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Educaciónen Reumatología en AméricaLatina 
Education in Rheumatology in Latin America 
Carlo V Caballero-UribeMD-PhD (c) 
Internist-Rheumatologist 
AssociatedProfesor of Medicine 
Universidad del Norte 
Barranquilla-Colombia
Nothing to Disclose 
Thanks to Drs. Loreto Massardo, Claudio Galarza, Carlos Pineda and PANLAR.
Education in Rheumatology . Trends to consider 4 
1. Burdenof disease 
2. Worldwideshortageof Rheumatologists 
3. Inadequaciesof RheumatologyTeaching 
4. New learningmethods 
5. Needsof workforcein Rheumatology
Undergraduate Teaching of Rheumatology in Latin America . Outline 6 
Education for undergraduate students: 
A survey to Latin American Rheumatologistsabout pre grad medical education on Rheumatology 
Seven points survey to Presidents of National Societies (N°10) 
Individual Survey to members of National Societies sent from Panlar: N°320
Survey to the Presidents of National Societies
Millions 
Hab. 
(aprox.) 
MD 
per 1 millionh. 
Rheumatologists 
Per 1 millionh. 
N º of medicalschools 
N º teachingpregraduaterheumatology(%) 
Argentina 
40 
500 
13 
29 
7 (24%) 
Chile 
17 
170 
9 
21 
9 (43%) 
Colombia 
48 
160 
3 
57 
NA 
CostaRica 
4 
260 
6 
6 
3 (50%) 
Ecuador 
14 
170 
4 
16 
7 (44%) 
ElSalvador 
5 
254 
33 
4 
1 (25%) 
DominicanRep. 
10 
300 
2 
9 
NA 
Mexico 
112 
180 
6 
85 
35 (41%) 
Uruguay 
3 
470 
33 
2 
2 (100%) 
Venezuela 
30 
200 
6 
8 
5 (62%) 
TOTAL 
283 
266.4 
11.5 * 
237 
69 (29.1%) 
Rheumatologyteachingin pregradmedschool 
Surveytopresidentsof nationalsocieties 
*Ideal # 80 -100 /million h
Survey QuestionsSurvey using Survey Monkey via e- mail sent to Rheumatologists through their National Societies38 questions320 answers to the survey
Whoare theteachers? 
Feature 
Mostfrequentanswer 
Percentage 
Speciality 
Rheumatologist 
96% 
Universityaffiliation 
YES 
71% 
Academicposition 
Professor(Anylevel) 
64% 
Teachingin undergraduatestudents 
YES 
56% 
Paymentas aprofessor 
YES 
55% 
Teachingsemiology 
Semiologyin rheumatology 
51% 
Yearof medical degreeprogram(Teaching). 
3-4 year 
50 % 
PANLAR. Individual survey 2014
Relevant Survey Questions
En general ¿quétan de acuerdoestácon la siguienteafirmación? La mayoríade los médicosen AméricaLatina tieneun déficiten suformación/ pobreconocimientode la historiaclínicay examenarticular o exploraciónen reumatología. 
Answered: 316 Skipped: 4 
In general, to what extent do you agree with the following statements? Themajority of doctors in Latin America lack training or have a poor knowledge of the clinical history/background and articular tests or exploration in Rheumatology. 
72. % Totally agree or agree with a lack of training o poor Knowledge
En general ¿quétan de acuerdoestácon la siguientesafirmación? La mayoríade los médicosegresadosde mi universidad/ escuelade medicinaen AméricaLatina tieneun déficiten suformación/ pobreconocimientode la historiaclínicay examenarticular o exploraciónen reumatología. 
Answered: 320 Skipped: 0 
In general, to what extent do you agree with the following statements? A majority of doctors that studied atmy university/Institution lack training or have a poor knowledge of the clinical history/background and articular tests or exploration in Rheumatology. 
67.5% agree with lack of training by their own institution
¿Reumatologíase enseñaen etapas? (esdecirse reparteen distintosnivelesen distintoscursoso añosdurantela formacioncomomédico) 
Answered: 281 Skipped: 39 
¿Rheumatologyisteachedbysteps? (Severalcoursesacrosstheyearsof pre-medical school) 
61.57% Onecourseof rheumatologyin thelifetime
¿Hay un Perfilde egresadode suinstituciónqueincluyaelementosde la reumatología? 
