TeMPRA: advancing continuing professional development in pediatric rheumatology in Japan

Abstract

Background

In the context of the global shortage of pediatric rheumatologists, mid-career specialists who can play key roles in regional education, research, and clinical practice have become increasingly important. In Japan, the Team of Mid-career Pediatric Rheumatologists Alliance (TeMPRA) was founded in 2014 to support continuing professional development (CPD) and foster collaboration among mid-career pediatric rheumatologists. The aim of this study was to characterize the current status and future perspectives of the TeMPRA members.

Methods

In 2024, a cross-sectional, web-based survey was conducted among all 37 active members of the TeMPRA across Japan. Data were collected on career trajectories, educational roles, research activities, clinical practices, and international engagement. Categorical variables were compared using appropriate statistical tests, with a significance level of 0.05.

Results

Responses were obtained from 35 members (response rate: 95%). Most respondents (71%) were affiliated with university hospitals, and 60% had > 10 years of experience in pediatric rheumatology. Compared with those working in community hospitals, respondents affiliated with university hospitals were significantly more likely to be involved in research activities (50% vs. 0%, P = 0.0261) and global professional contributions (88% vs. 0%, P < 0.0001). Overall, 54% of respondents were engaged in teaching students or early-career pediatric rheumatologists, while 43% were involved in clinical or basic research, most commonly focusing on juvenile idiopathic arthritis and systemic lupus erythematosus. Collectively, respondents were responsible for the care of 1,677 children with pediatric rheumatic diseases. While all respondents reported willingness to contribute to pediatric rheumatology at the regional level, 94% and 71% reported willingness to contribute at the national and global levels, respectively.

Conclusions

This nationwide survey highlights the substantial educational roles, research activities, and clinical practices of mid-career pediatric rheumatologists in Japan and suggests that the TeMPRA framework can serve as a valuable model for supporting CPD and workforce sustainability. Similar alliance-based approaches may be applicable in other countries facing comparable challenges in pediatric rheumatology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12969-025-01182-4.

Introduction

Global pediatric rheumatology workforce challenges

Pediatric rheumatology is a highly specialized field dedicated to the diagnosis and management of autoimmune and inflammatory diseases in children [1]. However, there is a global shortage of pediatric rheumatologists, which is particularly acute in regions with limited access to specialized training programs and thereby affects the care of pediatric rheumatic diseases (PRDs) in the developing world [2–4]. This shortage is exacerbated by insufficient exposure to pediatric rheumatology services during pediatric residency, which contributes to a widening gap in healthcare delivery for children with PRDs [5]. Moreover, the literature also highlights inequality with respect to treatment availability in terms of access to care and drug approvals across countries, as well as practice differences in rheumatology [6, 7].

To tackle these issues, key organizations such as the Paediatric Rheumatology International Trials Organisation (PRINTO), Paediatric Rheumatology European Society (PReS), and Childhood Arthritis and Rheumatology Research Alliance (CARRA), play vital roles in advancing education, research, clinical practice, and collaborative efforts in pediatric rheumatology [8–10]. However, no reports have focused on the activities or support of mid-career pediatric rheumatologists despite their central role in clinical practice.

Japan-specific context and the origin of the TeMPRA

The Pediatric Rheumatology Association of Japan (PRAJ) has been pivotal in fostering the development of pediatric rheumatologists through various supportive activities and addressing the issues faced by pediatric rheumatologists on personal and professional levels [11]. As of 2024, there were 119 board-certified pediatric rheumatologists (Japan Pediatric Society [JPS] pediatricians and Japan College of Rheumatology [JCR] rheumatologists) in Japan, however, there remained a regional imbalance with some regions having no pediatric rheumatologists. Moreover, in Japan, a country with a long north-south axis (approximately 3,000 km), the few pediatric rheumatologists practiced independently in each region with no place where they could easily ask clinical questions or receive training. This lack especially affects mid-career rheumatologists who are central to clinical practice. In Japan, pediatric rheumatology is practiced predominantly in academic centers, and all pediatric rheumatologists are trained as general pediatricians before subspecialization. Due to geographic and workforce constraints, access to subspecialty care can be uneven, as there are few board-certified pediatric rheumatologists nationwide. Japan’s universal health coverage allows children to access pediatric care, but subspecialty institutions are concentrated in major urban centers. These factors partially motivated the establishment of the Team of Mid-career Pediatric Rheumatologists Alliance (TeMPRA) as a professional support network for mid-career pediatric rheumatologists.

