Background/Purpose
In many patients with rheumatoid arthritis (RA), the disease is not adequately controlled, and only a minority of patients attain the goal of consistent remission or low disease activity. Underlying clinical practice gaps and educational needs were identified and a study was conducted to determine if online, simulation-based educational interventions could improve competence and performance of rheumatologists in managing patients with RA.
Methods
A cohort of US-practicing rheumatologists who participated in simulation-based educational interventions was evaluated. The interventions consisted of four cases presented in a platform that allowed physician learners to choose from numerous lab tests and assessment scales as well as thousands of diagnoses, treatments, and procedures. The clinical decisions made by the participants were analyzed using an artificial intelligence technology, and instantaneous or delayed clinical guidance was provided employing current evidence-based and expert faculty responses. Participant decisions were collected after clinical guidance and compared with each user’s baseline data using a 2-tailed paired T-test to provide P values for assessing the impact of simulation-based education on the clinical decisions made by participants.
Results
The assessment sample consisted of185 rheumatologists who made at least one clinical decision within the simulation and proceeded to the end, debrief section. As a result of clinical guidance provided through simulation, significant improvements were observed in several areas of management of patients with RA, specifically:
- 32% improvement in the selection of a biologic agent in a patient with inadequate response to methotrexate (62% post intervention vs 30% baseline, P<.001)
- 11% improvement in recommendations for corticosteroids (77% post intervention vs 66% baseline, P=.044)
- 10% more participants correctly ordered clinical disease activity index and C-reactive protein to determine the level of disease activity (84% post intervention vs 74% baseline, P<.03)
- 16% improvement in selection of non-TNF biologic agent in a patient with RA not adequately controlled on methotrexate plus trials of etanercept and then adalimumab (60% post intervention vs 44% baseline; P=.004)
- 21% more participants selected an appropriate biologic in a patient failing an initial anti-TNF agent. (57% post-intervention vs 36% baseline, P<.001)
Conclusion
This study demonstrated the success of simulation-based educational interventions on improving the evidence-based practice patterns of rheumatologists in the management of patients with RA. Simulation-based instructions that lead to improvement in physician performance in a consequence-free environment can result in more evidence-based clinical decisions for RA and improvement in patient outcomes.
Disclosure:
N. Mehta,
None;
M. Warters,
None;
D. Blevins,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/simulation-in-continuing-education-improving-evidence-based-decisions-for-rheumatoid-arthritis-management/