Background/Purpose: Rheumapalooza was implemented in 2008 as an elective course with support from an ACR/REF Clinical Scholar Educator Award.¹ The course was incorporated into the required UW Medical School 2nd year curriculum in 2010 and expanded to 3 half days. In 2015 and 2016 a flipped classroom instructional model was incorporated. The UW implemented an entirely new 18 month preclinical curriculum for entering first year students in 2015 presenting new educational challenges. We describe lessons learned from ongoing curriculum revision with emphasis on increasing learner engagement.

Methods: The course was designed for 3 consecutive half-day sessions. Day 1 was structured as a series of foundational lectures;¹ Day 2 was initially delivered in large-group lecture format and was revised to place more emphasis on basic rheumatologic disorders and opportunities for active learning. Students are given required reading and 4 case studies (RA, Gout, JIA and SLE) to prepare prior to class. Faculty facilitate student discussion of cases in a small-group format. On day 3, students rotate through 14 stations, including adult and pediatric rheumatology patients, demonstrations of physical therapy, pathology specimens and imaging modalities. In the new curriculum course content is dispersed throughout several different blocks and there are decreased hours for in-class instruction. The other new challenges is that course presentation must be equivalent at 6 regional teaching sites. These constraints have lead to development of detailed faculty guides and incorporation of a webinar format. The patient panel experience will become an elective option in Seattle until alternate regional solutions are developed.

Multiple choice exams assess mastery of course material. Students complete course evaluations including numerical and qualitative responses for overall rating, achievement of learning objectives, ratings of specific lectures and days.

Results: The patient panel has received consistently high student ratings (Figure 1). Feedback on lectures indicated students felt overloaded and requested more opportunities for cementing knowledge. Modification of the 2^nd day to a small-group flipped classroom model was associated with improvement in student’s rating of active learning opportunities and overall satisfaction (Figure 1). However, students indicated concern about less coverage of rare disorders and inconsistencies between small group instructors.

Conclusion: Integration of a case-based flipped classroom model into the Rheumapalooza curriculum was associated with improved student satisfaction, however, the breadth of information covered decreased. These findings have important ramifications for future medical school curricula given increasing emphasis on active learning delivery models and shorter duration of pre-clinical teaching hours. Future work will focus on partnership with clinical year course directors to ensure adequate coverage of essential concepts across the entire curriculum while meeting the challenge of uniform content presentation over a five state area.

Reference:

1. Emery, Helen, Gardner, Gregory. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1433 DOI: 10.1002/art.29199.