In response to these challenges, the TeMPRA was founded in Japan in 2014. The TeMPRA is an independent organization focusing on supporting mid-career pediatric rheumatologists and providing continuing professional development (CPD) in the clinical management of PRDs. The TeMPRA aims to facilitate communication, case consultation, and collaborative research among rheumatologists. All the TeMPRA members were JPS pediatricians and have a proactive approach to pediatric rheumatology care. Currently, the TeMPRA has 47 members, with ten members over the age of 50 years serving as observers.

The organization’s name and logo (Fig. 1) feature a shrimp tempura motif, symbolizing the TeMPRA’s aspiration to achieve broad recognition in pediatric rheumatology—both within Japan and globally—similar to the worldwide familiarity with tempura as a representative Japanese dish. The history of the TeMPRA, including successive presidents, vice presidents, secretary generals, and academic conferences, is presented in Supplementary Table 1. Dr. Masaki Shimizu of Kanazawa University (now Institute of Science Tokyo) was the first president of the TeMPRA, and Dr. Kunio Hashimoto of Nagasaki University became the second president in 2023. From 2014 to 2019, the TeMPRA held annual academic meetings at various locations, including Kanazawa University (Dr. Masaki Shimizu; now Institute of Science Tokyo), Hyogo Prefectural Kobe Children’s Hospital (Dr. Yasuo Nakagishi), Nagasaki University (Dr. Kunio Hashimoto), Hiroshima University (Dr. Junko Yasumura; now Hiroshima Prefectural Hospital Organization Futabanosato Prefectural Hospital), Sapporo Hokushin Hospital (Dr. Toshitaka Kizawa), and Kagoshima City Hospital (Dr. Tomohiro Kubota; now Kagoshima Prefectural Satsunan Hospital). Due to the pandemic, the meetings were temporarily suspended but resumed in 2023 at Yamaguchi University (Dr. Hiroyuki Wakiguchi; now Oita University) and in 2024 at Yokohama City University (Dr. Kenichi Nishimura). To provide the standard of care in each region, the TeMPRA members across regions attend the TeMPRA conference held annually in each prefecture to discuss a topic and clinical question independently selected by the TeMPRA organizers, as well as undiagnosed or refractory case reports from the members, and to exchange information on education, research, and clinical practice. The TeMPRA members extensively engage in CPD activities. Between 2014 and 2024, the TeMPRA facilitated more than 40 case consultations and organized over 20 research and educational meetings, through email discussions and in-person workshops. These activities contributed to peer learning and may have facilitated improvements in clinical decision-making among mid-career pediatric rheumatologists. As the TeMPRA celebrates its 10th anniversary, a system for disseminating information to a global audience has been established. The aim of this study was to characterize the current status and future perspectives of the TeMPRA, the professional development of its members, and the effect of the TeMPRA on pediatric rheumatology.

Fig. 1.

The TeMPRA logo. The logo features the acronym “TeMPRA” over a red circle symbolizing Japan, with a shrimp tempura character atop the “T” to reflect the name of the group and its goal of global recognition—much like the worldwide popularity of tempura. Mount Fuji underscores the group’s Japanese roots and stability. TeMPRA: Team of Mid-career Pediatric Rheumatologists Alliance

This is the first report detailing the TeMPRA. Through this report, we hope to contribute to the national and international efforts aimed at addressing the growing need for specialized pediatric rheumatology care.

Methods

Study design and participants

A cross-sectional, web-based survey was conducted in 2024 to characterize the current status and future perspectives of the TeMPRA members. The survey targeted 37 full members from 36 institutions in Japan (excluding observer members). These individuals were selected based on their recognition as mid-career pediatric rheumatologists in their respective institutions, meeting predefined criteria of mid-career as under 50 years of age and active participation in the TeMPRA. Observers and non-members of the TeMPRA were not included, as they do not uniformly meet these criteria, and including them would have reduced the interpretability of the dataset regarding mid-career workforce capacity. Participants were invited via email, and responses were collected anonymously.