Answered: 282 Skipped: 38 
Does your institution have a Graduate Profile that includes elements of Rheumatology? 
Not a clear profile that includes rheumatology elements (67%)
¿Do you participate choosing the rheumatology topics ? 
Answered: 283 Skipped: 37 
48% Do not participate choosing the topics 
¿Participa Ud. en las decisiones del temario que se enseña en reumatología?
En general ¿quétan de acuerdoestáUd. con el temariode enseñanzade la reumatologíaen pregradoen suinstitución? 
Answered: 273 Skipped: 47 
In general; to what extent do you agree with the subjects that are taught in Rheumatology for undergraduates at your institution? 
71.4%. Agree with the subjects or topics
¿Are the topics focus in the reality of your country or institution? 
Answered: 270 Skipped: 50 
63.3% agree withfocus on the topics 
¿El temario se encuentra enfocado a la realidad de los problemas de atención de reumatología de su región o país?
Are immunology and rheumatology teaching integrated in the curriculum? 
Answered: 276 Skipped: 44 
Separate courses in 42.75% 
La enseñanza de la inmunología en relación con la reumatología en su programa se encuentra integrada?
In your country. The education program its regulated by a national institution or organization regarding depth and extension of the courses? 
Answered: 280 Skipped: 40 
In 50% there is a national organization 
En su país ¿Existe una entidad nacional que regule los temas a enseñar en cuanto a profundidad y extensión entre la distintas instituciones educativas?
¿Cuálesla metodologíaqueutilizade preferenciasuescuelade medicinay en particular reumatología? (puedemarcarvariasrespuestas) 
Answered: 275 Skipped: 45 
What is the methodology of choice with regard to Rheumatology at your institution? (You may choose more than one answer) 
73.8% use a traditional teaching methodology
¿Does you med school has interactive methods to teach rheumatology? 
Answered: 274 Skipped: 46 
62% Does not have interactive methods to teach rheum 
¿Cuenta su escuela de medicina con métodos interactivos para la enseñanza de reumatología?
How many teaching hours does your Rheumatology course have annually? 
Answered: 261 Skipped: 59 
38% have 24 or more hours dedicated to rheumatology 
¿Cuántas horas lectivas tiene el curso de Reumatologiaanualmente?
¿Los alumnostienenaccesoen forma sistematizadaa la atenciónde pacientesambulatorios? 
Answered: 261 Skipped: 59 
Do students have access to attend Rheumatology out-patient clinics in a systematic way? 
59 % teach in settings with real patients
¿QuébarrerasidentificaUd. paraobtenerunaenseñanzaefectivade pregradoen reumatología? (puedemarcarvariasrespuestas) 
Answered: 243 Skipped: 77 
In your opinion, what are the main barriers to effective undergraduate teaching in Rheumatology? (You may choose more than one answer) 
60% mention lack of motivation as a barrier to effective teaching
¿IdentificaUd. algunade lassiguientesbarrerasparala enseñanzay aprendizajedel examendel sistemamúsculo-esqueléticoen suinstitución? (puedemarcarmásde unarespuesta) 
Answered: 239 Skipped: 81 
Could you identified any of the barriers in relation to the teaching of MSK examination skills at your institution ? (You may choose more than one answer) 
57.32% lackof standarizedapproachto MSK examinationskills
Acercadel sistemade exploracióno examendel aparatolocomotor"GALS" (Gait, Arms, Legs, Spine) 
Answered: 272 Skipped: 48 
Are you familiar with "GALS" (Gait, Arms, Legs, Spine) examination? 
31.62% Doesn’tknowabouttheGALS
Conclusions 
•Very few rheumatologists per habitants and fewschoolsteachingrheumatology 
•Lack of training o poor Knowledge with more than a half with pre grad teaching by Non Rheumatologists. 
•The curriculum It’s not standarizedto teach reumathology. 
•Only 1/3 knows, practice and teach the GALS.
Conclusions. Whatneedsto be done 
•Set of recommendations for core content of a musculoskeletal course through a task force on pregraduateeducation (i.ePANLAR Education Committee? 
