Psoriasis and Psoriatic Arthritis Educational Initiatives: An Update from the 2013 GRAPPA Annual Meeting

GRAPPA Video Project

The video project is a collection of online video modules that provide standardized training for psoriasis and psoriatic arthritis (PsA) disease severity instruments commonly used in clinical trials. In 2009, GRAPPA dermatologists and rheumatologists recognized a significant need for standardized and accessible training of psoriasis and PsA trial endpoints. Progress on these modules has been described^1,2,3, and GRAPPA members have collaborated with KIT Digital (formerly Accela Communications; Southborough, Massachusetts, USA) to produce 13 online educational videos of commonly used endpoints.

Each module consists of a video where an expert in the field provides instruction on a particular disease severity measure and then actively demonstrates the examination using graphics, photographs, and video footage. The rheumatology modules include footage demonstrating the measure on volunteer patients. Most dermatology modules include a certification portion to assess proficiency. The 13 currently available modules are detailed in Table 1. In the last year, a new module for assessment of axial spondyloarthropathy was added.

The prototype module, which reviews the Psoriasis Area and Severity Index (PASI)⁴ and body surface area⁵, has been the most widely accessed. As of June 2013, over 1000 individuals from more than 45 countries have viewed the video and completed the 16½-min instructional video and certification portion. This module was also the subject of a recently published equivalency study comparing PASI assessments performed by patients and PASI-naive physicians to those of PASI-experienced dermatologists before and after viewing the training video⁶.

GRAPPA has now joined with ePharmaSolutions (Philadelphia, Pennsylvania, USA) to provide access for GRAPPA members and for investigators with study-specific training needs as required by pharmaceutical industry sponsors. GRAPPA members can access the dermatology modules through the GRAPPA Website using their login and password (http://grappanetwork.org/). Industry sponsors can develop a customized workspace with password-protected entry as well as customized training modules for individual study requirements.

Still needed are additional patient examples with varied skin types, disease phenotypes, and disease severity, translation or subtitling in languages other than English, and further studies demonstrating validity.

GRAPPA Educational Initiatives

Because of their interest in developing and delivering cross-disciplinary educational content to varied audiences, GRAPPA members developed and participated in numerous national and global educational initiatives, 3 of which are detailed below.

Global Outreach

In 2012, GRAPPA joined with SPARTAN (Spondylo-arthritis Research and Treatment Network) to conduct continuing medical education (CME) symposia around the United States. These events provided updates on spondyloarthritis (SpA), including PsA, to community and academic rheumatologists, nurse practitioners, physician assistants, and rheumatology trainees. Full-day symposia feature 5 faculty from SPARTAN and GRAPPA and include plenary lectures on epidemiology, pathogenesis, assessment, and management of SpA and PsA. Breakout sessions with faculty and 2 to 3 patients teach ultrasound techniques and physical examination of joints, entheses, dactylitis, spine, and skin. Half-day and quarter-day sessions have also been conducted, with fewer plenaries and no breakout sessions. Programs have been presented for the Intermountain Rheumatology Society (Idaho) and the upstate New York (Buffalo) Rheumatology Society. In 2013, a half-day symposium including breakouts for physical examination training was conducted at the American College of Rheumatology meeting in San Diego; members of the Ankylosing Spondylitis International Society participated with GRAPPA and SPARTAN members.

GRAPPA has also collaborated with the National Psoriasis Foundation (NPF) to conduct psoriasis and PsA CME programs beginning in 2014. Modeled after the SPARTAN collaboration, educational sessions will be developed to allow tailoring to particular venues, e.g., stand-alone symposia in major cities, CME programming for state dermatology or rheumatology society meetings, or evening dinner events.

Internationally, programs will be conducted in Canada, Europe, Latin America, and Asia in collaboration with thought leaders in psoriasis and PsA affiliated with GRAPPA, the NPF, and international psoriasis organizations. In 2013, 2 rheumatology and dermatology collaborative congresses were conducted in Latin America (Mexico City, Mexico, and Salvador Bahia, Brazil), and GRAPPA leaders presented modules on psoriasis and PsA at the 4th Congress of Psoriasis International Network in Paris. Other events included a combined rheumatology/dermatology congress in Israel in January 2014 and the Saudi Arabia annual rheumatology meeting in April 2014, where GRAPPA leaders presented a PsA module.

Dermatology and Rheumatology Trainee Education Initiative

Despite an expansive body of scientific and didactic literature in psoriasis and PsA, GRAPPA recognizes that gaps exist in knowledge and practice among trainees in dermatology and rheumatology that affect the care of patients. Rheumatology fellows may lack experience in identifying specific morphologic features that distinguish psoriasis from conditions such as seborrheic dermatitis, nummular eczema, hand dermatitis, chronic contact dermatitis, or cutaneous T cell lymphoma. Likewise, dermatology residents are well versed in the clinical presentation of psoriasis and its mimics, but they may have practice gaps related to longitudinal systemic management of psoriasis patients with moderate to severe disease, or in screening psoriasis patients for PsA. Barriers include limited exposure to psoriasis patients with high disease burden, variations in practice patterns among program faculty, and a limited number of didactic hours allocated to evaluation and management of complex psoriasis patients. Both groups of trainees may have gaps in knowledge related to pathophysiology, immunologic pathways, and corresponding targeted therapies in psoriasis and PsA. Some training programs may have few faculty with a current and fluid grasp of disease immunology and mechanisms of targeted therapy. Even when faculty expertise is present, it can be difficult, time-consuming, or expensive to create and regularly update case modules and slide decks teaching immunology and the most relevant pathways.

In the interest of developing cross-discipline educational content and inspiring a paradigm of interdisciplinary care for patients with psoriasis and PsA, the GRAPPA Education Subcommittee has outlined a path to identify specific training gaps through needs assessment delivered to both trainees and training directors. Parallel initiatives within GRAPPA will develop content, including didactic slide decks with graphic illustrations, problem-based learning modules, and instructional films demonstrating technique. GRAPPA will also develop a dissemination plan for the content, which will facilitate access to all types of trainees.

GRAPPA Slide Project

The goal of the GRAPPA slide project is to produce a comprehensive and freely available series of PowerPoint slides for GRAPPA members that cover the pathogenesis, tissues, genetics, epidemiology, classification, clinical features, imaging, comorbidities, natural history and prognosis, and treatment of psoriasis and PsA. The slides will be standardized in format, include the GRAPPA logo, and be “non-modifiable.” Appropriate acknowledgments and references will be given, and permissions sought where necessary. Funding for the project will come from GRAPPA central funding.