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Training Requirements for the Specialty Rheumatology - European Standards of Postgraduate Specialty Training was endorsed by UEMS in 2014. The document describes the training requirements for trainee (content of training with learning outcomes and organisation of training), training requirements for trainer (process of recognition of trainer and quality management for trainers), training requirements for institutions (process of recognition of training centre and quality management within training institution); the proposed record of clinical work and list of conditions are included.Based on the training requirements, assessments of knowledge, skills and professional behaviour is needed. Progressively, the common approach to determining whether an individual is suitable to be recognised as a European Rheumatologist is expected.In order to develop the assessment strategy it was agreed that a discussion of how best to ensure that a trainee meets the outcomes of the Training Requirements will be organised.The questionnaire is being developed seeking for the information on the record of clinical work and clinical skills, that exists in many European countries. Within the set of questions it is asked how is the trainee's knowledge examined, how a trainee's involvement with the care of patients is determined, how is the competency in a range of clinical procedures assessed, which topics related to professional behaviours are in use and how they are assessed, which evidence of a doctor's good standing are provided. The answers from the countries' representatives and a follow-up questionnaire would allow the Section and Board to develop an agreed way in which European trainees might be assessed.Disclosure of InterestNone declared

Current therapeutic and diagnostic resources have turned systemic lupus erythematosus (SLE) into a chronic disease by reducing mortality rates. The exact contribution of disease activity and disease related damage to mortality is not well studied. The aim of this study was to describe the current causes of death (COD) in a multinational European cohort of patients with SLE in relation to quantified measures of disease activity and damage. Prospective five-year observational study of case fatalities in SLE patients at 12 European centres was performed. Demographics, disease manifestations, interventions and quantified disease activity (by ECLAM and SLEDAI) and damage (by SLICC-DI) at the time of death were related to the various COD. Ninety-one case fatalities (89% females) occurred after median disease duration of 10.2 years (range 0.2—40) corresponding to a annual case fatality of one for each of the participating cohorts. Cumulative mortality correlated linearly with disease duration with nearly 10% of fatalities occurring in the first year and 40% after more than 10 years of disease. Death occurred during SLE remission in one third of cases. In the remaining cases a mixture of disease activity (median ECLAM 5.5, median SLEDAI 15) and accrued damage (median SLICC-DI 5.0) with opposing relationships to disease duration contributed to death. Infections and cardiovascular events were the most frequent COD in both early and late fatalities with no gender differences for type of COD, disease activity, damage or comorbidity. In Europe, case fatalities have become uncommon events in dedicated SLE cohorts. The bimodal mortality curve has flattened out and deaths now occur evenly throughout the disease course with infectious and cardiovascular complications as the main direct COD in both early and late fatalities. Accrued damage supplants disease activity over time as the main SLE specific contributor to death over time. Lupus (2007) 16, 309—317.

BackgroundEULAR has developed several recommendations and strategies for early referral, diagnosis and treatment of rheumatic diseases. These strategies, however, can only be implemented if sufficient manpower is available. An estimation of how many rheumatologists are needed to meet current and future population needs must be provided in order to counsel health care planners and decision makers. Current methods used for forecasting manpower are disparate, as are the variables incorporated into workforce projection models. Consequently, projections for the need of rheumatologists may vary by a factor of five between studies.(1 TableEULAR points to consider for the conduction of workforce requirement studies in rheumatologyObjectivesThe aim of this project was to develop EULAR points to consider on the methodology of future workforce calculation models for rheumatologists in order to produce reliable, standardised and realistic estimates.MethodsThe EULAR Standardised Operating Procedures were followed. A systematic literature review (SLR) was conducted to retrieve workforce models in rheumatology and other specialities. The task force consisted of 20 experts (rheumatologists, health professionals and representatives from PARE) from 11 EULAR countries and the USA. Points to consider were based on expert opinion informed by the SLR, followed by group discussions with consensus obtained through informal voting. The level of agreement with the recommendations was voted anonymously.ResultsA total of 10 points to consider were formulated (table 1). The task force recommends models integrating supply (=workforce available to rheumatology), demand (=health services requested by the population) and needs (=health services that are considered appropriate to serve the population). Projections of workforce requirements should consider all factors relevant for current and future workload in and outside rheumatology patient care. Forecasts of workforce supply should consider demography and attrition of rheumatologists, as well as the effects of new developments in health care.ConclusionsThese are the first EULAR points to consider providing guidance on the methodology and the parameters to be applied in future national and international workforce requirement studies in rheumatology.Reference[1] Dejaco C, et al. Arthritis Care Res2016.Disclosure of InterestNone declared