•Teach the GALS? . Students who had formal instruction in the GALS were proficient in examining the locomotorsystem 
•A PANLAR basicalcourse oriented to pregraduateusing different methods to reach those students lacking of rheumatology education (i.eonline text or course)
Education in Rheumatology in Latin America #ACR14
Education in Rheumatology in Latin America #ACR14

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Education in Rheumatology in Latin America #ACR14

  • 1. Educaciónen Reumatología en AméricaLatina Education in Rheumatology in Latin America Carlo V Caballero-UribeMD-PhD (c) Internist-Rheumatologist AssociatedProfesor of Medicine Universidad del Norte Barranquilla-Colombia
  • 2. Nothing to Disclose Thanks to Drs. Loreto Massardo, Claudio Galarza, Carlos Pineda and PANLAR.
  • 3. Education in Rheumatology . Trends to consider 4 1. Burdenof disease 2. Worldwideshortageof Rheumatologists 3. Inadequaciesof RheumatologyTeaching 4. New learningmethods 5. Needsof workforcein Rheumatology
  • 4. Undergraduate Teaching of Rheumatology in Latin America . Outline 6 Education for undergraduate students: A survey to Latin American Rheumatologistsabout pre grad medical education on Rheumatology Seven points survey to Presidents of National Societies (N°10) Individual Survey to members of National Societies sent from Panlar: N°320
  • 5. Survey to the Presidents of National Societies
  • 6. Millions Hab. (aprox.) MD per 1 millionh. Rheumatologists Per 1 millionh. N º of medicalschools N º teachingpregraduaterheumatology(%) Argentina 40 500 13 29 7 (24%) Chile 17 170 9 21 9 (43%) Colombia 48 160 3 57 NA CostaRica 4 260 6 6 3 (50%) Ecuador 14 170 4 16 7 (44%) ElSalvador 5 254 33 4 1 (25%) DominicanRep. 10 300 2 9 NA Mexico 112 180 6 85 35 (41%) Uruguay 3 470 33 2 2 (100%) Venezuela 30 200 6 8 5 (62%) TOTAL 283 266.4 11.5 * 237 69 (29.1%) Rheumatologyteachingin pregradmedschool Surveytopresidentsof nationalsocieties *Ideal # 80 -100 /million h
  • 7. Survey QuestionsSurvey using Survey Monkey via e- mail sent to Rheumatologists through their National Societies38 questions320 answers to the survey
  • 8. Whoare theteachers? Feature Mostfrequentanswer Percentage Speciality Rheumatologist 96% Universityaffiliation YES 71% Academicposition Professor(Anylevel) 64% Teachingin undergraduatestudents YES 56% Paymentas aprofessor YES 55% Teachingsemiology Semiologyin rheumatology 51% Yearof medical degreeprogram(Teaching). 3-4 year 50 % PANLAR. Individual survey 2014
  • 10. En general ¿quétan de acuerdoestácon la siguienteafirmación? La mayoríade los médicosen AméricaLatina tieneun déficiten suformación/ pobreconocimientode la historiaclínicay examenarticular o exploraciónen reumatología. Answered: 316 Skipped: 4 In general, to what extent do you agree with the following statements? Themajority of doctors in Latin America lack training or have a poor knowledge of the clinical history/background and articular tests or exploration in Rheumatology. 72. % Totally agree or agree with a lack of training o poor Knowledge
  • 11. En general ¿quétan de acuerdoestácon la siguientesafirmación? La mayoríade los médicosegresadosde mi universidad/ escuelade medicinaen AméricaLatina tieneun déficiten suformación/ pobreconocimientode la historiaclínicay examenarticular o exploraciónen reumatología. Answered: 320 Skipped: 0 In general, to what extent do you agree with the following statements? A majority of doctors that studied atmy university/Institution lack training or have a poor knowledge of the clinical history/background and articular tests or exploration in Rheumatology. 67.5% agree with lack of training by their own institution
  • 12. ¿Reumatologíase enseñaen etapas? (esdecirse reparteen distintosnivelesen distintoscursoso añosdurantela formacioncomomédico) Answered: 281 Skipped: 39 ¿Rheumatologyisteachedbysteps? (Severalcoursesacrosstheyearsof pre-medical school) 61.57% Onecourseof rheumatologyin thelifetime
  • 13. ¿Hay un Perfilde egresadode suinstituciónqueincluyaelementosde la reumatología? Answered: 282 Skipped: 38 Does your institution have a Graduate Profile that includes elements of Rheumatology? Not a clear profile that includes rheumatology elements (67%)
  • 14. ¿Do you participate choosing the rheumatology topics ? Answered: 283 Skipped: 37 48% Do not participate choosing the topics ¿Participa Ud. en las decisiones del temario que se enseña en reumatología?
