Session Title: Education
Session Type: Abstract Submissions (ACR)
Opportunities for exposure to rheumatology are limited in medical school, especially during the clinical years. In addition, because the rheumatic diseases represent a small portion of the National Board of Medical Examiners Subject Examination (SHELF exam) for the Internal Medicine clerkship, clerkship directors are reluctant to devote limited class time to rheumatology.
This project aims to improve medical student exposure to rheumatology during the third-year Internal Medicine Clerkship via Decision-Based Learning (DBL), a simulated case-based teaching technique. Learners work in teams on a challenging clinical case. Teams are given a description of the patient’s history and physical examination; each team collaborates to generate a differential diagnosis, then order tests and studies to work up the case. A simulated “bank” of tests and studies is available, with each test coming with a “price” that the team is charged. The teams compete to solve the case by ordering and interpreting studies while also spending the least amount of money. Because of the cost-conscious and competitive nature of the exercise, learners are incentivized to employ prudent hypothesis testing and diagnostic reasoning to decide what is “the next best step” to arrive at the diagnosis.
DBL facilitates rheumatology exposure within the broad context of internal medicine, a format more appropriate for the medical student level than typical disease-specific rheumatology curricula. In addition, the DBL format highlights the diagnostic complexity of rheumatic cases. Students also practice critical thinking and cost consciousness, areas of medical education that are frequently lacking.
The project introduced DBL to third year medical students during their clerkship in Internal Medicine. Control sessions consisted of usual lecture-style didactics. Learners were given a survey after each session to rate their learning experience.
Student feedback for DBL sessions was significantly higher than control didactic sessions (p < 0.01). 67% of learners rated DBL a “10” on a 10-point Likert scale compared to 35% for control (p < 0.01). Positive responses to DBL were also noted in the survey comments:
“Really productive exercise; thought provoking”
“Very high-yield, learned lots of new things”
“Made us think about what to order & why- I don’t feel we have gotten much experience with that during the rotation”
A novel case-based teaching technique facilitated medical student exposure to rheumatology during their clerkship in Internal Medicine. DBL resulted in significantly higher ratings of didactic sessions compared to traditional lecture-style didactics. Learners found the DBL sessions to be engaging and educationally valuable. This interactive teaching method can enhance the learning experience during the Internal Medicine clerkship; the realistic context in which Rheumatology topics are addressed may make it more appealing for Clerkship Directors to adopt. These findings support future evaluation of DBL with a case-control study to determine efficacy in the principal areas of Rheumatology-specific knowledge, diagnostic reasoning, and cost awareness.
Rheumatology Research Foundation,
J. R. Pittman,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/using-decision-based-learning-to-highlight-rheumatic-disease-for-third-year-medical-students/