Survey instrument

The questionnaire consisted of six main domains and 39 sub-items (Supplementary Table 2). Questions 1–6 evaluated the member’s career, education, research, clinical practice, internationality, and future prospects. Question 1 (Career) had 10 sub-questions, addressing the following topics: 1–1, Affiliation; 1–2, Age; 1–3, Sex; 1–4, Years of experience as a doctor; 1–5, Years of experience in pediatric rheumatology; 1–6, PRAJ member; 1–7, PRAJ council member; 1–8, JCR member; 1–9, JCR rheumatologist; and 1–10, Subspecialty, Question 2 (Education) had three sub-questions, addressing the following topics: 2 − 1, Experience; 2–2, Lectures for students; and 2–3, Training of JCR rheumatologists. Question 3 (Research) had three sub-questions, addressing the following topics: 3 − 1, Experience; 3 − 2, Basic/Clinical; and 3–3, Disease. Question 4 (Clinical practice) had 10 sub-questions, addressing the following topics: 4 − 1, Number of group members; 4 − 2, Systemic juvenile idiopathic arthritis (JIA); 4 − 3, Non-systemic JIA; 4–4, Systemic lupus erythematosus (SLE); 4–5, Juvenile dermatomyositis (JDM) 4–6, Sjögren’s disease (SD); 4–7, Systemic sclerosis (SSc); 4–8, Mixed connective tissue disease (MCTD); 4–9, Behçet’s disease (BD); and 4–10, Vasculitis (except Kawasaki disease and IgA vasculitis). Question 5 (Internationality) had 10 sub-questions, addressing the following topics: 5 − 1, CARRA; 5 − 2, PReS; 5 − 3, American College of Rheumatology (ACR); 5 − 4, Asia Pacific League of Associations for Rheumatology (APLAR); 5–5, European League Against Rheumatism (EULAR); 5–6, International collaborative research; 5–7, The first author of a case report; 5–8, Co-author of a case report; 5–9, The first author of an original article; and 5–10, Co-author of an original article. Question 6 (Future prospects) had three sub-questions, addressing the following topics: 6 − 1, Region; 6 − 2, Japan; and 6 − 3, World.

The questionnaire was developed by the TeMPRA steering committee and reviewed by senior pediatric rheumatologists to ensure face validity. Although no formal pilot testing was performed, iterative revisions were made based on expert feedback. The domains were derived from expert consensus and practical considerations specific to mid-career pediatric rheumatologists in Japan, rather than being directly adapted from a pre-existing CPD framework.

Outcome measures

Outcome measures included affiliations; age; sex; experience; PRAJ and JCR involvement rates; subspecialties other than pediatric rheumatology; percentage of members who supervise students or trainees; basic or clinical researcher rates and disease interests; number of doctors in pediatric rheumatology clinical groups; number of children with PRDs; conference participation in the CARRA, PReS, ACR, APLAR, and EULAR; international collaborative research interests; publication rates; and willingness to contribute to pediatric rheumatology.

Statistical analysis

Data collected from the survey were analyzed using statistical methods to identify significant differences in the responses based on specific variables. Fisher’s exact test was applied to categorical variables to assess the relationships between factors. The Mann–Whitney U test was used to evaluate continuous variables. Multiple hypothesis testing was handled using the Holm method of correction, and both original and adjusted P-values are presented. Statistical significance was set at a threshold of P < 0.05, and all analyses were conducted using SAS software (version 9.4, SAS Institute, Cary, NC, USA). Differences in response rates across various demographic groups, regions, and roles within professional organizations were examined to identify patterns of engagement in education, research, and international collaboration.

Results

We received questionnaire responses from 35 members of the TeMPRA, representing pediatric rheumatologists from 34 institutions in Japan (a response rate of 95% [35/37]). The two non-respondents were from non-university hospitals and represented different geographic regions of Japan.

