Background/Purpose: Despite frequent use of infusion therapies, previous studies have demonstrated that trainees are poorly knowledgeable in managing infusion reactions, resulting in patient safety concerns. There are no easily implementable curricula addressing this barrier. The goal of this project was to refine, implement, and evaluate a concise and exportable curriculum on infusion reactions management for rheumatology fellows.

Methods: Fellows from 6 training programs completed an online pre-curriculum survey. Participants were emailed a link to a 9-minute educational video describing the pathophysiology and management of infusion reactions with a focus on anaphylaxis. The following week, fellows managed a simulated infusion reaction in a telephone conversation with “an infusion nurse.” Two examiners scored simulation performance on a standardized form, then provided immediate feedback. A post-curriculum survey assessed changes in self-reported confidence and comfort managing acute infusion reactions.

Results: Pre-curriculum. Learning about infusion reactions was deemed “extremely” or “somewhat useful” by 92% (30/32). While 72% of respondents indicated no prior formal training on identification or management of infusion reactions, 54% had been directly involved in managing an acute infusion reaction; 87% of those were involved in more than one. Of fellows who had managed infusion reactions, 61.1% reported feeling “somewhat uncomfortable” doing it (Table 1). Exactly one half of the participants were “somewhat not confident” or “not at all confident” in doing so (Table 2).

Simulation. Fellows generally performed well, especially on the topics directly addressed in the video. However, learners across institutions missed similar expected tasks of infusion reaction management, such as activating EMS, ordering oxygen, notifying family, and adding the medication to the allergy list.

Post-curriculum. After completing the curriculum, 96% (27/28) of respondents reported feeling “extremely comfortable” or “somewhat comfortable” managing infusion reactions. All participants reported feeling either “extremely confident” or “somewhat confident” in their ability to manage these reactions. Fellows provided overwhelming positive feedback after the simulation.

Conclusion: This short curriculum successfully addressed a knowledge gap in management of acute infusion reactions in rheumatology fellows. Fellows agreed that the curriculum was needed. Respondents across institutions missed performing similar tasks on the infusion reaction simulation. Completing the curriculum increased participants’ comfort and confidence in their ability to manage infusion reactions. Ongoing improvements are focused on creating a fully online interactive curriculum including an updated simulation script, a high-fidelity simulation exercise with real-time feedback, and expanding the curriculum to medicine residents and other subspecialty fellows.

Table 1. Comfort level with managing acute infusion reactions before and after exposure to the infusion reactions curriculum

Table 2. Confidence in managing acute infusion reactions before and after exposure to the infusion reactions curriculum

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/itching-to-learn-infusion-reactions-curriculum-for-medicine-trainees/