Background/Purpose:

Lupus is one of the prototypic rheumatic
diseases, yet only a small amount of time in medical school curricula is
devoted to lupus-specific education.  Moreover, when present, most lupus curricula
focus on lists of disease characteristics, overlooking the challenging aspects
of the disease, including its often elusive presentation and the social and
ethnic factors that contribute to patient outcomes.

To address these concerns, we designed a library
of interactive case studies titled “Practice Improvement using Virtual Online
Training,” or PIVOT.  These cases highlight the diagnostic reasoning
necessary when evaluating a patient with suspected lupus or lupus-related
complications.  Unlike traditional curricula, PIVOT engages learners on an
interactive diagnostic journey accessible from any mobile or desktop device.
 Each case has 8 key clues to focus the learner as they work through the
case.  A point score gives feedback on learner progress.  Embedded
multimedia to demonstrate patient history and physical exam findings add to the
case interactivity and authenticity, and introduce social themes and concepts
of health disparities in lupus.  Learners select which laboratories to order
and interpret the results to arrive at a diagnosis.  Each case is followed
by a full debrief as well as the diagnostic pathway of expert clinicians as an
additional learning opportunity.  In this manner, PIVOT reinforces
important lupus concepts including diagnosis and health disparities in a fresh,
appealing format, while also piloting an innovative method of medical
education.  

Methods:

Twelve Fourth-year medical students from a
single medical school completed PIVOT cases during their elective in
rheumatology.  Our primary outcome measure was learner satisfaction.
 Secondary outcomes included general feedback about the PIVOT platform and
educational content. A descriptive analysis was performed of the data and
free-text responses.

Results:

Student feedback for the PIVOT cases was
positive.  100% of learners rated the PIVOT experience ³4 on a 5-point
Likert scale.  

Survey comments highlighted the most effective
teaching points:

• “I liked having to order labs and think about how the exam and labs made certain diagnoses more or less likely”
• “[I learned about] atypical manifestations, subtle history and physical clues… what labs to look for and what else to keep in mind (viral infection, drug induced lupus, etc)”
• “There are significant health disparities in lupus that lead to morbidity that [can be] partially preventable”

Conclusion:

PIVOT, a novel, interactive digital case series,
successfully engaged novice learners in lupus education.  The case-based
curricula richly illustrated both diagnostic reasoning and social
considerations that may be overlooked by traditional curricula. Learners found
the key clues and interactive lab ordering unique and appealing.  These
features may be augmented in future cases to further expand PIVOT’s utility.