Career

Affiliations

The majority of respondents were affiliated with university hospitals (69% [24/35]), followed by community hospitals (20% [7/35]), children’s hospitals (9% [3/35]), and a clinic (3% [1/35]). Additionally, respondents from university hospitals were more likely to engage in research, global contributions, and international collaborations compared to those from community hospitals (50% [12/24] vs. 0% [0/7], P = 0.0261, Holm-adjusted P = 0.0261; 88% [21/24] vs. 0% [0/7], P < 0.0001, Holm-adjusted P < 0.0001; and 79% [19/24] vs. 29% [2/7], P = 0.0218, Holm-adjusted P = 0.2185, respectively). The institutions were geographically diverse and evenly distributed, with responses received from regions including the northernmost, eastern, central, western, and southernmost parts of Japan (Hokkaido 6% [2/35], Kanto 26% [9/35], Chubu 14% [5/35], Kinki 17% [6/35], Chugoku-Shikoku 20% [7/35], and Kyushu 17% [6/35] regions) (Fig. 2). However, there were no members from the Tohoku region (An observer who was not included in this survey is from the Tohoku region). Regional differences were observed in the members’ willingness to participate in international collaborative research, with the Chugoku-Shikoku region showing lower participation (29% [2/7]) than the Kyushu region (100% [6/6], P = 0.0210, Holm-adjusted P = 0.1888).

Fig. 2.

Regional distribution of the TeMPRA members in Japan. (A) Map of Japan showing each region. (B) Map of Japan showing distribution of respondents. TeMPRA: Team of Mid-career Pediatric Rheumatologists Alliance

Age, sex, and experience

As for the age distribution, 80% (28/35) of the respondents were in their 40s (Supplementary Fig. 1). Age-related differences were also notable, as respondents in their late 40s were less likely to have experience with training JCR rheumatologists and willingness to make global contributions to pediatric rheumatology (P = 0.0157, Holm-adjusted P = 0.0472; P = 0.0436, Holm-adjusted P = 0.0872, respectively) (Supplementary Table 3). Of the respondents, 74% (26/35) were male. Regarding professional experience, 80% (28/35) of the members had 16 years or more experience as doctors, while 60% (21/35) had 11 years or more experience in pediatric rheumatology (Supplementary Fig. 1).

PRAJ and JCR involvement rates

Among the respondents, 97% (34/35) were members of the PRAJ, and 89% (31/35) were members of the JCR. In addition, 62% (21/34) of the respondents who were PRAJ members served as council members, and 74% (23/31) of the respondents who were JCR members served as JCR rheumatologists. The PRAJ council members/JCR rheumatologists demonstrated greater involvement in education, research, or internationality than non-PRAJ council members/non-JCR rheumatologists (Supplementary Tables 4 and 5).

Subspecialties other than pediatric rheumatology

Most respondents (83% [29/35]) had additional subspecialties. The most common were allergy and immunology, followed by nephrology, infectious diseases, gastroenterology, emergency medicine, neonatology, and hematology (Fig. 3).

Fig. 3.

Subspecialty distribution of the TeMPRA members. (A) Number of subspecialties held by a member in addition to pediatric rheumatology. Although all the TeMPRA members specialize in pediatric rheumatology, only 17% (6/35) specialize exclusively in this field. The remaining 83% (29/35) participate in multiple subspecialties including pediatric rheumatology. (B) Specific subspecialties, in addition to pediatric rheumatology, are represented among the members. A total of 49 subspecialties, in eight subspecialty categories and other categories, are held by 29 members of the TeMPRA. TeMPRA: Team of Mid-career Pediatric Rheumatologists Alliance

Education

Percentage of members who supervise students or trainees

A total of 54% (19/35) of the respondents were involved in education. Of these, 89% (17/19) had experience lecturing students in pediatric rheumatology, and 47% (9/19) had experience in training JCR rheumatologists.

