Pediatric Rheumatology

Meredith Riebschleger, MD, MS

Clinical Lecturer, Pediatrics and Communicable Diseases Pediatrics-Immunology/Rheumatology

Elizabeth E. Kennedy Children’s Research Initative and Charles Woodson
Interdisciplinary Award in Children’s Health Award ($30,000)

Development of a Novel Teaching Module and Assessment Tools
for the Focused Pediatric Rheumatology Musculoskeletal Exam


Pediatric rheumatology is the third smallest of the pediatric subspecialties with approximately 300 clinically active board certified practitioners in the US. In addition, pediatric rheumatologists are concentrated in metropolitan academic centers. As such, when measured by the average population-weighted distance to providers, pediatric rheumatology is the third least geographically accessible pediatric subspecialty. In Michigan, there are six pediatric rheumatologists, but all are primarily located in the lower third of the state, while children with rheumatologic disease are distributed in both the upper and lower peninsulas. This results in a disproportionately high burden on the families of children with rheumatologic diseases who live far from academic centers. This burden includes the increase in pain and functional limitations that occur with periods of prolonged inactivity, such as during long car-rides to pediatric rheumatology appointments, as well as the direct and indirect costs associated with travel and disruption to work and school. Hypothesis: Primary care physicians can be trained to provide focused pediatric rheumatology musculoskeletal exams that identify active rheumatologic disease. Specific Aims: 1) To develop a teaching module and assessment tools for the focused pediatric rheumatology musculoskeletal exam intended for primary care physicians; 2) To conduct a pilot trial of the module developed in Aim 1.

This project is critical in establishing the feasibility of Dr. Riebschleger’s career development award, which she will submit to the National Institute of Arthritis, Musculoskeletal Diseases and Skin (NIAMS) in November 2014. This career development award will focus on the development and testing of telemedicine and co-management models of care for children with juvenile idiopathic arthritis.

Ultimately, Dr. Riebschleger hopes to develop a system whereby the entire teaching and assessment process can occur remotely. Expansion of this system into other pediatric subspecialties will facilitate the use of telemedicine to provide care to children with a variety of chronic diseases, thereby affording the opportunity to further develop telemedicine in the University of Michigan Department of Pediatrics In addition to its clinical and health services research importance, this project will also open the door to other funding mechanisms in educational research, such as the American College of Rheumatology Research Foundation (ACR RRF) Clinician Scholar Educator Award. Finally, this project will improve the teaching and assessment of pediatric rheumatology musculoskeletal exam skills for UM pediatrics residents.