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Education in rheumatology.

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Education in Rheumatology
Emmanuel Rudd and Satoshi Sasaki
T h e XI11 International Congress of tism, its regional components and national
Rheumatology, held in Kyoto, Japan, Oc- societies.
1. Rheumatology should be defined
tober 2-6,1973, had as one of the topics
broadly, taking into account the freEducation in Rheumatology. Presented in
quency and the impact on man of disa Symposium in two parts, under the chaireases
of the locomotor system, and
manship of Professor F. Herrera Ramos
evolving knowledge of the pathophyand Professor Y. Oshima, it was organized
siology of the connective tissue.
by Dr. E. Rudd and Professor S. Sasaki.
T h e spectrum of rheumatology
With simultaneous interpretation in the
should include complex connective tisofficial languages of the Congress, introducsue disease, the prototype of chronic
tory speakers, authors of abstracts and disillness and disability, emerging as one
cussers from the audience, considered trainof the big health problems of conteming at all levels of the physician and the
porary medicine. It should also inallied health professionals, (nurses, physical
clude rheumatic complaints of ill-deand occupational therapists, social workers)
fined disorders of back and limbs,
the structure of a Rheumatic Disease Unit,
which often have a poorly understood
the role of professional Societies, nongovpathology.
ernmental and governmental agencies.
Dr. M. A. Akhmateli, Director of the
2. The majority of patients with diseases
of connective tissue and rheumatic
Division of Noncommunicable Diseases of
complaints are treated by the first conthe World Health Organization, particitact physician. In most countries this
pated in the Symposium and outlined the
is the general practitioner. In other
activities of this organization in education.
countries it is the internist, the pediaSummation of the first part was presented
trician, the surgeon, the family physiby Dr. H. F. Polley, and of the second part
cian. It is clear that rheumatology
by Professor E. G. L. Bywaters.
Statements derived from the introductory
needs to be taught adequately to all
undergraduates, and to be included in
speakers and the discussors are presented
herein together with recommendations to
the continuing education of all practhe International League Against Rheumatitioners.
3. Traditional teaching i n medical
EMMANUEL RUDD, MD: Chairman, Committee on
schools is undergoing changes. T h e
Education, International League Against Rheumanew trend is to use a core curriculum
tism; SATOSHI SASAKI. MD: Secretaly General, XI11
the integrated approach based on
International Congress of Rheumatology.
Address reprint requests to: Dr. E. Rudd, 1 West,
body systems. Instruction in the loco64th Street, New York. NY 10023.
motor system should lead to an underSubmitted for publication December 18, 1973;
standing of the clinical approach to
accepted February 1, 1974.
Arthritis and Rheumatism, Vol. 17, No. 5 (September-October 1974)
diagnosis and management of common
rheumatic diseases. Teachers must be
aware of and utilize modern technology of education, audiovisual and computerized instruction, among other
techniques. They must communicate
advantageously with specialists in closely related disciplines and experts in
4. Teaching of management of chronic
illness, as represented by rheumatic
diseases, is best accomplished in specialized rheumatic disease units. They
should be patient oriented, integrate
different disciplines, train and utilize
appropriately the allied health professionals, and get the informed support
of the public.
5. Printed material and postgraduate
courses are the backbone of continuing education. Modern technology
should be used to update medical education, focusing on diagnostic and
management problems with consideration of the impact of chronic illness
on the patient, his family, and the
community. Continued education
should include a critical evaluation of
delivery of health services.
6. The specialist in rheumatic diseases
needs no longer to look for his identity. Rheumatology has achieved the
maturity as an integral part of internal medicine.
The clinical rheumatologist is an
internist, well informed in special
skills of orthopedic surgery, neurology,
radiology and rehabilitation medicine.
He has basic knowledge of the biochemistry and pathophysiology of the
connective tissue, epidemiology and
social medicine.
The researcher and the teacher has
given to rheumatology an academic
recognition which attracts students, allows full participation in the integrated curriculum and provides leadership in postgraduate and continuing
7. There is an urgent need for standardization of terminology. Current concepts of natural history, pathogenesis,
and management of rheumatic diseases
need to be widely disseminated. Educational tools, written and audio-visual
material, should be made available
nationally and internationally. Flexibility will be required to accommodate
evolving knowledge, local needs and
8. Leadership for the progress in education could best be provided by professional rheumatism societies in each
Communication with and within
medical schools and schools of allied
health professionals should insure the
place of basic rheumatology in the
Professional societies should initiate
and develop educational programs for
the primary physician and continuing
education for the specialist. Production and dissemination of informational bulletins, journals, slide collections and films should be their responsibility. They should provide the stimulus for the creation of social agencies
to help combat rheumatic diseases and
influence the thinking of the public
and public health authorities.
International and regional leagues
are charged with the task of unifying
national efforts in education, and with
the exchange of information, educational material and personnel. They
should further develop improved formats for international conferences and
Arthritis and Rheumatism, Vol. 17, No. 5 (September-October 1974)
force of the International League
congresses, adapt and distribute internationally acceptable teaching mateAgainst Rheumatism has to carry it
further toward better understanding
rial, and promote Fellowships. Much
of this could be facilitated by coopera.of rheumatic diseases and their contion with the World Health Organiquest.
The manpower required consists of
physicians and allied health profes9. Physicians alone cannot effectively
sionals. There is need to increase their
fight rheumatic diseases. Their partnumber, give them superb training,
nerships with voluntary health agenand for tbis task to get the awareness
cies gives the financial backing from
and support of the public and the
an informed and concerned commugovernment.
nity to initiate and develop demonstration projects. These could lead to
development of better facilities for the
care of rheumatic patients. The magExcerpta Medica, The International Medical
nitude of the problem, the increasing
Abstracting Service, International Congress Secost of medical education and delivery ries No. 299. XI11 International Congress of
of health services, calls for significant Rheumatology, Kyoto, Japan, September 30governmental participation.
October 6, 1973. Symposium 12-A, Education in
10. In historical perspective, rheumatology rheumatology (Abstracts 201-21 1). Symposium
has progressed in fifty years to the 12-B, Education in rheumatology (Abstracts
mainstream of medicine. The unifying 2 12-220).
Arthritis and Rheumatism, Vol 17, No. 5 (8eptemberOctob.r 1974)
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rheumatology, education
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