Research

Basic or clinical researcher rates and disease interests

Approximately half (43% [15/35]) of the respondents conducted research related to pediatric rheumatology, with 87% (13/15) involved in clinical research and 60% (9/15) in basic research (Supplementary Fig. 2). The primary diseases researched were JIA and SLE, each accounting for 33% (5/15) of responses, whereas JDM accounted for 7% (1/15) (Supplementary Fig. 3).

Clinical practice

Number of doctors in pediatric rheumatology clinical groups

The questions on clinical practice revealed that most of the TeMPRA members are affiliated with pediatric rheumatology teams at university hospitals, while a substantial number also work in community and children’s hospitals and a clinic. Moreover, 38% (13/34) of respondents reported having only one doctor in their pediatric rheumatology group, with the remainder including two or more (Supplementary Fig. 4).

Number of children with PRDs

In total, 1,677 children with PRDs were reported among the TeMPRA members’ clinical practices. Among these, 959 (57%) were JIA cases with 225 (13%) being systemic JIA and 734 (44%) being non-systemic JIA. Additionally, 240 cases (14%) were SLE, 166 (10%) JDM, 92 (6%) BD, 85 (5%) SD, 68 (4%) vasculitis, 37 (2%) MCTD, and 30 (2%) SSc (Fig. 4). The median (interquartile range; range) number of children managed per member was 17 (7.5–34; 0–110) for JIA, five (1.5–8; 0–28) for systemic JIA, 15 (5–27.5; 0–90) for non-systemic JIA, four (1.5–10; 0–31) for SLE, three (1–6.5; 0–17) for JDM, one (0–2; 0–22) for BD, two (0–4; 0–13) for SD, one (0–3; 0–8) for vasculitis, 0 (0–1; 0–4) for MCTD, and one (0–2; 0–4) for SSc.

Fig. 4.

Distribution of children with PRDs being followed-up by the TeMPRA members. (A) Number of children with each disease. (B) Percentage of children with each disease. BD: Behçet’s disease; JDM: juvenile dermatomyositis; JIA: juvenile idiopathic arthritis; MCTD: mixed connective tissue disease; PRDs: pediatric rheumatic diseases; SD: Sjögren’s disease; SLE: systemic lupus erythematosus; SSc: systemic sclerosis; TeMPRA: Team of Mid-career Pediatric Rheumatologists Alliance

Internationality

CARRA, PReS, ACR, APLAR, and EULAR conference participation and international collaborative research interests

Among the respondents, 57% (20/35) attended international rheumatology-related conferences, particularly those held by the PReS and ACR (Table 1). 69% (24/35) of respondents showed an interest in engaging in international collaborative research.

Table 1.

Participation rates in key international rheumatology conferences

	Category	Yes
Number of international conferences attended	Zero	43% (15/35)
	One	23% (8/35)
	Two	14% (5/35)
	Three	11% (4/35)
	Four	9% (3/35)
	Five	0% (0/35)
Conference
PReS		31% (11/35)
ACR		31% (11/35)
APLAR		26% (9/35)
EULAR		26% (9/35)
CARRA		6% (2/35)

ACR: American College of Rheumatology; APLAR: Asia Pacific League of Associations for Rheumatology; CARRA: Childhood Arthritis and Rheumatology Research Alliance; EULAR: European League Against Rheumatism; PReS: Paediatric Rheumatology European Society

Publication rates

A significant number of the respondents had published English-language case reports and original articles related to pediatric rheumatology. Less than half of the respondents had experience as first authors, while approximately 60% of the respondents had experience as co-authors (Table 2).

Table 2.

Publication rates in pediatric rheumatology

	First author	Co-author
Case report	43% (15/35)	66% (23/35)
Original article	43% (15/35)	57% (20/35)

Future prospects

Willingness to contribute to pediatric rheumatology

All respondents reported willingness to contribute regionally to pediatric rheumatology. 94% (33/35) and 71% (25/35) of the respondents reported willingness to contribute to the field nationally and globally, respectively. Furthermore, individuals reporting willingness to contribute globally to pediatric rheumatology were significantly more likely to engage in international collaborative research (88% [22/25] vs. 20% [2/10], P = 0.0003, Holm-adjusted P = 0.0026).

