To the Editors:

We appreciate the comments by Drs. Jandial and Foster, and share their concern that exposure to pediatric musculoskeletal problems and pediatric rheumatology should come even earlier than residency, ideally during medical school. We found that the elements of pediatric rheumatology curricula for pediatric residents were being addressed most effectively in training programs that have one or more pediatric rheumatologists. Unfortunately, only 56.4% of residency training programs that responded to our survey have pediatric rheumatologists, leaving over 40% of training programs with minimal or no access to pediatric rheumatology training. This same deficiency also holds for medical schools, such that exposure to pediatric rheumatology and musculoskeletal medicine is similarly limited there. It is likely that training in pediatric rheumatology and musculoskeletal medicine in US medical schools will be suboptimal until there is a major focus on this area. We applaud your progress in the UK in elevating the perceived importance of pediatric musculoskeletal medicine in medical school.

Christy Sandborg MD*, Michelle L. M ayer PhD, MPH†, Laura Brogan MSPH†, * Stanford University School of Medicine Stanford, CA, † University of North Carolina at Chapel Hill.