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Article: The Challenge of Addressing the Rheumatology Workforce Shortage.

Miloslavsky, Eli M / Marston, Bethany

2022 Volume 49, Issue 6, Page(s) 555–557

MeSH term(s)	Humans ; Rheumatologists ; Rheumatology ; Workforce
Language	English
Publishing date	2022-04-15
Publishing country	Canada
Document type	Editorial ; Comment
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.220300
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Article ; Online: Juvenile Idiopathic Arthritis.

Long, Andrew M / Marston, Bethany

Pediatrics in review

2023 Volume 44, Issue 10, Page(s) 565–577

Abstract: Juvenile idiopathic arthritis (JIA) comprises a group of heterogenous disorders characterized by childhood-onset chronic joint inflammation. It is the most common rheumatologic disease in the pediatric population and an important cause of chronic illness ...

Abstract	Juvenile idiopathic arthritis (JIA) comprises a group of heterogenous disorders characterized by childhood-onset chronic joint inflammation. It is the most common rheumatologic disease in the pediatric population and an important cause of chronic illness in children. Early recognition and treatment are vital to prevent sequelae of uncontrolled inflammation on the developing skeleton. JIA can have significant complications that general pediatricians should be aware of, especially uveitis, which can be insidious and asymptomatic in very young children, and macrophage activation syndrome, which can be life-threatening if not recognized and appropriately treated. Although advances have been made in the past few decades, the etiology of JIA remains incompletely understood. Efforts are underway to refine the classification of JIA. The currently accepted classification scheme identifies subsets of JIA that are important clinically in terms of prognosis and tailoring treatment approaches. However, it is limited in identifying homogenous groups of children with early childhood onset and antinuclear antibody positivity, which may have different pathogenic mechanisms that could be important in developing more targeted and effective treatment approaches in the future. Treatment strategies for JIA have changed significantly in recent years with the availability of multiple newer targeted therapies, often modeled after medications used in adult-onset forms of arthritis. These treatments, and likely many others to come, have markedly improved symptom control and reduced complications in patients with JIA.
MeSH term(s)	Adult ; Humans ; Child ; Child, Preschool ; Arthritis, Juvenile/diagnosis ; Arthritis, Juvenile/therapy ; Arthritis, Juvenile/complications ; Uveitis/diagnosis ; Uveitis/drug therapy ; Uveitis/etiology ; Prognosis ; Treatment Outcome ; Inflammation
Language	English
Publishing date	2023-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.2022-005623
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Article ; Online: Migratory Arthralgia in a 3-year-old Girl.

Fries, Carol / Long, Andrew M / Marston, Bethany A / Andolina, Jeffrey R

Pediatrics in review

2021 Volume 43, Issue 1, Page(s) 41–44

MeSH term(s)	Arthralgia/diagnosis ; Arthralgia/etiology ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans
Language	English
Publishing date	2021-12-14
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.2020-003657
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Article ; Online: Bringing Reproductive Health Guidelines Into Fellowship Training: A National Survey of Adult and Pediatric Rheumatology Fellows and Program Directors.

Rubino, Selene / Battistone, Michael J / Ardoin, Stacy P / Berlan, Elise D / Carandang, Kristine / Chiseri, Kate / Kavanaugh, Arthur / White, Whitney / Wise, Kelly A / Wong, Andrew L / Marston, Bethany / Clowse, Megan E B

Arthritis care & research

2023

Abstract: Objective: This study seeks to assess rheumatology fellows' (RFs') and program directors' (PDs') interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease.: ... ...

Abstract	Objective: This study seeks to assess rheumatology fellows' (RFs') and program directors' (PDs') interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease. Methods: Constructs were conceptualized in four dimensions: 1) RF and PD confidence in their current curriculum relating to the American College of Rheumatology (ACR) Reproductive Health Guidelines (RHGs), 2) personal interest in this topic, 3) opinions of the importance of this topic, and 4) interest in a range of learning materials and educational experiences. The final survey was distributed to 753 RFs and 179 PDs in the United States using the ACR Committee on Training and Workforce email list. Results: Response rates were 13% (n = 98) for RFs and 25% (n = 44) for PDs. Both groups indicated more interest in the topic than confidence in their curriculum and rated summary sheets, question banks, didactics, and online modules higher than nine other educational tools or methods. Despite interest in the topic, 38% of RF respondents and 24% of PD respondents were unaware of the recently published ACR RHGs. Conclusion: RFs and PDs consider reproductive health very important and report high personal interest in this topic. In contrast, both groups indicated lower confidence in current curricula, and substantial proportions of both groups were unaware of recently published guidelines. RFs' and PDs' interests in specific educational modalities are aligned. Curriculum development efforts should prioritize summary sheets, question banks, didactics, and online modules. Efforts are needed to address the educational needs of practicing rheumatologists and other professionals caring for patients with rheumatic disease.
Language	English
Publishing date	2023-07-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25203
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Article ; Online: Addressing Competency in Rheumatology Telehealth Care Delivery.

