Background/Purpose:

The 5 topics in rehabilitative rheumatology (RR) included in the ACR Core Curriculum Outline include exercise, adaptive equipment, orthotics, thermal modalities and splinting. A 2004 survey of Program Directors (PD) led to a subsequent increase in RR clinical symposia at ACR Annual Meetings. Fellowship program instruction in RR is still felt to be under-represented.

Methods:

An online needs assessment survey of PD (107), therapy providers (34), and physicians with an interest in RR (31) yielded response rates of 37%, 27% and 16%, respectively. For PD respondents, 56% did not offer a RR rotation, 71% had no one interested in leading a group teaching session, but 93% said self-study could be part of teaching resources. There was consensus among all respondents that exercise should be the first RR content to be addressed. Using certain software, we created a two-part, interactive, online educational module on exercise. The first part addresses exercise modalities, CDC exercise recommendations and creating an exercise prescription, and the second part presents current literature for self-directed study on exercise applications in selected rheumatic diseases.

An educational trial of the content in the first part of the exercise module was completed with fellows in the Carolina Fellows Collaborative as our study participants. Fellow level of confidence in, and frequency of, prescribing exercise, as well as providing an exercise prescription for a simulated patient, was assessed during a rheumatology OSCE (ROSCE) station. Fellows were then asked to provide an exercise prescription immediately after, and 6 weeks after completion of the exercise module. In a randomized subset of fellows, spaced education by email was used as a means to improve retention during the 6 weeks between the second and third prescription assignments. All prescriptions were scored using the same metrics applied during the ROSCE station.

Results:

18 fellows (85.7%) participated in the ROSCE. 4 of 21 fellows (19.0%) completed the exercise prescriptions immediately following completion of the module and 5 fellows (23.8%) completed the prescriptions 6 weeks after completion of the module, 1 of which had participated in the spaced education program. Only 2 fellows (9.5%) completed all 3 sets of prescriptions, none of which had completed the spaced education program. The average correct responses paralleled level of training, overall increasing from 70.94% to 85.42% with the introduction of the module content. At 6-week follow-up, the average score had fallen to 67.91%. Fellow confidence in prescribing exercise, assessed on a 6-point Likert-type scale, increased over the study from an average rating of somewhat unconfident to somewhat confident.

Conclusion:

We have created an online primer on exercise for use as part of a mini-curriculum on RR. In a pilot trial, completion of the module led to an immediate improvement in the completeness of an exercise prescription, but this improvement was not durable in the short-term, most likely due to the low participation rate and small sample sizes. A larger study including the effect of faculty supervision of learner participation is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-primer-on-exercise-an-interactive-online-educational-module-incorporating-spaced-education-to-supplement-the-acr-core-curriculum-outline-for-rheumatology-fellowship-programs/