Discussion

Overview and significance of the TeMPRA

This study provides the first comprehensive characterization of mid-career pediatric rheumatologists. The TeMPRA members constitute a highly experienced workforce, actively engaged in education, research, and clinical practice with a clear commitment to CPD in pediatric rheumatology regionally. Thus, the TeMPRA initiative could help address issues affecting PRD care in areas with a shortage of pediatric rheumatologists and limited access to specialized training programs [2–4].

Addressing regional and institutional gaps

However, the data also reveal areas that could benefit from further development, such as increasing participation from underrepresented regions such as Tohoku and encouraging members practicing in community hospitals to engage more actively in international collaborations. As the TeMPRA progresses, it is expected to play a critical role in shaping the future of pediatric rheumatology through ongoing collaborations, research, and international partnerships.

TeMPRA’s role in CPD

The position of the TeMPRA as a cooperative body, while maintaining independence from other societies, such as the PRINTO, PReS, CARRA, and PRAJ, is vital for advancing pediatric rheumatology in Japan and other countries. The TeMPRA is key in recruiting new pediatric rheumatologists and strengthening clinical practice, while supporting CPD internationally, particularly in regions lacking specialists. The TeMPRA fosters communication and collaboration among pediatric rheumatologists across countries, providing a strong network for education, research, and clinical practice. Its emphasis on collegiality further promotes the free exchange of ideas and insights, which is essential for addressing the challenges faced by pediatric rheumatologists globally.

A pediatric rheumatologist is defined as a doctor who actively treats children with PRDs and has expertise in both pediatrics and rheumatology. In Japan, this role typically requires dual specialization from the JPS and JCR. This dual requirement ensures that pediatric rheumatologists are highly skilled in the unique aspects of pediatric care and the complexities of rheumatic diseases. However, the number of such specialists remains limited, highlighting the need to expand training opportunities to meet growing demands [2].

Training needs and workforce expansion

One of the significant obstacles to the growth of the pediatric rheumatology workforce is the insufficient exposure to this specialty during pediatric training. As noted in previous studies, pediatricians in programs without pediatric rheumatologists often fail to gain the necessary exposure to pediatric rheumatology, which subsequently impedes their ability to effectively recognize and treat PRDs [2]. This lack of specialized training often leads to a shortage of skilled pediatric rheumatologists and a growing gap in healthcare delivery for children with PRDs, especially in regions with limited access to specialized care [5]. Furthermore, training programs often lack resources or structured curricula and require collaborative efforts across different societies, both nationally and internationally, to equip trainees with the necessary skills to address the complex needs of children with PRDs [12].

While much of the focus in literature has been on the training of pediatric rheumatologists, little attention has been paid to mid-career rheumatologists. There is a need to foster further CPD of this group, especially in the context of regional and national healthcare disparities.

Regional disparities and educational opportunities

For instance, differences in the awareness and practice of pediatric rheumatology have been noted in regions such as the Chugoku-Shikoku and Kyushu in Japan. Ogdie et al. made similar observations regarding the delivery of training [13], which highlight how these disparities contributed to unequal access to care and training opportunities. The TeMPRA, in collaboration with international organizations, may play an instrumental role in addressing these disparities by offering continuing education and mentorship to mid-career rheumatologists, fostering a culture of CPD, and encouraging collaboration with international networks.

Disease epidemiology and registry collaboration

The epidemiology of PRDs in Japan including conditions such as JIA and SLE continue to evolve. A nationwide surveillance study conducted in 1997 reported that JIA accounted for 52% of PRD cases, with other diseases such as SLE and JDM accounting for smaller proportions [14]. A more recent study, covering data between 2016 and 2021 in the Pediatric Rheumatology International Collaboration Unit Registry (PRICURE) database of the PRAJ, showed that JIA remained the most prevalent disease, accounting for 67% of cases, followed by SLE (10%) and JDM (9%) [15]. This pattern is reflected in the current survey, where JIA accounted for 57% of the cases treated by the TeMPRA members, supporting the consistency of the disease prevalence observed in earlier studies.