Background:Workforce requirement studies should be conducted in order to ensure the right number of people with the right skills, in the right place at the right time to deliver organizational objectives.Objectives:As part of the EULAR project to develop points to consider for the conduction of workforce studies in rheumatology, we reviewed the literature on workforce prediction with the aim to develop a workforce prediction quality appraisal tool and apply it to existing studies in rheumatology.Methods:Two literature searches were performed in Ovid MEDLINE, EMBASE, CINAHL, Cochrane Library and the grey literature comprising: (1) an update of a previous systematic literature review (SLR) of workforce prediction studies in rheumatology[1] and (2) a hierarchical SLR of workforce prediction studies in other medical fields. We extracted data on type of model used, details on need, demand and supply factors considered in the model, and other relevant aspects such as regional heterogeneity or uncertainty analyses. Based on the results, key general as well as specific need/demand, and supply factors for workforce calculation in rheumatology were identified and each factor was assigned a quality level (low, moderate, high). The quality appraisal tool was applied to the existing workforce modeling studies in rheumatology.Results:Data was extracted from 14 original workforce prediction studies in rheumatology and 10 SLRs in other fields. Studies used a variety of prediction models based on a heterogeneous set of need and/or demand and/or supply factors. While only a few studies attempted to empirically validate the prediction quality of the model (n=3), the consensus was that an integrated model including all these factors is expected to have the highest validity. Based on the different factors considered in existing studies, our quality appraisal tool included the three groups of factors: general factors (e.g. type of the model, stakeholder involvement), need/demand factors (e.g. scope of diseases covered by rheumatologists, morbidity, demography) and supply factors (e.g. time dedicated to clinical work, entry to profession, demographic composition of workforce) (table 1). The majority of studies scored low or moderate on most of the factors.Table 1Workforce prediction quality appraisal toolConclusions:The existing evidence on workforce prediction in rheumatology and other fields is scarce, heterogeneous and of low or moderate quality. The workforce prediction quality appraisal tool will enable future evaluation of workforce prediction studies. This review informs the EULAR points to consider for the conduction of workforce requirement studies in rheumatology.Reference1. Dejaco C, et al. Arthritis Care Res (Hoboken)2016.Disclosure of Interest:None declared

ObjectivesTo assess the association between the country where rheumatology training takes place and the acquired confidence, exposure to education, practical experience and competence assessments in 21 core competencesMethodsAs part of a European project to evaluate the differences in training in rheumatology across Europe, we developed an online survey to assess the training experience. The target population was rheumatologytrainees and rheumatologists certified in the past 5 years. We selected 21 competences, core to rheumatology: 13 clinical (MSK examination, detecting synovitis, managing a patient with monoarthritis, lab test interpretation, managing a patient with OA, gout, early RA/undifferentiated arthritis, SpA, CTD, vasculitis, OP, with a biologic DMARD, using disease activity measures), 4 procedures (knee arthrocentesis, crystal identification, hand X-ray interpretation, performing an MSK US) and 4 generic competences (engaging in a multidisciplinary team, interpreting a research paper, performing a scientific presentation, and patient communication). For each competence, respondents were asked to assess the confidence in their abilities (0-10), the exposure to formal education (yes/no), the amount of patient experience (0; 1-10; 11-50; 51-100; 101-150; >150) and assessment (yes/no) where appropriate. For each competence, regression models (linear or logistic, as appropriate) were developed to assess the influence of country of training on the level of confidence, education, practical experience and assessment for that given competence.Results1243 answers were included in the analysis (30% male, 58% trainees) from the 41 EULAR countries that offer rheumatology post-graduate training. For all given competences, the country of training was significantly associated with the acquired confidence. For example, trainees from the UK (arbitrary reference) had on average 1.4 points higher confidence in their ability to manage a patient with early RA than a trainee from France (Table 1). Education and exposure to ≥10 patients were also associated with the acquired confidence for all competences. The existence of an assessment was associated to the level of confidence for only some competences (MSK exam, managing a patient with CTD, with vasculitis, crystal ID, MSK US, multidisciplinary team and interpreting a paper).The country of training was also associated with a higher odds of receiving formal education, of being exposed to ≥10 patients and of being assessed in a given competence (all separate multivariable models).ConclusionsThe European country where rheumatology postgraduate training is performed is associated with the level of confidence acquired in many of the core competences, odds of receiving formal education, of patient experience and of assessment. Further attempts are needed to harmonize rheumatology training educational outcomes across Europe.Disclosure of InterestNone declared

