Background/Purpose: Internal medicine (IM) residents need to be trained in the diagnosis and care of patients with rheumatologic disease. Our prior data show that a multimodal simulation training session (MSTS) enhanced curriculum improves post graduate year (PGY) 1 IM residents’ self-confidence in rheumatologic history taking, physical exam, ordering and interpreting laboratory test results, procedures and patient care. To assess if this enhanced curriculum has a long-term impact on trainees’ self-confidence, we compared self-assessment surveys of PGY3 IM residents who received this MSTS curriculum while PGY1 residents to those who had not.

Methods: Since 2014, all PGY1 IM residents participate in a MSTS enhanced curriculum during the ambulatory rheumatology block which includes direct observation , discussion and feedback of their evaluation of a standardized patient with knee pain as well as knee aspiration training using a mannequin model. All PGY3 residents are invited to complete a web-based survey assessing confidence (0=not confident, 100=extremely confident) in performing a rheumatologic history, exam and common rheumatologic procedures (injection and aspiration of the knee and shoulder and trochanteric bursa injection), in ordering and interpreting rheumatologic lab tests (ESR, CRP, RF, CCP, ANA) and in caring for patients with OA, SLE, RA, gout, and fibromyalgia. The survey also includes demographics and participation in additional rheumatology electives. We compared the PGY3 survey results between those who had participated in the MSTS enhanced curriculum 2 years prior during their PGY1 year (Group 1) with an historical control group who did not have the enhanced curriculum (Group 2)using the Wilcoxon Signed Rank test. The Institutional Review Board approved the study.

Results: 33/42 (79%) PGY3 IM residents from the MSTS enhanced group (Group 1) and 67/85 (79%) from the control group completed the survey. 48% of respondents were female in Group 1 and 55% were female in Group 2. 14/33 (42%) in group 1 and 30/67 (45%) in group 2 took an additional rheumatology elective during training. There was a significantly higher self-assessed confidence in ordering and interpreting ANA and RF in those residents that had participated in the MSTS enhanced curriculum (Group 1) compared to controls (Group 2). There was no significant difference in self-assessed confidence in all other metrics (Table).

Conclusion: Our MSTS enhanced curriculum during the PGY1 ambulatory rheumatology block was associated with higher self-assessed confidence two years later at the PGY3 level in ordering and interpreting ANA and RF, but not in the other metrics measured. This suggests that repeat or additional rheumatology specific training may be necessary during the later years of residency to improve IM residents’ confidence in all aspects of the diagnosis and care of patients with rheumatologic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-impact-of-an-enhanced-rheumatology-curriculum-for-internal-medicine-residents/