The American College of Rheumatology (ACR)/Association of Rheumatology Health Professionals (ARHP) has created a rheumatology curriculum outline that can be used to create more efficient integration of nurse practitioners (NPs) and physician assistants (PAs) into rheumatology practice, according to a study published in Arthritis Care & Research.

The task force consisted of private practice and academic rheumatologists and was led by Benjamin J. Smith from the Florida State University College of Medicine in Tallahassee. The researchers created a rheumatology curriculum outline (RCO) to provide a structured and comprehensive educational approach for the NP/PA and the supervising/collaborating physician mentor as the NP/PA enters a rheumatology practice. The task force created the RCO in a stepwise approach as follows: 1) conducted a needs assessment through a literature search and survey of NPs/PAs; 2) evaluated data obtained from literature search and survey; 3) collaborated in development of the RCO; and 4) obtained valued stakeholder feedback.

A needs assessment survey was distributed to ARHP NP/PA members (n = 317) to obtain their input regarding key elements of their initial rheumatology training to provide guidance in curriculum development. Data requested in the needs assessment survey included demographic data, length of employment of NP/PA in rheumatology, rheumatic diseases treated in practice, practice setting and responsibilities in specific settings, classes of medications prescribed, and how knowledge, skills, and attitudes were developed upon initial entry into rheumatology practice.

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The RCO uses the core competencies for NPs/PAs, which parallel the Accreditation Council for Graduate Medical Education Core Competencies established for physicians. These NP/PA core competencies served as a framework for the RCO development. Given the similarities between NP and PA core competencies, it was evident that a single curriculum could be developed for use by NPs/PAs joining rheumatology practice.

The needs assessment survey, sent to the NP/PA ARHP membership, resulted in 81 responses of 317 surveys (25.6% response rate); 90.1% of responders were female. The needs assessment survey revealed that the largest proportion of respondents (45.2%) had been in rheumatology for less than 5 years. The respondents listed a variety of resources important to NPs/ PAs new to rheumatology, with the most important being: 1) a colleague mentor physician, NP, or PA; 2) the ACR/ARHP; 3) a textbook; and/or 4) online resources.

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The RCO for NPs/PAs is the first specialty-specific curriculum outline for NPs/PAs developed and endorsed by a professional medical specialty society, the ACR/ARHP.

A strength of the RCO is its applicability and practicality for the rheumatologist and the NP/PA, and as a standard, yet flexible, tool to meet any rheumatology practice’s unique needs. The RCO can be used throughout the entire training period as an NP/PA begins working in any rheumatology practice.


Smith BJ, Bolster MB, Slusher B, et al. Core curriculum to facilitate the expansion of a rheumatology practice to include nurse practitioners and physician assistants. Arthritis Care Res (Hoboken). 2018 May;70(5). doi: 10.1002/acr.23546.