Background/Purpose: Traditional medical school curricula divided the basic sciences from clinical rotations using a compartmentalized approach, though the need for curricular integration in the preclinical years is now well recognized.[1] Simulation offers learners opportunities for active engagement with basic science knowledge in relevant clinical contexts, thereby enhancing knowledge acquisition.[2]   We developed a simulated clinic experience for pre-clinical medical students to reinforce learning content presented in the rheumatology course.

Methods: Students were divided into groups of 3-4 learners to rotate through a series of 3, 20-minute standardized patient (SP) cases during which they were tasked with performing a targeted history and physical exam.  Small groups then had 10 minutes to discuss their findings to develop a differential diagnosis and determine next best step in diagnostic testing for each case. The activity concluded with a large-group debrief with a content expert.  Learners’ evaluation of the activity was assessed through a voluntary, anonymous online survey.

Results: Twenty-five (18%) learners responded to the survey. Eighty-eight percent (22/25) of respondents found the activity extremely or quite relevant to their role as a future physician. All respondents felt the small-group format and the pace and duration of the learning activity were appropriate. Greater than 90% of respondents found the activity to be extremely or quite effective for reviewing and applying learning content from the rheumatology course, practicing how to approach specific chief complaints, practicing history taking skills, practicing physical exam skills, practicing differential diagnosis formation skills, and practicing creating a diagnostic plan for the cases.  Eighty-four percent (21/25) of respondents felt the large group debrief was effective. Twenty out of 24 respondents rated the activity’s overall effectiveness as ≥ 8 out of 10.

Conclusion: The simulated rheumatology clinic activity was well received by learners, who rated it as effective for reinforcing and applying concepts discussed in the rheumatology basic science curriculum. Simulation-based activities structured like this one can provide opportunities for clinical applications in other domains of the pre-clinical curriculum.  Future directions include evaluating higher-order learning outcomes beyond learner perception.

[1] Bandiera G, Boucher A, et al. Integration and timing of basic and clinical sciences education. Med Teach. 2013 May;35(5):381-7. doi: 10.3109/0142159X.2013.769674

[2] Eason, MP. The use of simulation in teaching the basic sciences. Curr Opin Anaesthesiol. 2013 Dec;26(6):721-5. doi: 10.1097/ACO.0000000000000008.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/simulated-rheumatology-clinic-bridging-basic-science-and-clinical-application/