Background/Purpose:

Immunology knowledge in the rheumatology community is important for a better understanding of disease pathogenesis and management, especially in an era of an expanding number of biologic therapies. Focus on immunology and immunopharmacology within rheumatology fellowship training programs varies depending on institution, as well as the involvement and availability of immunologists. The ACGME Program Requirements for Rheumatology requires “knowledge in pharmacokinetics, metabolism, adverse events, interactions, and relative costs of drug therapies used in the management of rheumatic diseases” and 5% of the rheumatology certification exam tests immunology and pharmacology. Immunology knowledge of rheumatology fellows and attendings has anecdotally been inadequate, though official data on immunology and immunopharmacology knowledge is lacking. We hypothesized that teaching and applying immunology in the clinic setting at “point of care” would promote a better understanding of immunopharmacology.

Methods:

Over the course of 6 months, with the use of diagrams and flash cards, a brief (25min) tutorial covering the basic science behind a drug, followed by the pharmacology of said drug, was held at every fellow’s clinic by our immunologist and a senior fellow. Baseline immunology and immunopharmacology knowledge of the rheumatology fellows was determined with a pre-assessment test on the selected topic prior to each tutorial. The handouts were compiled into a book, which was available both in print and online and used on a regular basis when discussing patient management in clinic. The attending would initially model how to teach the material in a 3-5 minute format, and thereafter the fellow would use the same material to teach medical residents and students. A post-test assessment was performed 6 months after the lectures.

Results:

Rheumatology fellows showed a significant improvement in test scores after our immunology tutorials, with pre-test scores ranging from 51-68% to post-test scores 82-95%. Post-test assessments not only evaluated improvement in knowledge, but also identified areas of weakness for repeat teaching.

Conclusion:

Teaching immunology and immunopharmacology at “point of care” has proven to be an effective and well-liked tool to use in clinical practice among rheumatology fellows. Our innovative approach makes immunology clinically relevant and will indirectly improve patient care given better understanding of drug side effects and interactions. Our approach is interactive, convenient, time-efficient, flexible, easily updated, promotes the “fellow as teacher”, and can be used in the clinic even by programs with limited immunology expertise. We encourage application of this approach to future generations of rheumatology fellows within our fellowship program and beyond.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunology-and-immunopharmacology-at-point-of-care-a-quality-improvement-teaching-initiative-for-rheumatology-fellows/