Background/Purpose: Evidence suggests that Internal Medicine (IM) residents are not confident in basic rheumatologic skills (history taking, exams, and procedures).  To improve IM residents’ confidence in rheumatologic skills, we implemented and evaluated a multimodal simulation training session (MSTS) using standardized patients and mannequins to enhance Post Graduate Year (PGY) 1 IM residents’ rheumatologic skills. To assess the utility and effectiveness of the MSTS enhancement, we conducted pre/post self-assessment of residents completing the curriculum.

Methods: We developed and implemented our MSTS for all PGY1 IM residents rotating on the 1 week ambulatory rheumatology block during the 2014 academic year. The two-part training consisted of a live standardized patient (SP) and deliberate practice with a mannequin for knee aspirations with feedback for both. PGY 1 residents performed a rheumatologic history and exam on a SP presenting with monoarticular inflammatory knee arthritis and practiced knee joint aspiration using a mannequin under the direct supervision of an attending rheumatology faculty member.

All PGY 1 residents completed an online, self-assessment survey on self-confidence (0=not confident, 100=extremely confident) in performing a rheumatologic history, physical examination and common rheumatologic procedures pre/post their  rheumatology block as well as a separate MSTS evaluation form.  Pre/post-rotation assessments were analyzed and 2014 results compared to the 2013 academic year, a historical control using the Wilcoxon Signed Rank test.   IRB approval and consent was obtained prior to completing the survey. 

Results: In 2013 and 2014, 22/27(81%) and 39/43 (91%) of PGY1 IM residents completed pre/post surveys respectively. Both cohorts significantly increased (p<0.05) their self-assessed confidence ratings from pre to post rotation in all variables other than trochanteric bursa injection in the 2013 cohort (Table 1).  The 2014 cohort had significantly greater changes in self-assessed confidence ratings than the 2013 historical controls. The difference in the median in rheumatology history was 12, exam was 11, knee aspiration was 37 and knee injection was 34 (Table 1).  35/43 (81%) PGY1 IM residents strongly agreed and 8/43 (19%) agreed that the MSTS was a valuable training exercise.

Conclusion: Our results indicate that our MSTS enhanced curriculum improves residents’ self-confidence in performing a rheumatologic history and exam and knee injection and aspiration techniques when compared to an unenhanced prior curriculum. Further study is required to assess if these results are sustained over time and whether this translates into IM residents performing more procedures competently during their training.