  • 15. En general ¿quétan de acuerdoestáUd. con el temariode enseñanzade la reumatologíaen pregradoen suinstitución? Answered: 273 Skipped: 47 In general; to what extent do you agree with the subjects that are taught in Rheumatology for undergraduates at your institution? 71.4%. Agree with the subjects or topics
  • 16. ¿Are the topics focus in the reality of your country or institution? Answered: 270 Skipped: 50 63.3% agree withfocus on the topics ¿El temario se encuentra enfocado a la realidad de los problemas de atención de reumatología de su región o país?
  • 17. Are immunology and rheumatology teaching integrated in the curriculum? Answered: 276 Skipped: 44 Separate courses in 42.75% La enseñanza de la inmunología en relación con la reumatología en su programa se encuentra integrada?
  • 18. In your country. The education program its regulated by a national institution or organization regarding depth and extension of the courses? Answered: 280 Skipped: 40 In 50% there is a national organization En su país ¿Existe una entidad nacional que regule los temas a enseñar en cuanto a profundidad y extensión entre la distintas instituciones educativas?
  • 19. ¿Cuálesla metodologíaqueutilizade preferenciasuescuelade medicinay en particular reumatología? (puedemarcarvariasrespuestas) Answered: 275 Skipped: 45 What is the methodology of choice with regard to Rheumatology at your institution? (You may choose more than one answer) 73.8% use a traditional teaching methodology
  • 20. ¿Does you med school has interactive methods to teach rheumatology? Answered: 274 Skipped: 46 62% Does not have interactive methods to teach rheum ¿Cuenta su escuela de medicina con métodos interactivos para la enseñanza de reumatología?
  • 21. How many teaching hours does your Rheumatology course have annually? Answered: 261 Skipped: 59 38% have 24 or more hours dedicated to rheumatology ¿Cuántas horas lectivas tiene el curso de Reumatologiaanualmente?
  • 22. ¿Los alumnostienenaccesoen forma sistematizadaa la atenciónde pacientesambulatorios? Answered: 261 Skipped: 59 Do students have access to attend Rheumatology out-patient clinics in a systematic way? 59 % teach in settings with real patients
  • 23. ¿QuébarrerasidentificaUd. paraobtenerunaenseñanzaefectivade pregradoen reumatología? (puedemarcarvariasrespuestas) Answered: 243 Skipped: 77 In your opinion, what are the main barriers to effective undergraduate teaching in Rheumatology? (You may choose more than one answer) 60% mention lack of motivation as a barrier to effective teaching
  • 24. ¿IdentificaUd. algunade lassiguientesbarrerasparala enseñanzay aprendizajedel examendel sistemamúsculo-esqueléticoen suinstitución? (puedemarcarmásde unarespuesta) Answered: 239 Skipped: 81 Could you identified any of the barriers in relation to the teaching of MSK examination skills at your institution ? (You may choose more than one answer) 57.32% lackof standarizedapproachto MSK examinationskills
  • 25. Acercadel sistemade exploracióno examendel aparatolocomotor"GALS" (Gait, Arms, Legs, Spine) Answered: 272 Skipped: 48 Are you familiar with "GALS" (Gait, Arms, Legs, Spine) examination? 31.62% Doesn’tknowabouttheGALS
  • 26. Conclusions •Very few rheumatologists per habitants and fewschoolsteachingrheumatology •Lack of training o poor Knowledge with more than a half with pre grad teaching by Non Rheumatologists. •The curriculum It’s not standarizedto teach reumathology. •Only 1/3 knows, practice and teach the GALS.
  • 27. Conclusions. Whatneedsto be done •Set of recommendations for core content of a musculoskeletal course through a task force on pregraduateeducation (i.ePANLAR Education Committee? •Teach the GALS? . Students who had formal instruction in the GALS were proficient in examining the locomotorsystem •A PANLAR basicalcourse oriented to pregraduateusing different methods to reach those students lacking of rheumatology education (i.eonline text or course)