Table 3.

Example of Resources, Models of Care and Training in paediatric MSK medicine.

	Model Description	Reach and target audiences	Impact and Outcomes
African Paediatric Fellowship Programme (APFP) [117]	The APFP aims to develop critical specialist skills for physicians working in Africa. This innovative model of training brings post-graduate medical, nursing and allied health trainees from all over Africa to train in various areas of paediatric specialisation using a model that ensures that newly trained specialists continue to deliver care in their home countries.	Training is done in South Africa, providing contextually relevant experience and expertise and trainees, selected based in part on their leadership qualities, are supported in adapting and applying their training and exposure to ensure maximal relevance to their home situation.	Using this model, five paediatric rheumatologists from countries in Africa with no existing specialist expertise available have been trained and are now developing services in their home countries (among more than 100 trained in other disciplines).
JAMLess [5]	Consensus evidence-based recommendation for management of juvenile arthritis in less resourced settings; includes clinical care, education, training, research and advocacy.	Targets clinicians, healthcare planners and training bodies in resource-poor settings.	Developed in Africa, Asia and South America primarily and has transferable value to other regions.
MiracleFeet (https://www.miraclefeet.org/)	MiracleFeet is a non-profit organisation and uses a ‘bottom up approach’, offering continuous technical and financial support for the treatment of children with clubfoot in LRIC.	Support includes identifying local partners, training healthcare workers and practitioners in the Ponseti method, hiring and training parent educators to increase compliance with treatment, providing treatment supplies, including braces and establishing systems to collect and analyse patient and clinic-level data to monitor quality and measure impact.	International rolling programme in many countries in Africa, Asia and South America. As a cost-effective intervention, MiracleFeet has helped change the lives of more than 44,000 children in 26 different countries [120].
PMM [124] (www.pmmonline.org)	PMM is a free evidence-based online information resource launched in 2014. PMM-Nursing launched 2016. PMM-International (2018) with input of many global partners, includes further content-relevant different healthcare contexts.	Targets a wide audience, including medical students, primary care, general paediatricians, orthopaedic surgeons, nurses and allied health professionals to know about the essentials of paediatric MSK medicine PMM courses (https://cpd.ncl.ac.uk)	Google analytics (April 2020): >500,000 hits, >300 countries and >100,000 users. Supported by e-modules and access to pGALS app. PMM app in pipeline (2020).
pGALS assessment [123]	pGALS is a simple and quick basic MSK assessment and validated in school-aged children and clinical practice. pGALS app (available on apple and google play).	Targets medical students, family medicine, primary care, paediatricians, nurses, allied health to have an approach to MSK examination.	Widely taught in medical schools around the world and has been translated into many languages. Validated in clinical practice in many countries, including LRIC.
PReS EMERGE (EMErging RheumatoloGists and rEsearchers) https://www.pres.eu/activities/young-investigators/about-pres-emerge.html	The PReS EMERGE programme supports training in paediatric rheumatology with clinical and research opportunities.	Young doctors and researchers from all over the world, supported by an experienced faculty and connected online and through social media. The PReS EMERGE fellowship programme funds trainees in paediatric rheumatology to spend up to 6 months in a relevant centre in Europe to gain clinical experience and complete a project.	PReS EMERGE supports several programmes, including the fellowship programme, Peer Review Mentoring Programme, Young Investigators Meetings at the annual PReS congress, courses and collaborations with other international consortia to develop shared initiatives
PReS Educational Courses [116]	PReS supports a rolling programme of basic and advanced courses in paediatric rheumatology.	PReS Basic Courses target paediatricians, nurses and allied health and are supported in part by PReS. Advanced courses target specialists and trainees and focussed on skills (e.g. ultrasound) and topics (e.g. JIA, JSLE or autoinflammatory diseases).	Courses have been held around the world (Europe, Africa, Asia and South America). Bursaries from PReS are available to support attendees from LRIC/MRIC.
Project ECHO (https://echo.unm.edu/)	Project ECHO is an exemplar of e-technology to facilitate knowledge mobilisation and empowering the local healthcare providers.	The model connects groups of community providers with specialists at centres of excellence in real-time collaborative interactive sessions. ‘Tele-mentoring’ with two-way learning; local providers gaining skills and confidence to manage patients closer to home and specialists learning new approaches for applying knowledge across diverse cultural and geographical contexts.	An international initiative based in the US with network hubs in many parts of the world and across medicine. Project ECHO has great potential for wide reach and impact in the context of MSK workforce capacity building and initiatives for CYP are developing (e.g. ‘PROMISE’ based in India).
RightPath (www.rightpath.solutions)	RIghtPath is a model of care involving MSK triage in the community by paediatric physiotherapists.	Targets primary care and community care to support triage teams with triage guidance and targeted training to identify those CYP who can be managed locally (without specialist hospital referral) and those who do need referral for specialist opinion.	Based in the UK and approximately 25% of referrals can be triaged to be managed in the community rather than referred to hospital specialist care.
WHO EML https://list.essentialmeds.org/	The WHO EML informs countries around the world about the minimum medicine items necessary to meet the most important priority health needs of a population.	The EML informs national medicine lists and health systems to enable safe and effective implementation of therapy in clinical practice; with implications for transportation, storage and handling, staffing and training, care pathways and clinical guidelines.	By 2016, more than 150 countries had developed national lists based on the WHO EML. The need to revise the EML for paediatric rheumatology has been highlighted as the current list does not include ‘routine’ drugs [6].