Zickuhr, Lisa / Albert, Daniel A / Herndon, Connie / Imundo, Lisa F / Lopker, Michael J / Marston, Bethany / Mian, Nabeela / O'Rourke, Kenneth / Torralba, Karina D / Westrich-Robertson, Tiffany / Venuturupalli, R Swamy / Kolfenbach, Jason / Bolster, Marcy B

Arthritis care & research

2023 Volume 75, Issue 6, Page(s) 1213–1219

Abstract: Objective: Telehealth is an essential facet of care delivery for patients with rheumatic diseases. The Association of American Medical College's (AAMC) telehealth competencies (TCs) define the skills required for delivering general telehealth care ... ...

Abstract	Objective: Telehealth is an essential facet of care delivery for patients with rheumatic diseases. The Association of American Medical College's (AAMC) telehealth competencies (TCs) define the skills required for delivering general telehealth care across the range of clinician experience. In this study, the American College of Rheumatology's (ACR) TCs working group aimed to adapt the AAMC TCs to rheumatology, outlining the skills acquisition unique to rheumatology with a focus on knowledge, skills, and behaviors expected of recent rheumatology fellowship graduates. Methods: Through a collaborative process, the working group adapted the AAMC TCs to the training structure and practice of rheumatology. The rheumatology TCs underwent peer review among recipients of the Clinician Scholar Educator Award and attendees at the ACR 2021 Convergence conference. Results: The rheumatology TCs define 24 essential skills required for synchronous telehealth care of patients with rheumatic diseases. The working group adapted the AAMC's 20 TCs organized within 6 domains, added 2 skills to the AAMC's domains of patient safety and appropriate use, and data collection and assessment, and created a novel domain of systems-based requirements with 2 competencies. The rheumatology TCs define expected skill levels for recent rheumatology fellowship graduates and experienced rheumatology clinicians. Conclusion: The rheumatology TCs represent the first adaptation of the AAMC TCs to subspecialty care, expanding the scope to include rheumatology fellowship graduates and additional domains of rheumatology practice. These competencies can guide curricular innovations and measurements of proficiency in telehealth care delivery among rheumatology trainees and experienced clinicians, enhancing the care provided to patients with rheumatic diseases.
MeSH term(s)	Humans ; Rheumatology ; Rheumatic Diseases ; Education, Medical, Graduate ; Curriculum ; Telemedicine
Language	English
Publishing date	2023-01-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.25023
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Article ; Online: Spinal muscular atrophy and Farber disease due to ASAH1 variants: A case report.

Lee, Bo Hoon / Mongiovi, Phillip / Levade, Thierry / Marston, Bethany / Mountain, Joan / Ciafaloni, Emma

American journal of medical genetics. Part A

2020 Volume 182, Issue 10, Page(s) 2369–2371

Abstract: Genetic variations in the ASAH1 gene are associated with a spectrum of disorders ranging from Farber disease (FD) to spinal muscular atrophy with or without progressive myoclonic epilepsy (SMA-PME). FD presents most commonly in infants with subcutaneous ... ...

Abstract	Genetic variations in the ASAH1 gene are associated with a spectrum of disorders ranging from Farber disease (FD) to spinal muscular atrophy with or without progressive myoclonic epilepsy (SMA-PME). FD presents most commonly in infants with subcutaneous joint nodules, progressive arthritis and granulomas of the larynx and epiglottis leading to a hoarse cry. SMA-PME is characterized by childhood onset progressive weakness due to motor neuron disease followed by progressive epilepsy, tremor, and sensorineural hearing loss. We present a case of a 4-year-old boy with phenotypic features of both FD and SMA who was found to have two previously unreported heterozygous variants in the ASAH1 gene.
MeSH term(s)	Acid Ceramidase/genetics ; Child ; Child, Preschool ; Farber Lipogranulomatosis/genetics ; Farber Lipogranulomatosis/pathology ; Genetic Predisposition to Disease ; Genetic Variation ; Humans ; Infant ; Male ; Muscular Atrophy, Spinal/genetics ; Muscular Atrophy, Spinal/pathology
Chemical Substances	ASAH1 protein, human (EC 3.5.1.23) ; Acid Ceramidase (EC 3.5.1.23)
Language	English
Publishing date	2020-07-05
Publishing country	United States
Document type	Case Reports ; Research Support, Non-U.S. Gov't
ZDB-ID	2108614-X
ISSN	1552-4833 ; 0148-7299 ; 1552-4825
ISSN (online)	1552-4833
ISSN	0148-7299 ; 1552-4825
DOI	10.1002/ajmg.a.61764
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Article ; Online: Rheumatology Milestones 2.0: A Roadmap for Competency-Based Medical Training of Rheumatology Fellows in the 21st Century.

