rheumatology face similar challenges. This chapter will discuss barriers to rheumatology learning, educational need of the junior and training rheumatologists and ways to tackle these barriers.

Keywords

Learning rheumatology Barriers to learning Education in rheumatology Learning concept Critical thinking Evidence-based medicine 

References

  1. 1.
    Woolf AD. Healthcare services for those with musculoskeletal conditions: a rheumatology service. Recommendations of the European Union of Medical Specialists Section of Rheumatology/European Board of Rheumatology 2006. Ann Rheum Dis. 2007;66(3):293–301.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Forsman H, et al. Use of research by nurses during their first two years after graduating. J Adv Nurs. 2010;66(4):878–90.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nutley SM, Walter I, Davies HTO. Using evidence: how research can inform public services. Bristol: The Policy Press; 2007.CrossRefGoogle Scholar
  4. 4.
    Squires JE, Moralejo D, Lefort SM. Exploring the role of organizational policies and procedures in promoting research utilization in registered nurses. Implement Sci. 2007;2:17.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    El Miedany Y. MABS: targeted therapy tailored to the patient’s need. Br J Nurs. 2015;24(16 Suppl 1):S4–13.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Deighton C, et al. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009;338:b702.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chen YF, et al. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess. 2006;10:1–229.CrossRefGoogle Scholar
  8. 8.
    Nam JL, et al. Current evidence for the management of rheumatoid arthritis with biological disease-modifying anti-rheumatic drugs: a systematic literature review informing the EULAR recommendations for the management of RA. Ann Rheum Dis. 2010;69(6):976–86.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Illeris K. The fundamentals of workplace learning – understanding how people learn in working life. London: Routledge; 2011.Google Scholar
  10. 10.
    Merriam SB, Caffarella RS, Baumgartner LM. Learning in adulthood: a comprehensive guide. San Francisco: Jossey-Bass; 2007.Google Scholar
  11. 11.
    Argyris C, Schon D. Theory in practice: increasing professional effectiveness. San Francisco: Jossey Bass; 1974.Google Scholar
  12. 12.
    Ellström PE. Integrating learning and work: problems and prospects. Hum Resour Dev Q. 2001;12(4):421–35.CrossRefGoogle Scholar
  13. 13.
    Miloslavsky E. The resident-fellow interaction: limiting barriers and maximizing learning. American College of Rheumatology conference 2013. Abstract number 2814. http://acrabstracts.org/abstract/the-resident-fellow-interaction-limiting-barriers-and-maximizing-learning/.
  14. 14.
    Doherty M, Abawi J, Pattrick M. Audit of medical inpatient examination – a cry from the joint. J R Coll Physicians Lond. 1990;24:115–8. Google Scholar.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Walker DJ, Kay LJ. Musculoskeletal examination for medical students: the need to agree what we teach. Rheumatology. 2002;41:1221–3.  https://doi.org/10.1093/rheumatology/41.11.1221.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Marshall RW, Hull RG. For crying out loud: musculoskeletal assessment of inpatients referred to rheumatology. Rheumatology. 2004;43:1447.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rigby JC, Oswald AG. An evaluation of the performing and recording of physical examinations by psychiatric trainees. Br J Psychiatry. 1987;150:533–5.  https://doi.org/10.1192/bjp.150.4.533.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    O’Dunn-Orto A, Hartling L, Campbell S, Oswald AE. Teaching musculoskeletal clinical skills to medical trainees and physicians: a best evidence in medical education systematic review of strategies and their effectiveness: BEME guide no. 18. Med Teach. 2012;34:93–102.  https://doi.org/10.3109/0142159X.2011.613961.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lanyon P, Pope D, Croft P. Rheumatology education and management skills in general practice – a national study of trainees. Ann Rheum Dis. 1995;54:735–9.  https://doi.org/10.1136/ard.54.9.735.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Dequeker J, Esselens G, Westhovens R. Educational issues in rheumatology. The musculoskeletal examination: a neglected skill. Clin Rheumatol. 2007;26:5–7.  https://doi.org/10.1007/s10067-006-0288-0.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Coady D, Walker D, Kay L. The attitudes and beliefs of clinicians involved in teaching undergraduate musculoskeletal clinical examination skills. Med Teach. 2003;25:617–20.  https://doi.org/10.1080/0142159031000137454.CrossRefPubMedGoogle Scholar
  22. 22.
    Vlieland T, van den Ende C, Alliot-Launois F, Beauvais C, et al. Educational needs of health professionals working in rheumatology in Europe. RMD Open. 2016;2(2):e000337.  https://doi.org/10.1136/rmdopen-2016-000337.CrossRefGoogle Scholar
  23. 23.
