Educational initiatives and training for paediatric rheumatology in Europe

The annual scientific meeting of PReS disseminates advances in knowledge and research (basic science, clinical care and education) through ‘state of the art’ lectures and presentations. There are active allied health and consumer parallel programmes. The annual scientific meeting has become one of the most important educational events in the paediatric rheumatology international calendar and provides a platform to disseminate knowledge, opportunities to network and foster new collaborations. The annual Young Investigators Meeting (YIM) is held over the two days preceding the annual scientific meeting and is organized with support from PReS to facilitate attendance by young researchers (PhD students, post-doctoral level) and trainee doctors. The YIM aspires to nurture the PReS research ethos and aims to promote networking and foster opportunities for international collaboration; young investigators are encouraged to present their work to an international audience with feedback and guidance from PReS & YIM senior faculty. Over recent years the number of young investigators attending the YIM meeting has increased significantly with a substantial number of trainees from non-European countries (including India, Africa, North America, South America, Asia, Australia). Proceedings of future meetings and how to apply for YIM bursaries are available on the PRES website (https://​www.​pres.​eu).

The ETC oversees a ‘rolling programme’ of courses which are financially supported by grants from PReS. Details of future courses and how to register for them are available. (http://​www.​pres.​eu). The aim is to have one of either the Basic or Advanced course per year and to reach audiences who may not otherwise have access to education and training. PReS members are encouraged to contact the ETC for further information if they wish to consider organizing a Basic or Advanced course in their country and seek PReS support.

1. The PReS Basic courses are set at the level of the general paediatric trainee or resident and cover the breadth of topics as outlined in the European syllabus. To date, PReS Basic Courses have been held in countries where paediatric rheumatology is less well developed Mumbai (India 2012), Sao Paulo (Brazil 2015), Budapest (Hungary 2015) and Cape Town (South Africa 2017) with future courses planned in the Ukraine and South East Asia. The aim is to promote the specialty, facilitate networking and ultimately improve patient care. The model includes an organising committee led by a local paediatric rheumatologist with faculty drawn from local and national colleagues as well as international faculty who are PReS members. Examples of previous Basic Courses are available from the ETC and it is envisaged that lectures from courses will be archived on the PReS website. The Basic Courses have a similar format (over 2–3 days with local and international faculty [n = 10–15]) and up to 100 delegates, with interactive lectures and workshops. Case presentations are encouraged from delegates. Workshops focused on joint examination have been included since 2015 with practical demonstrations of pGALS (paediatric Gait Arms Legs and Spine) [ [3] Foster and Jandial 2013] involving local patients. The importance of research and how to get involved is also highlighted (e.g. clinical trials, cohort studies and registries). Attendance at the Basic courses has grown year on year - e.g. Cape Town 2017 with 117 delegates, 66 from many countries in Africa and 40 from Europe and the Middle East. Feedback has been very positive to address educational needs as well as networking and peer support opportunities.

2. The PReS Advanced courses (e.g. JIA, Slovenia 2017, Auto-inflammatory diseases Jerusalem, Israel 2018, childhood-onset SLE Lausanne, Switzerland 2018) target a more experienced audience and in the main, senior paediatric rheumatology trainees and paediatricians with an interest in paediatric rheumatology. The childhood-onset SLE Advanced course (2018) was recorded and transmitted by video conferencing to colleagues in India, who were able to participate in case presentations and interactive sessions. It is envisaged that this facility will be available in future courses to reach a wider audience and especially those in low income countries. The scientific programme of an Advanced course is focused on a given condition (e.g. JIA, childhood-onset SLE, auto-inflammatory conditions) or specialist skills (e.g. Musculoskeletal Ultrasound [MSUS], or ‘hands on’ joint examination). The format of the Advanced Courses to date have included interactive ‘state of the art’ lectures delivered by international and local faculty, ‘meet the expert’ small group sessions, joint examination ‘how to teach’ workshops and interactive case presentations. It has been proposed by the ETC that future Advanced courses address recommendations from other PReS / EULAR initiatives such as Transitional care [ [4] Foster et al. 2016] and Musculoskeletal Ultrasound skills (MSUS) [ [5] Iagnocco 2015].