Liebowitz, Jason E / Torralba, Karina D / Kolfenbach, Jason / Marston, Bethany / Dua, Anisha B / O'Rourke, Kenneth S / McKown, Kevin / Battistone, Michael J / Valeriano-Marcet, Joanne / Edgar, Laura / McLean, Sydney / Gouze, Karen R / Bolster, Marcy B

Arthritis care & research

2022 Volume 74, Issue 4, Page(s) 675–685

Abstract: Objective: Since 2014, rheumatology fellows have been assessed not only based on their ability to provide patient care and possession of medical knowledge but also on their skill in serving as patient advocates, navigators of health systems, and members ...

Abstract	Objective: Since 2014, rheumatology fellows have been assessed not only based on their ability to provide patient care and possession of medical knowledge but also on their skill in serving as patient advocates, navigators of health systems, and members of a health care team. Such assessments have been carried out through the use of competency-based milestones from the Accreditation Council of Graduate Medical Education (ACGME). However, a needs assessment has demonstrated interest in more context validity and subspecialty relevance since the development of the ACGME internal medicine (IM) subspecialty reporting milestones. The ACGME thus created a milestones working group, and the present study was undertaken to develop Rheumatology Milestones 2.0 as well as a supplemental guide to assist with implementation. Methods: The working group, consisting of 7 rheumatology program directors, 2 division directors, a community practice rheumatologist, a rheumatology fellow in training, and a public member who is a rheumatology patient, was overseen by the ACGME vice president for milestones development and met through three 12-hour, in-person meetings to compose the rheumatology specialty milestones and supplemental guide within the ACGME Milestones 2.0 project. Results: Informed by the needs assessment data and stakeholders, the working group revised and adapted the ACGME IM subspecialty reporting milestones to create a rheumatology-specific set of milestones and a supplemental guide for their implementation. Conclusion: The Rheumatology Milestones 2.0 provides a specialty-specific, competency-based evaluation tool that can be used by program directors, clinical competency committees, and others to assess the competencies of rheumatology fellows during training and help measure readiness for independent practice.
MeSH term(s)	Accreditation ; Clinical Competence ; Education, Medical, Graduate ; Humans ; Internal Medicine/education ; Internship and Residency ; Rheumatology/education
Language	English
Publishing date	2022-02-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.24507
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Article ; Online: North American musculoskeletal ultrasound scanning protocol of the hip, knee, ankle, and foot: update of a Delphi consensus study.

Yinh, Janeth / Torralba, Karina D / Choi, Kristal S / Fairchild, Robert M / Cannella, Amy / Salto, Lorena / Kissin, Eugene Y / Thiele, Ralf / Oberle, Edward J / Marston, Bethany / Nishio, Midori Jane

Clinical rheumatology

2021 Volume 40, Issue 10, Page(s) 4233–4242

Abstract: Background/objective: A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform ... ...

Abstract	Background/objective: A North American rheumatology consensus on tiered-mastery designation for anatomic views was developed in 2011 for course and fellowship teaching. This study updates the lower extremity joint scanning protocols aiming to inform musculoskeletal ultrasound curriculum development for the American College of Rheumatology affiliated Fellowship Programs. Methods: Three Delphi rounds were conducted to reach consensus for tiered-level mastery designation for hip, knee, ankle, and foot scanning views. The survey was disseminated (Qualtrics™) to 101 potential participants with ultrasound teaching experience. High agreement was defined as ≥ 85% consensus and final tier designation as having >50% agreement for the preferred tier. Response changes were evaluated by McNemar's chi-square test. Results: Consensus regarding tier designations was reached for 80% of the views. Three knee views (anterior transverse suprapatellar, medial, and lateral longitudinal) and 2 ankle views (anterior and posterior transverse) achieved upgrades to tier 1 from 2. The transverse sacroiliac hip joint was downgraded from tier 2 to 3. The lateral longitudinal hip view was added with a tier 1 designation. Conclusion: Updated scanning protocols support modifications reflecting current scanning methods delivered by North American rheumatologists performing point of care ultrasound that may inform educators involved in rheumatology ultrasound. Key Points • The anterior transverse suprapatellar, medial, and lateral longitudinal knee views; the anterior and posterior transverse ankle views; and the lateral longitudinal view hip view were perceived as important to master and perform routinely. • The transverse sacroiliac joint view was suggested to be performed based on practice focus.
MeSH term(s)	Ankle/diagnostic imaging ; Consensus ; Delphi Technique ; Humans ; North America ; Ultrasonography
Language	English
Publishing date	2021-04-05
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-021-05716-5
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Article ; Online: Activated Peripheral Blood B Cells in Rheumatoid Arthritis and Their Relationship to Anti-Tumor Necrosis Factor Treatment and Response: A Randomized Clinical Trial of the Effects of Anti-Tumor Necrosis Factor on B Cells.

