Background/Purpose: There exists a critical lack of rheumatology resources in many parts of the world including sub-Saharan African countries. As a result, in these countries, rheumatology education is limited and often provided by specialists with variable rheumatology expertise. As an initial step to improving rheumatology capacity in Africa, our organization “Rheumatology For All” (RFA) has developed a rheumatology program for Internal Medicine (IM) Residents that can be delivered in person or virtually. Here we describe the evolution, implementation and acceptance of the virtual educational program in Rwanda.

Methods: We delivered a virtual rheumatology curriculum course for second year IM residents (approximately 30/year) in the University of Rwanda, Rwanda in 2021,2022 and 2023.Weekly lectures and tutorials were delivered (in English) over 16 weeks by rheumatology faculty from Ghana, Ethiopia, South Africa, United Kingdom, United States and Canada. In 2021, prerecorded lectures were uploaded to a central course website for students to review in preparation for weekly interactive online tutorials. In 2022 and 2023, there were no prerecorded lectures only the interactive lectures and tutorials. Additional teaching material including customized videos demonstrating musculoskeletal exam techniques and reading material was uploaded to a central website. In 2023, the virtual lecture series was followed by a week-long program delivered in Kigali by 4 faculty (CH, IC, MM, RS) consisting of supplementary lectures, case-based tutorials and clinical skill teaching. We evaluated virtual course experiences from 29 responding students (13 in 2021; 12 in 2022; 4 in 2023) and evaluated on-site teaching experiences from 10 students.

Results: Feedback from 2021 was incorporated into the 2022 and 2023 courses when feasible. Only 8/29 (27%) were able to attend all virtual lectures. All students found lectures and tutorials beneficial, especially physical exam videos. Half (52%) wanted more interaction with faculty (2021 vs 2022 p=NS).Some students reported difficulty accessing online content, though this improved in 2022 after switching to a university-based platform. Case-based discussions were considered important and culturally relevant images were appreciated. Students requested more clinical cases, including student-led case presentations even if this extended course/tutorial duration. While appreciative of the online course, many students requested on-site training to allow more face-to face discussion, bedside teaching, and hands-on demonstration of rheumatology skills. Student comment: “… we hope this will continue for the coming years and probably not only virtually but also [face-to-face] … It would be good if we share cases … (though we don’t have all investigations) …” At the end of the courses, students’ confidence level with rheumatology cases was good with a median rating of 7/10 (range 5-9) for the virtual course and 7.5 (range 5-8) for the in-person course.

Conclusion: The RFA virtual rheumatology course is a feasible means to provide rheumatology education to African medical students but does not replace the need for in person teaching. This program will continue to evolve in response to regional needs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/delivery-of-rheumatology-education-to-internal-medicine-residents-in-rwanda-evaluation-of-a-new-virtual-rheumatology-course-supplemented-by-on-site-clinical-teaching/