3.1 Musculoskeletal Ultrasound (MSUS) imaging. The aim of the ETC is that all fellows in paediatric rheumatology have access to MSUS training facilitated through attending PReS courses. To date there have been MSUS courses organized with EULAR (Madrid [Spain] 2012, 2017, Belgrade [Serbia] 2013, 2015) and further courses are planned (details on PReS website). In addition to the delivery of the MSUS training courses, PReS has worked extensively with OMERACT and EULAR to work towards MSUS as a potential outcome measure in JIA with standardization of procedures, validation of definitions and grading of synovitis using MSUS in JIA. Outputs to date from these collaborations include the following:

3.2 PReS clinical skills workshops - Joint examination skills ( [3] pGALS Foster and Jandial, pREMS [11] Foster 2011) are included in the PReS Basic Course (with a focus on pGALS) and Advanced JIA Course (with a focus on pREMS and ‘how to teach’ pGALS). Feedback to date has been very positive. The format includes ‘hands on’ workshops involving consented patients demonstrating physical signs and small groups of learners with facilitated observation and feedback from experienced paediatric rheumatologists. The ETC aims for the ‘clinical skills’ workshop concept to be expanded and to include, for example, scleroderma skin scores, nail fold capillaroscopy, muscle power testing, and transitional care consultation skills.

3.3 PReS ‘Teach the teachers’ workshops - Paediatric Rheumatologists have an integral role as educators and need to ‘reach out’ to medical students, general paediatricians and colleagues in orthopaedics and primary care to raise awareness, facilitate diagnosis and prompt referral to specialist care. Learning ‘how to teach’ is therefore an important skill and included in the European syllabus. The aim of the ETC is that all fellows will attend a ‘how to teach’ course during their training. PReS has included ‘teach the teacher’ workshops alongside the PReS scientific meetings (2016, 2017) with excellent feedback and it is envisaged that such workshops will be included in future PReS meetings and the Advanced Course rolling programme.

PReS EMERGE (EMErging RheumatoloGists and rEsearchers) encompasses young paediatric rheumatologists and researchers working together to improve clinical and research opportunities for trainees, participating in organisation of PReS educational events (YIM, Basic and Advanced courses) and liaising with other young investigator groups (e.g. EMEUNET, CARRA early investigators). The group was set up following the 2016 YIM and currently includes trainees mainly from Europe but also from all other continents. Further details are available through an active social media network (www.​facebook.​com/​PReSEMERGE, twitter.​com/​PReSEMERGE) and through a bimonthly newsletter highlighting activities and opportunities for members (contact emerge.pres@gmail.com). The PReS EMERGE fellowship programme (https://​www.​pres.​eu/​activities/​young-investigators/​fellowship-programs.​html) was launched in 2017 with financial and practical assistance for clinical trainees who are members of PReS and younger than 40 years, to facilitate placements of up to 6-months within a European Paediatric Rheumatology Centre. In addition to gaining clinical knowledge and skills, the trainee is expected to participate in a research project. From 2018, the programme is open to basic science trainees (pre-PhD to five years post-PhD) working in paediatric rheumatology. It is envisaged that the programme will enhance both clinical and basic collaborative research, foster a network of emerging and established paediatric rheumatologists and allow sharing of ideas and practices between different countries to harmonize paediatric rheumatology training.

The Standards of care for Juvenile Arthritis Management in Less Resourced countries (JAMLess) is a collaborative effort with funding and support from International League Against Rheumatism (ILAR) and PReS to develop consensus based guidelines relevant to challenging health care contexts; these highlight the importance of education and training being integral to the delivery of clinical care. This project was initiated by PReS colleagues from South Africa, Argentina and India and has resulted in a consensus document [ [14] Scott C 2018], with further work to develop iterations of these recommendations for other parts of the world being underway.