Attitude toward pediatric rheumatology among residency-trained pediatricians.

BACKGROUND Pediatric rheumatology (PR) is a relatively new and scarce subspecialty in emerging countries. This study aimed to investigate physicians' attitude toward and real-life clinical practice in PR among residency-trained pediatricians. METHODS An electronic questionnaire was developed and sent via email to pediatricians that completed their residency training during 2007-2015 from Thailand. Confidence was rated using a 5-point Likert scale. RESULTS The response rate was 31% (281/902), and the mean age of respondents was 33.8±2.7 years. Confidence was rated as adequate for history taking of children with rheumatic diseases (2.76, 95% 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-Schonlein 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 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), and in those who had experienced a PR rotation (p<0.001, p=0.01). 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. More emphasis on PR education is needed.