Background/Purpose: An increasing number of nurse practitioners (NPs) and physician assistants (PAs) are pursuing careers in rheumatology. To serve their educational interests, the American College of Rheumatology and the American Association of Physician Assistants will launch “The Training Rheum”, a 3-day continuing professional development (CPD) course offered August 2019 and January 2020. This program includes instruction in physical exam skills of the hand, wrist, and elbow, reinforced through low-stakes, formative assessment. An interprofessional group of Training Rheum faculty was engaged in a statistically-guided consensus project to develop a useful learning and assessment tool geared to the needs of advanced clinicians new to the practice of rheumatology.

Methods: A literature review was performed to determine physical exam maneuvers of the hand, wrist and elbow that were relevant to informing a clinical diagnosis. Seven faculty involved in the practice and assessment sessions engaged in a 3-step Delphi process. Step 1 involved reviewing the physical exam maneuvers identified in the literature review, and offering suggestions for additional items for the group to consider. In step 2, each faculty member rated every item’s importance relative to a curriculum designed for NPs or PAs working in rheumatology, using a 5-point Likert scale (1 = not at all important; 5 = extremely important). In the third step, faculty were asked to make a final 5-point rating considering the group’s overall average rating for each item and their own initial rating. Individual responses to each step remained anonymous. To determine the final consensus checklists, items meeting the predetermined criteria of mean >/= 4 and standard deviation (s.d.) < /= 1 were retained.

Results: All seven faculty members (4 physicians (rheumatologists), 2 NPs, and 1 PA) completed all three Delphi steps. The initial list, including items added in step 1, consisted of 78 elements. The consensus process eliminated 22 items, leaving 53 in the final version of the checklist. Mean ratings of all elements for step 2 and step 3 are shown in Table 1.

All seven faculty members (4 physicians (rheumatologists), 2 NPs, and 1 PA) completed all three Delphi steps.

The initial list, including items added in step 1, consisted of 78 elements. The consensus process eliminated 22 items, leaving 53 in the final version of the checklist.

Mean ratings of all elements for step 2 and step 3 are shown in Table 1.

Conclusion: Using a systematic consensus exercise, an interprofessional group of faculty participating in the “Training Rheum” CPD program has developed a checklist for use in teaching and assessing learners’ physical examination of the hand, wrist, and elbow. The next steps will include an evaluation of the effectiveness of this tool, including its response process, internal structure, relation to other variables, and consequences, when used in actual teaching sessions.

Exam Consensus Abstract Table

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-shared-mental-model-for-teaching-and-assessing-examination-of-the-hand-wrist-and-elbow-in-the-training-rheum-continuing-professional-development-program/