A Consensus Based Shoulder Examination for Rheumatology Training.

Abstract

Background: Physical examination of a patient with nonspecific shoulder pain is a non-standardized teaching objective among rheumatology fellowship programs. We investigated consensus among rheumatology fellowship program directors (PD) in shoulder examination maneuvers to be performed by rheumatology fellows.

Methods: Past or present rheumatology PDs currently working in New England taught a 5-minute shoulder examination to one of their trainees and recorded the resulting video of the shoulder examination. We cataloged all the performed maneuvers from these videos. Anonymized electronic surveys instructed PDs to rank each maneuver into one of the three categories: (Tier 1) Teach all fellows and should be performed routinely; (Tier 2) Teach all fellows but should be performed only in specific scenarios; (Tier 3) Teach only to selected fellows and should be performed only in specific scenarios. For maneuvers performed differently, we surveyed for consensus. Items not meeting ≥70% consensus threshold were included in the second survey and this process was repeated for a third survey. A separate survey collected PD demographics.

Results: 11 of 13 recruited PDs agreed to participate and 100% of participants completed all rounds of the study. The study addressed 65 items: 52 questions for tier designation of the examination maneuvers and 13 questions for different examination techniques. Participants achieved consensus for 40/52 tier designation items and for 8/13 technique items.

Conclusion: This is the first study focused on shoulder examination specific to rheumatology practice and these results can provide high yield guidance for the rheumatology community. Febuxostat use is associated with a significantly greater risk of mild to moderate perturbation of liver function compared to benzbromarone in patients with gout.