Advertisement

The Art of Teaching Primary Care Physicians

  • Yasser El Miedany
Chapter

Abstract

Rheumatologic diseases represent a growing health crisis. Primary care physicians encounter a significant number of rheumatologic problems in the course of practice. Millions of work days are lost per year due to osteoarthritis, low back pain and rheumatoid arthritis. The morbidity of arthropathies results in numerous hospitalizations annually. Given the sheer number of patients, primary care physicians cannot rely on referral to rheumatologists to identify, diagnose and manage this growing health need. The general practitioners are an integral part of the healthcare team that needs to recognize the importance of early diagnosis, treatment and holistic care of the patients presenting with musculoskeletal problems. As part of a comprehensive treatment plan, primary care physicians need competency in assessing the patient and understanding the disease and on how to participate in the treatment plan through self-management skills. This will be achieved through a general practitioner-targeted teaching programme. This chapter will discuss why teaching rheumatology in primary care is important, the primary care need, who to teach and what needs to be done. The chapter will then discuss the art of primary care physicians teaching, clinical tips for primary care physicians to use in their standard clinical practice and how can we improve education in the primary care.

Keywords

Teaching primary care physicians Primary care education Rheumatology education Continuous medical education Appraisal of teaching primary care 

References

  1. 1.
    Council on Graduate Medical Education. Improving access to health care through physician work force reform: directions for the twenty-first century (third report). Washington, DC: United States Department of Health and Human Services, Public Health Service, Health Resources Services Administration; 1992.Google Scholar
  2. 2.
    Colwill JM. Where have all the primary care applicants gone? N End J Med. 1992;326:387–93.CrossRefGoogle Scholar
  3. 3.
    Aiken LH, Lewis CE, Craig J. The contribution of specialists to the delivery of primary care: a new perspective. N Engl J Med. 1979;300:1363–70.CrossRefGoogle Scholar
  4. 4.
    Sergent JS, Kaplan H, Ruddy S, Weaver A, Koopman W. Managed competition and the rheumatologist. Bulletin on healthcare reform from the ACR executive group. Atlanta: American College of Rheumatology; 1993.Google Scholar
  5. 5.
    Branch WT. Teaching models for ambulatory training programs. J Gen Intern Med. 1990;5(suppl):S15426.Google Scholar
  6. 6.
    Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–81.CrossRefGoogle Scholar
  7. 7.
    Branch W. Primary care practice and training in rheumatology. Arthritis Rheum. 1994;37(3):305–6.CrossRefGoogle Scholar
  8. 8.
    Office of Population Censuses and Surveys. Morbidity statistics from general practice – 4th national study 1991/92. London: HMSO; 1995.Google Scholar
  9. 9.
    El Miedany Y, Youssef S, Mehanna A, El Gaafary M. Development of a scoring system for assessment of outcome of early undifferentiated inflammatory synovitis. Joint Bone Spine. 2008;75(2):155–62.CrossRefGoogle Scholar
  10. 10.
    Åkesson K, Dreinhöfer KE, Woolf AD. Improved education in musculoskeletal conditions is necessary for all doctors. Bull World Health Organ. 2003;81:677–83.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Cantillon P, Jones R. Does continuing medical education in general practice make a difference? BMJ. 1999;318:1276–9.CrossRefGoogle Scholar
  12. 12.
    Craton N, Matheson GO. Training and clinical competency in musculoskeletal medicine. Identifying the problem. Sports Med. 1993;15:328–37.CrossRefGoogle Scholar
  13. 13.
    Booth A, Wise DI. General practice training in musculoskeletal disorders. Br J Gen Pract. 1990;40:390.PubMedPubMedCentralGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    Crawley HS, Levin JB. Training for general practice: a national survey. BMJ. 1990;300:911–5.CrossRefGoogle Scholar
  16. 16.
    Matheny JM, Brinker MR, Elliott MN, Blake R, Rowane MP. Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop. 2000;29:945–52.PubMedGoogle Scholar
  17. 17.
    Saywell RM Jr, O’Hara BS, Zollinger TW, Wooldridge JS, Burba JL, McKeag DB. Medical students’ experience with musculoskeletal diagnoses in a family medicine clerkship. Med Teach. 2002;24:186–92.CrossRefGoogle Scholar
  18. 18.
    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
  19. 19.