Enhancing research capacity through the TeMPRA

In addition to national surveys, the importance of data collection on PRDs cannot be overstated. A key distinction was the contrast between the data available in the PRICURE database and that held by the TeMPRA. While the PRICURE database contains 402 registered cases [15], it is limited by the fact that the case data are cross-sectional and follow-up studies are not possible. In contrast, the TeMPRA members collectively follow 1,677 cases of PRDs, offering a considerably richer source of longitudinal data. As the TeMPRA members are closely connected and able to exchange information, follow-up studies and research are more feasible within the TeMPRA. Furthermore, through collaboration with the PRAJ, the TeMPRA has the potential to expand the data in the PRICURE database, improve the comprehensiveness of epidemiological studies, and facilitate more robust research on PRDs.

The future of pediatric rheumatologists lies in addressing key areas of education, research, and clinical practice. In particular, more studies are required in underrepresented regions with resource limitations [16, 17]. Virtual education platforms may also disseminate knowledge widely and support PRD care in resource-limited settings [5]. Moreover, increasing research opportunities and mentorship support, particularly for mid-career pediatric rheumatologists, is essential to advance the field and overcome barriers such as limited funding and professional isolation [13].

Expanding the scope through multispecialty expertise

Because approximately 40% of the TeMPRA members are the only pediatric rheumatologists at their institutions, they often have difficulty treating severe cases, intractable cases, and cases that are difficult to diagnose. In such cases, they can consult with the TeMPRA members online in real time, leading to high-quality medical care. In addition, a system has been established to provide feedback to members on their experiences through annual case reports. This truly ties into the “inter-institutional career program for pediatric rheumatologists” theme for CPD. The TeMPRA members often hold dual expertise in fields such as allergy, immunology, or nephrology. Similar to “two-sword” specialists, they play a vital role in maximizing limited pediatric medical resources by managing a broad range of conditions. While the second subspecialty added to pediatric rheumatology is often allergy, immunology, or nephrology, it is noteworthy that several pediatric rheumatologists have gastroenterology, infectious disease, emergency medicine, hematology, and neonatology as subspecialties. This diversity is because of the fact that there were originally few pediatric rheumatologists in Japan, and pediatricians with other subspecialties may have later become pediatric rheumatologists in order to contribute to pediatric rheumatology care in their local areas. These pediatricians study pediatric rheumatology at the TeMPRA and become pediatric rheumatologists. In other words, the TeMPRA is involved in training pediatricians in the region who can handle not only pediatric rheumatology but also a wide range of pediatric diseases. Furthermore, when the TeMPRA members discuss PRD cases, they can examine not only PRDs but also a wide range of differential diagnoses.

Mentorship and global partnerships

Japan has a small pediatric rheumatology workforce, and a similar situation has also been documented in parts of Europe [5, 18, 19]. In North America, inter-institutional mentorship networks have been developed to strengthen mentorship and capacity building [20]. The TeMPRA shares similar goals and could potentially benefit from bilateral exchange or collaboration with such established initiatives.

In addition to the educational community formed, continued access to mentorship opportunities for the pediatric rheumatology community is important. The ACR/CARRA Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology [20–22]. The AMIGO program provides a venue for late-career pediatric rheumatologists to train and thereby develop early-career pediatric rheumatologists. Collaboration between the AMIGO program and the TeMPRA could have interesting possibilities. Compared to the AMIGO, which primarily pairs late- and early-career pediatric rheumatologists, the TeMPRA focuses on supporting mid-career specialists. This distinction highlights complementary strengths. Potential collaboration could include joint webinars, exchange of educational materials, or shared case-based discussions, providing opportunities for mutual learning across different healthcare contexts. Such strategies could enhance mentorship opportunities in Japan while contributing unique perspectives to the global pediatric rheumatology community.

