Background/Purpose: Teaching is an ACGME milestone for pediatric subspecialty fellows. Despite this expectation, there is little literature regarding how to empower fellows to teach residents. In a recent survey, 100% of Stanford Pediatric Rheumatology fellows were either extremely or very dissatisfied with the teaching they provide. Corroborating fellows’ perceptions, Stanford pediatric residents rated the rheumatology rotation the lowest overall in 2014-2015, with teaching identified as a primary weakness. The objective of this study was to evaluate the effect of a novel resident curriculum on resident education and fellow teaching of core pediatric rheumatology topics.

Methods: This is an IRB-exempt, single site, prospective interventional study. Four existing pediatric rheumatology didactic lectures were converted into interactive, computer-assisted, case-based learning modules using e-learning software. Modules were designed to encourage fellow and resident interaction at each clinical decision point. Fellows led didactic sessions on four consecutive Thursdays during the rotation. Study participants included 27 residents and 5 pediatric rheumatology fellows during academic year 2015-2016. 15 residents in the pre-intervention group received 4 existing lectures. So far, 9 of 12 residents in the intervention group have received interactive, computer-assisted, case-based teaching modules. All residents received a pre- and post-rotation knowledge assessment and survey. The primary outcome was resident evaluation of fellow teaching. Secondary outcomes included fellow self-evaluation of teaching, resident knowledge of rheumatologic conditions, and resident evaluation of the Rheumatology rotation.

Results: 10/15 residents (66.6%) in the pre-intervention group and 7/9 residents (77.8%) in the post-intervention group completed the post-rotation survey. Pre-intervention feedback included desire for case-based instruction, a structured approach to rheumatologic diagnoses, and increased teacher-learner interaction. After the intervention, resident rating of fellow lectures improved from 2.75 to 3.60 on 4-point Likert scale (p<0.05) and amount of interaction/discussion improved from 2.63 to 3.60 (p<0.05). Pre and post-rotation knowledge assessment analysis was limited by suboptimal completion rates. Data collection regarding fellow self-evaluation of teaching and resident rotation evaluation will be completed by July 1, 2016.

Conclusion: Residents on the pediatric rheumatology rotation value case-based, interactive modules, which improve satisfaction and guide teacher-learner discussions about the complex clinical reasoning process in rheumatology. Additionally, this study suggests that computer-assisted case-based modules may be an effective, standardized and easily accessible modality to enhance fellows’ teaching of residents.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/enhancing-pediatric-rheumatology-education-through-computer-assisted-fellow-taught-case-modules/