Meednu, Nida / Barnard, Jennifer / Callahan, Kelly / Coca, Andreea / Marston, Bethany / Thiele, Ralf / Tabechian, Darren / Bolster, Marcy / Curtis, Jeffrey / Mackay, Meggan / Graf, Jonathan / Keating, Richard / Smith, Edwin / Boyle, Karen / Keyes-Elstein, Lynette / Welch, Beverly / Goldmuntz, Ellen / Anolik, Jennifer H

Arthritis & rheumatology (Hoboken, N.J.)

2021 Volume 74, Issue 2, Page(s) 200–211

Abstract: Objective: B cells can become activated in germinal center (GC) reactions in secondary lymphoid tissue and in ectopic GCs in rheumatoid arthritis (RA) synovium that may be tumor necrosis factor (TNF) and lymphotoxin (LT) dependent. This study was ... ...

Abstract	Objective: B cells can become activated in germinal center (GC) reactions in secondary lymphoid tissue and in ectopic GCs in rheumatoid arthritis (RA) synovium that may be tumor necrosis factor (TNF) and lymphotoxin (LT) dependent. This study was undertaken to characterize the peripheral B cell compartment longitudinally during anti-TNF therapy in RA. Methods: Participants were randomized in a 2:1 ratio to receive standard dosing regimens of etanercept (n = 43) or adalimumab (n = 20) for 24 weeks. Eligible participants met the American College of Rheumatology 1987 criteria for RA, had clinically active disease (Disease Activity Score in 28 joints >4.4), and were receiving stable doses of methotrexate. The primary mechanistic end point was the change in switched memory B cell fraction from baseline to week 12 in each treatment group. Results: B cell subsets remained surprisingly stable over the course of the study regardless of treatment group, with no significant change in memory B cells. Blockade of TNF and LT with etanercept compared to blockade of TNF alone with adalimumab did not translate into significant differences in clinical response. The frequencies of multiple activated B cell populations, including CD21- double-negative memory and activated naive B cells, were higher in RA nonresponders at all time points, and CD95+ activated B cell frequencies were increased in patients receiving anti-TNF treatment in the nonresponder group. In contrast, frequencies of transitional B cells-a putative regulatory subset-were lower in the nonresponders. Conclusion: Overall, our results support the notion that peripheral blood B cell subsets are remarkably stable in RA and not differentially impacted by dual blockade of TNF and LT with etanercept or single blockade of TNF with adalimumab. Activated B cells do associate with a less robust response.
MeSH term(s)	Adalimumab/pharmacology ; Adalimumab/therapeutic use ; Adult ; Aged ; Antirheumatic Agents/pharmacology ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/blood ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/immunology ; B-Lymphocytes/drug effects ; B-Lymphocytes/physiology ; Etanercept/pharmacology ; Etanercept/therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Single-Blind Method ; Tumor Necrosis Factor Inhibitors/pharmacology ; Tumor Necrosis Factor Inhibitors/therapeutic use
Chemical Substances	Antirheumatic Agents ; Tumor Necrosis Factor Inhibitors ; Adalimumab (FYS6T7F842) ; Etanercept (OP401G7OJC)
Language	English
Publishing date	2021-12-27
Publishing country	United States
Document type	Clinical Trial, Phase IV ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2756371-6
ISSN	2326-5205 ; 2326-5191
ISSN (online)	2326-5205
ISSN	2326-5191
DOI	10.1002/art.41941
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Article: Ambulatory Training Program to Expand Procedural Skills in Primary Care.

Fortuna, Robert J / Marston, Bethany / Messing, Susan / Wagoner, Gunnar / Pulcino, Tiffany L / Bingemann, Todd / Caiola, Enrico / Scofield, Steven / Nead, Karen / Robbins, Brett W

Journal of medical education and curricular development

2019 Volume 6, Page(s) 2382120519859298

Abstract: Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and ... ...

Abstract	Introduction: Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. Methods: A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. Results: Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; Conclusions: A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.
Language	English
Publishing date	2019-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2798123-X
ISSN	2382-1205
ISSN	2382-1205
DOI	10.1177/2382120519859298
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