ObjectivesTo describe the confidence and training experience acquired during rheumatology training in 21 core competences across the different European countries.MethodsAs part of a European project to evaluate the differences and similarities in training in rheumatology across Europe, we developed an online survey to assess the training experience. The target population was trainees in rheumatology and rheumatologists certified in the past 5 years. We selected 21 competences, core to rheumatology clinical practice, from the UEMS European curriculum framework (1). For each competence, respondents were asked to assess the confidence in their abilities (0-10 numerical rating scale), the existence of formal education (yes/no), the exposure to patients (0; 1-10; 11-50; 51-100; 101-150; >150) and the existence of an assessment (yes/no) where appropriate. All questions referred to the training period. The survey (June-December 2014) was disseminated in each country by a national PI.ResultsWe gathered 1433 answers to the survey of which 1243 could be included in the analysis (28% of overall target population). Respondents came from the 41 EULAR countries with rheumatology training (30% male, 58% trainees). A summary of the results is presented in Table 1.For any given competence, mean confidence was higher in respondents who had received formal education than in those who had not. Similarly, for all clinical competences and rheumatologic techniques, mean confidence was also higher amongst those who had a higher patient exposure during their training that in those who managed ≤10 patients with that given disease. Mean acquired confidence was also higher in respondents who had a longer training period (internal medicine plus rheumatology) than in those with a shorter training period for all competences except osteoporosis and hand Xray interpretation. The level of confidence was also higher for specialists (vs trainees).ConclusionsThe acquired confidence in competences during the rheumatology training program considered core for rheumatology practice is variable, but overall reasonably high. Most of the trainees seem to receive formal education and have some patient exposure in all competences, though only around half are assessed in each competence.ReferencesEuropean Board of Rheumatology (a section of UEMS). The European Rheumatology Curriculum Framework. www://dgrh.de/fileadmin/media/Praxis_Klinik/european_curriculum_uems_april_2008.pdfDisclosure of InterestNone declared

BackgroundThe Union of European Medical Specialists (UEMS) seeks through its speciality Sections and Boards (S&B) to enhance the training of its doctors and to encourage and support the movement of doctors between countries. The Rheumatology S&B has delegates from all EU countries and has developed a document (European Training Requirements (ETR) – at uemsrheumatology.eu) that provides guidance about the rheumatology curriculum.ObjectivesTo determine:1. The extent of use of the Rheumatology ETR by EU countries2. The extent of use of logbooks in recording the progress of a trainee3. If training centres are accredited4. If national assessment programmes exist for trainees5. If a country has quality assurance and enhancement processes in rheumatology trainingMethodsA questionnaire was sent to all S&B members asking questions in relation to all of the objectives with one follow-up questionnaire to non-responders. Verification of responses as well as obtaining responses from continuing non-responders occurred in December 2016.ResultsNineteen countries responded. Most (18/19) have developed and implemented their own curriculum, often with the influence of the ETR, and also are using a logbook to record the progress of trainees. Training Centres are required to undergo accreditation in 15/19 countries. Another three countries are planning to introduce this. One country does not have an accreditation programme. After accreditation only 8 countries have quality assurance (QA) and enhancement (QE) programmes. In one of these countries the QA and QE processes are variable. Two other countries are either discussing or developing such processes. In 14 countries trainees are assessed to determine their suitability to become specialists. In one of these countries the approach is variable. Two other countries are planning to introduce assessments. Three countries do not assess their trainees.ConclusionsMost EU countries have implemented their own, and varied, curricula for rheumatology training. All countries either use or are planning to use a portfolio, again variable in nature, to record trainees' progress. Thus, it appears that at present any pan-European standardised curriculum or logbook will be of limited utility.Most countries require training centres to undergo accreditation. However, less than half of the countries have a continuation of quality assurance or quality enhancement processes after accreditation with some countries it seems having no plans to do so.At present, a specialist in one European country is required by European law to be recognised as such in another. This study did not determine the nature of the assessments undertaken in different countries but this is not of current relevance within Europe as regards the possible movement of a doctor from one country to another for professional reasons.Disclosure of InterestNone declared

Objectives To analyse the similarities and discrepancies between the official rheumatology specialty training programmes across Europe. Methods A steering committee defined the main aspects of training to be assessed. In 2013, the rheumatology official training programmes were reviewed for each of the European League Against Rheumatism (EULAR) countries and two local physicians independently extracted data on the structure of training, included competencies and assessments performed. Analyses were descriptive. Results 41 of the 45 EULAR countries currently provide specialist training in rheumatology; in the remaining four rheumatologists are trained abroad. 36 (88%) had a single national curriculum, one country had two national curricula and four had only local or university-specific curricula. The mean length of training programmes in rheumatology was 45 (SD 19) months, ranging between 3 and 72 months. General internal medicine training was mandatory in 40 (98%) countries, and was performed prior to and/or during the rheumatology training programme (mean length: 33 (19) months). 33 (80%) countries had a formal final examination. Conclusions Most European countries provide training in rheumatology, but the length, structure, contents and assessments of these training programmes are quite heterogeneous. In order to promote excellence in standards of care and to support physicians’ mobility, a certain degree of harmonisation should be encouraged.

Systemic connective tissue diseases can affect the brain, meninges, spinal cord, cranial and peripheral nerves. Different pathogenic mechanisms, particularly autoantibody or T-cell mediated lesions, appear to be involved. The neurological manifestations of the connective tissue diseases and their diagnostic possibilities including newer imaging techniques are reviewed. Early recognition of neurological abnormalities can help in the differential diagnosis and in defining the underlying disease in order to initiate treatment and prevent progression of lesion or cognitive function loss.