Background/Purpose: The demand for rheumatologists continues to increase due to the high prevalence of rheumatic disease in a growing population. As outlined in ACR’s 2015 Workforce Study, recruitment of the future workforce is a critical part of strategies to address the predicted shortage. ACR has identified graduate medical education and early exposure at the medical student level as key parts of recruitment strategies. Yet, the diminished amount of time allotted to introduce and study rheumatic disease in the undergraduate medical curriculum stands at odds with this recommendation and may reduce the likelihood of attracting students to rheumatology. While there has been some attention paid at the graduate medical education level, little attention has been focused on the undergraduate level, particularly the pre-clinical years. We developed an interactive virtual patient platform that presents rheumatology case scenarios. Virtual patient platforms combine case-based learning with new technology and are increasingly used in medical school curricula as an engaging, interactive instructional strategy and assessment tool. Virtual patient platforms can, in theory, support learners’ development of clinical reasoning skills across health professions, but few studies provide evidence to support these claims. The development of clinical reasoning skills is of particular importance in rheumatology given the complex nature of rheumatic disease and diversity of clinical presentations.

Methods: We created a simulation platform, “Practice Improvement using Virtual Online Training” (PIVOT), to present virtual cases of patients. During their rheumatology block, 150 second-year medical students used PIVOT to work through a case of a young woman presenting with fatigue, joint pain, and low-grade fever, ultimately diagnosed with lupus. The case content (which included videos of the patient interview, photographs of exam findings, and lab results) was released via the app over four days. Each day, students worked in teams to answer 2-3 open-text questions and received timely feedback from an expert rheumatologist. Students also used a “differential diagnosis slider” to demonstrate their clinical reasoning by ranking diagnoses in order of likelihood.

Results: Individual responses to surveys were analyzed to measure user satisfaction. Use of the differential diagnosis slider and justifications for laboratory studies throughout the case measured clinical reasoning. The educational features most valued by learners included emphasis on clinical decision-making, working within a team, directed expert feedback, and support in “bridging the gap” between the pre-clinical and clinical years.

Conclusion: This application recognizes the evolving, iterative process of developing a differential diagnosis and encourages learners to engage in repeated hypothesis generation and refinement. Tracking the use of the differential diagnosis slider measures valuable information about the development of critical reasoning skills. This platform can be adapted for different learner levels in various settings. The asynchronous, technology-driven framework reflects the way healthcare providers increasingly interact in practice.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/practice-improvement-using-virtual-online-training-a-novel-app-based-platform-to-teach-clinical-reasoning-in-rheumatology/