Background/Purpose:  Rheumatology topics can be challenging for residents to master during training. In our program, a survey of residents completing a 2- or 4-week rheumatology elective in 2014-15 demonstrated that many still felt unprepared to provide primary care (67%) or inpatient care (46%) for patients with rheumatologic disease, and for board exams (56%). Residents were confident in their ability to diagnose rheumatologic conditions (71%) but less confident in management of these conditions (47%). We aimed to assess the role of the Virtual Rheumatology Clinic, an online self-study tool developed to supplement resident education in rheumatology through virtual exposure to several common rheumatologic diagnoses, in enhancing the education of the resident.

Methods:  Four virtual patient cases were developed to introduce evaluation and management options for patients presenting with symptoms commonly seen in primary care: 1) monoarticular swelling in an adult, 2) joint swelling in a child, 3) fatigue and unexplained fever, and 4) back pain. Each case begins with the complaint and proceeds through several stages. Learners’ decisions shaped the virtual patient’s course, allowing the trainee to practice longitudinal decision making and experimentation in a safe environment. Activities included drag-and-drop quizzes, script concordance testing, procedure simulation, and matching exercises, and offer immediate feedback to enhance learning. Links to images, videos, review articles, and primary literature were embedded as well. Modules were available to residents on the web via any computer or tablet. Rotating residents were given time to complete these modules during their elective. Participating residents were asked to complete a pre-test, a post-test associated with each module, and a final survey.

Results: Ten residents rotating in 2015-16 completed the pretest and survey, 7 completed at least one module post-test, and 16 completed the final survey. On post-tests, residents scored higher on knowledge-based multiple choice questions than on key features questions, (76% vs 64% average score). On a 0-10 scale, residents who completed at least one module rated these as helpful (8.8), easy to use (8.7), and realistic (8.1). They were rated as more useful in learning to care for patients in a primary care setting (8.7) or in the hospital (8.3) than for board study (7.4). Residents who completed modules were more confident in their ability to manage rheumatologic conditions and expressed greater interest in caring for patients with these conditions than those who did not complete any modules.

Conclusion:  The Virtual Rheumatology Clinic is a an online self-study tool developed to provide virtual exposure to common rheumatologic diagnoses likely to present in primary care. Participants in the pilot cohort found it helpful, easy to use, and realistic, and useful for a variety of settings. It is unclear whether participation increased interest in rheumatology or whether participants are self-selecting. Future work may be able to better assess knowledge acquisition and clinical reasoning skills by random selection of questions to be completed either before or after completion of each module.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-virtual-rheumatology-clinic-virtual-patients-for-resident-education-in-rheumatology/