Adult Rheumatology — Core of Discipline

C12 Recognizing and triaging presentations of common pediatric rheumatologic diseases and identifying when to refer

Key Features:
- The focus of this EPA is the assessment of pediatric patients with presentations of rheumatologic disease and the recognition of cases that need urgent intervention.
- This includes diagnosing common pediatric rheumatologic diseases, applying knowledge of the disease course, and recognizing differences in practice/management as the patients transition to adult care.
- It also includes counselling about disease or management using a child and family centred approach.

Assessment Plan:
Direct observation by pediatric rheumatologist (supervisor)
Use Form 1. Form 1 collects information on:
- Focus of encounter (select all that apply): history; joint examination; transition of care
- Presentation: JIA; JDM; HSP; periodic fever syndrome; Kawasaki; other
- Age of child (write in):
Collect 3 observations of achievement
- At least 1 of each encounter: history; joint examination; transition of care
- At least 1 case with a child under 12
- At least 1 case with JIA

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of common rheumatologic disease as it pertains to pediatric patients

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance

• ME 4.1. Assess the need, timing, risk and benefits of referring a patient to another health professional and/or care setting

• ME 2.2. Elicit a history relevant to the pediatric rheumatologic presentation

• ME 2.2. Perform a focused MSK exam using appropriate technique for joint examinations in pediatrics

• ME 2.2. Adapt the clinical assessment to the child’s age and development

• ME 2.2. Select and interpret appropriate investigations in the context of the child’s age

• COM 2.3. Seek and synthesize relevant information from other sources

• ME 2.4. Determine the setting of care appropriate for the patient’s health needs

• COM 3.1. Share information and explanations that are clear and accurate while checking for understanding

Context Variables

• Focus of encounter (multiple-choice)
  • history
  • joint examination
  • transition of care
• Presentation (single-choice)
  • JIA
  • JDM
  • HSP
  • periodic fever syndrome
  • Kawasaki
  • other
• Age of child (free-text)

Requirements

• Collect 3 observations of achievement (minimum 3)
• At least 1 of each encounter: history (minimum 1)
  • Only counts when Focus of encounter is history
• At least 1 of each encounter: joint examination (minimum 1)
  • Only counts when Focus of encounter is joint examination
• At least 1 of each encounter: transition of care (minimum 1)
  • Only counts when Focus of encounter is transition of care
• At least 1 case with JIA (minimum 1)
  • Only counts when Presentation is JIA