    Blake T. Teaching musculoskeletal examination skills to UK medical students: a comparative survey of rheumatology and orthopaedic education practice. BMC Med Educ. 2014;14(1):62.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Doherty M, Dacre J, Dieppe P, Snaith M. The GALS locomotor screen. Ann Rheum Dis. 1992;51:1165–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Plant MJ, Linton S, Dodd E, Jones PW, Dawes PT. The GALS locomotor screen and disability. Ann Rheum Dis. 1993;52:886–90.  https://doi.org/10.1136/ard.52.12.886.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Fox RA, Dacre JE, Clark CLI, Scotland AD. Impact on medical students of incorporating GALS screen teaching into the medical school curriculum. Ann Rheum Dis. 2000;59:668–71.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lillicrap MS, Byrne E, Speed CA. Musculoskeletal assessment of general medical in-patients – joints still crying out for attention. Rheumatology. 2003;42:951–4.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Jones A, Maddison P, Doherty M. Teaching rheumatology to medical students: current practice and future aims. J R Coll Physicians Lond. 1992;26:41–3.PubMedPubMedCentralGoogle Scholar
  29. 29.
    British Orthopaedic Association. Guidelines for undergraduate teaching on the musculoskeletal system. London: British Orthopaedic Association; 2001.Google Scholar
  30. 30.
    Doherty M, Woolf AD. EULAR standing committee on education and training. Guidelines for rheumatology undergraduate core curriculum. Ann Rheum Dis. 1999;58:133–5.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kay LJ, Deighton CM, Walker DJ, Hay E. Undergraduate rheumatology teaching in United Kingdom Medical Schools: a survey of current practice and changes since 1990. J Rheumatol. 2000;39:123–6.CrossRefGoogle Scholar
  32. 32.
    Glazier RH, Dalby DM, Badley EM, Hawker GA, Bell MJ, Buchbinder R, et al. Management of common musculoskeletal problems: a survey of Ontario primary care physicians. Can Med Assoc J. 1998;158:1037–40.Google Scholar
  33. 33.
    Meenan RF, Goldenberg DL, Allaire SH, Anderson JJ. The rheumatology knowledge and skills of trainees in internal medicine and family practice. J Rheumatol. 1988;15:1693–700.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Lambert TW, Goldacre MJ, Parkhouse J, Edwards C. Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980 and 1983. Br Med J. 1996;313:19–24.CrossRefGoogle Scholar
  35. 35.
    McDonagh JE, Southwood TR, Shaw KL, on behalf of the British Paediatric Rheumatology Group. Unmet education and training needs of rheumatology health professionals in adolescent health and transitional care. Rheumatology (Oxford). 2004;43:737–43.CrossRefGoogle Scholar
  36. 36.
    Hewlett S, Clarke B, O’Brien A, et al. Rheumatology education for undergraduate nursing, physiotherapy and occupational therapy students in the UK: standards, challenges and solutions. Rheumatology (Oxford). 2008;47:1025–30.CrossRefGoogle Scholar
  37. 37.
    Hanly JG. Manpower in Canadian academic rheumatology units: current status and future trends. Canadian Council of Academic Rheumatologists. J Rheumatol. 2001;28(9):1944–51.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Horn L, Tzanetos K, Thorpe K, Straus S. Factors associated with the subspecialty choices of internal medicine residents in Canada. BMC Med Educ. 2008;8:37.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Miloslavsky EM, Criscione-Schreiber LG, Jonas BL, et al. Fellow as teacher curriculum: improving rheumatology fellows’ teaching skills during in-patient consultation. Arthritis Care Res (Hoboken). 2016;68(6):877–81.CrossRefGoogle Scholar
  40. 40.
    Saleh K, Messner R, Axtell S, Harris I, Mahowald ML. Development and evaluation of an integrated musculoskeletal disease course for medical students. J Bone Joint Surg Am. 2004;86-A:1653–8.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Woolf AD, Walsh NE, Akesson K. Global core recommendations for a musculoskeletal undergraduate curriculum. Ann Rheum Dis. 2004;63:517–24.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Hays RB. Practice-based teaching: a guide for general practitioners. Melbourne: Eruditions Publishing; 1999.Google Scholar
  43. 43.
    Fulford KWMB, Peile E, Carroll H. Essential values-based practice: clinical stories linking science with people. Cambridge: CUP; 2012.CrossRefGoogle Scholar
  44. 44.
    Thistlethwaite JE. Values-based inter professional collaborative practice: working together in healthcare. Cambridge: CUP; 2012.CrossRefGoogle Scholar
  45. 45.
    Carr A. Defining the extended role for allied health professionals in rheumatology. ARC Conference Proceedings No: 12. Chesterfield: Arthritis Research Campaign; 2001.Google Scholar
  46. 46.
    Cooperrider DL, Srivastva S. Appreciative inquiry in organizational life. Stamford: JAI Press; 1987.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yasser El Miedany
    • 1
    • 2
  1. 1.King’s College London, Darent Valley HospitalDartfordUK
  2. 2.Rheumatology and RehabilitationAin Shams UniversityCairoEgypt

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