    Kay LJ, Deighton CM, Walker DJ, Hay EM. Undergraduate rheumatology teaching in the UK: a survey of current practice and changes since 1990. Arthritis Research Campaign Undergraduate Working Party of the ARC Education Sub-committee. Rheumatology. 2000;39:800–3.CrossRefGoogle Scholar
  20. 20.
    KUMEC Curriculum Change 2020. Curriculum Kings College 2020. https://www.kcl.ac.uk/lsm/research/divisions/hscr/study/undergradops/kumec/MBBS-2020.aspx.
  21. 21.
    Blake T. Teaching musculoskeletal examination skills to UK medical students: a comparative survey of rheumatology and orthopaedic education practice. BMC Med Educ. 2014;14:62.CrossRefGoogle Scholar
  22. 22.
    Miedany YE, Gaafary ME, Arousi NE, et al. THU0597 Flipped learning: can rheumatology lead the shift in medical education? Ann Rheum Dis. 2017;76:431.Google Scholar
  23. 23.
    Bellamy N, Goldstein LD, Tekanoff RA. Continuing medical education driven skills acquisition and impact on improved patient outcomes in family practice setting. J Contin Educ Heal Prof. 2000;20:52–61.CrossRefGoogle Scholar
  24. 24.
    Hosie G. Teaching rheumatology in primary care. Ann Rheum Dis. 2000;59:500–3.CrossRefGoogle Scholar
  25. 25.
    Criswell LA, Such CL, Yelin EH. Differences in the use of second-line agents and prednisone for treatment of rheumatoid arthritis by rheumatologists and non-rheumatologists. J Rheumatol. 1997;24:2290.Google Scholar
  26. 26.
    Yelin EH, Such CL, Criswell LA, Epstein WV. Outcomes for persons with rheumatoid arthritis with a rheumatologist versus a non-rheumatologist as the main physician for this condition. Med Care. 1998;36:513–22.CrossRefGoogle Scholar
  27. 27.
    Ward MM, Leigh JP, Fries JF. Progression of functional disability in patients with rheumatoid arthritis. Associations with rheumatology subspecialty care. Arch Intern Med. 1993;153:2229–37.CrossRefGoogle Scholar
  28. 28.
    Solomon DH, Bates DW, Panush RS, Katz JN. Costs, outcomes, and patient satisfaction by provider type for patients with rheumatic and musculoskeletal conditions: a critical review of the literature and proposed methodologic standards. Ann Intern Med. 1997;127:52–60.CrossRefGoogle Scholar
  29. 29.
    Singh J, Furst D, Bharat A, Curtis J, Kavanaugh A. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64(5):625–39.CrossRefGoogle Scholar
  30. 30.
    El Miedany, Palmer D, El Gaafary M. Diagnosis of early arthritis: outcomes of a nurse-led clinic. Br J Nurs. 2006;15(7):394–9.CrossRefGoogle Scholar
  31. 31.
    El Miedany Y, Palmer D. Early referral of ankylosing spondylitis patients: results of one year outcome of a specialized early ankylosing spondylitis clinic. Rheumatology (Oxford). 2011;50(S3). Abstract number 263. https://academic.oup.com/rheumatology/article/50/suppl_3/iii137/1789320.
  32. 32.
    Gladman D, Ginzler E, Goldsmith C, Fortin P, Liang M, Urowitz M, et al. The development and initial validation of the systemic lupus international collaborating clinics/American College of Rheumatology Damage Index for systemic lupus erythematosus. Arthritis Rheum. 1996;39(3):363–9.CrossRefGoogle Scholar
  33. 33.
    Price D. Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME. Med Teach. 2005;27:259–68.CrossRefGoogle Scholar
  34. 34.
    Rhee SO. Factors determining the quality of physician performance in patient care. Med Care. 1976;14:733–50.CrossRefGoogle Scholar
  35. 35.
    Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73.CrossRefGoogle Scholar
  36. 36.
    GMC. Supporting information for appraisal and revalidation. http://www.gmc-uk.org/doctors/revalidation/revalidation_information.asp.
  37. 37.
    Miedany YEI, Gaafary EIM, Youssef S, Almedany S, Bahlas S, et al. Rheumatoid arthritis comorbidity index (RACI): development and validation of a new comorbidity index for rheumatoid arthritis patients. J Arthritis 2017. 2017;6:244.  https://doi.org/10.4172/2167-7921.1000244.CrossRefGoogle Scholar
  38. 38.
    El Miedany Y, El Gaafary M, Youssef S, Bahlas S, Hegazi M. Psoriatic arthritis comorbidity index: development and validation of a new specific tool for classifying prognostic comorbidity in psoriasis and psoriatic arthritis patients. Rheumatol Orthop Med. 2017;2:1–7.  https://doi.org/10.15761/ROM.1000117.CrossRefGoogle Scholar
  39. 39.
    Miedany YE, Gaafary ME, Yassaki AE, Youssef S, Nasr A, Ahmed I. Monitoring osteoporosis therapy: can FRAX help assessing success or failure in achieving treatment goals? World J Rheumatol. 2014;4(2):14–21.CrossRefGoogle Scholar
  40. 40.
    El Miedany Y, Toth M. Osteoporosis, fracture prevention and falls risk assessment – closing the gap between treatment guidelines and clinical practice. Eur Musculoskelet Rev. 2011;6(1):7–14.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

Personalised recommendations