Strengths and limitations of this study

One of the key strengths of this study is that it provides the first comprehensive overview of the career development, educational roles, research engagement, clinical practice patterns and international collaboration among mid-career pediatric rheumatologists through a nationwide survey. It highlights the unique role of the TeMPRA for CPD as a collaborative platform that supports professional growth and facilitates communication among specialists in this field. The detailed institutional and subspecialty data offer valuable insights into the current landscape of pediatric rheumatology practice in Japan, which may serve as a reference for similar networks globally. This study has several limitations. (1) The response rate did not reach 100%, which may have introduced response bias into the results. The two non-respondents were from non-university hospitals and represented different geographic regions of Japan. As non-university hospitals managed smaller patient volumes than university hospitals in this study, the absence of data from these settings may have influenced the overall findings. Additionally, the lack of responses from certain regions may have affected regional comparisons. (2) The sample sizes of the children’s hospitals and clinics were small, preventing their inclusion in the statistical analyses, which may limit the generalizability of the findings to these settings. (3) The TeMPRA members represent only a subset of pediatric rheumatologists in Japan. Therefore, the findings of this study may not be fully generalizable to the entire national workforce. We were not able to examine how peer pediatric rheumatologists who are not members of the TeMPRA differ from the TeMPRA members, warranting future study.

Future directions for pediatric rheumatology

To our knowledge, no support systems focus on mid-career pediatric rheumatologists, even within CARRA, PReS, and PRINTO. Advancing CPD among mid-career pediatric rheumatologists could help bridge between early- and late-career pediatric rheumatologists, which would contribute to revitalizing and developing the clinical practice, education, and research of all generations of pediatric rheumatologists. While the TeMPRA provides a successful framework for supporting CPD in Japan, future efforts should expand beyond national contexts. Internationally, there remains an urgent need for more research on PRDs, improved training opportunities for pediatric rheumatologists, and stronger cross-border collaboration. Virtual education platforms and shared research networks may help to address disparities in resource-limited regions, thereby ensuring that children with PRDs worldwide have access to high-quality care. Ultimately, the future of pediatric rheumatology depends on cultivating a skilled and connected workforce capable of meeting these global challenges.

Conclusions

This nationwide survey highlights the substantial educational roles, research activities, and clinical practices of mid-career pediatric rheumatologists in Japan and suggests that the TeMPRA framework can serve as a valuable model for supporting CPD and workforce sustainability. Similar alliance-based approaches may be applicable in other countries facing comparable challenges in pediatric rheumatology.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

ACR

American College of Rheumatology

AMIGO

American College of Rheumatology/Childhood Arthritis and Rheumatology Research Alliance Mentoring Interest Group

APLAR

Asia Pacific League of Associations for Rheumatology

BD

Behçet’s disease

CARRA

Childhood Arthritis and Rheumatology Research Alliance

CPD

Continuing professional development

EULAR

European League Against Rheumatism

JDM

Juvenile dermatomyositis

JIA

Juvenile idiopathic arthritis

JPS

Japan Pediatric Society

MCTD

Mixed connective tissue disease

PRAJ

Pediatric Rheumatology Association of Japan

PRD

Pediatric rheumatic disease

PReS

Paediatric Rheumatology European Society

PRICURE

Pediatric Rheumatology International Collaboration Unit Registry

PRINTO

Paediatric Rheumatology International Trials Organisation

SD

Sjögren’s disease

SLE

Systemic lupus erythematosus

SSc

Systemic sclerosis

TeMPRA

Team of Mid-career Pediatric Rheumatologists Alliance

Author contributions

Conceptualization, HW; methodology, HW, KH, MY, KN, and TE; software, HW and NH; investigation, HW, KH, MY, KN, TE, KA, YU, TS, YY, JY, FO, TK, RY, TI, TY, YF, NI, AT, NS, KS, TT, and NH; data curation, HW, KH, MY, KN, TE, KA, YU, TS, YY, JY, FO, TK, RY, TI, TY, YF, NI, AT, NS, KS, and TT; writing—original draft preparation, HW; writing—review and editing, HW, KN, KA, YU, YY, NI, NO, and MS; and supervision, NO and MS. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data availability

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study involved an anonymous voluntary questionnaire survey among pediatric rheumatologists. Ethical review was not required for this type of study as it did not involve sensitive personal data or interventions. All participants were informed of the purpose of the study, and their voluntary participation was considered as provision of informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.