Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


A Controlled Pilot Study On the Use of Active Learning Techniques During a Rheumatology Elective for Medical Residents.

Scheers-Masters1,  Joshua, Blumenthal2,  David R., Macrae3,  Jeanne, Avitable3,  Matthew, Lazaro4,  Deana M.

SUNY Downstate, Brooklyn, NY
VA NY Harbor Healthcare System, Brooklyn, NY
SUNY Downstate Medical Center, NY
Brooklyn VA, Brooklyn, NY

Background/Purpose:

There is a need to train physicians to evaluate musculoskeletal (MSK) complaints. Previously, we found that providing passive learning materials to residents attending rheumatology clinic had no impact on measures of rheumatology knowledge and clinical exam proficiency. The purpose of this study was to examine the impact of active learning based upon Kolb's experiential theoretical framework on rheumatology knowledge, MSK physical exam skills, and subjects' attitudes towards rheumatology.

Methods:

Forty SUNY Downstate medical and neurology interns were enrolled in the study and completed a 45 question multiple choice (MC) pre-test and questionnaire. All residents were randomly assigned to participate in either an ambulatory rheumatology elective or another subspecialty experience for four weeks although all Neurology residents were assigned to the control arm due to administrative constraints. 24 residents completed the study after 6 months. All residents received a copy of the Primer on the Rheumatic Diseases. Residents assigned to the rheumatology group were given 12 case-based learning modules and 12 quizzes; each quiz was reviewed and discussed with a rheumatology attending. The rheumatology group had additional instruction on the MSK exam using active learning techniques and arthrocentesis and injection techniques using simulators. They participated in 3 out-patient Rheumatology clinic sessions and journal club weekly. At the end of the elective month, both groups completed a 45 question MC post-test, a 4 station objective structured clinical examination (OSCE) on the evaluation and treatment of MSK diseases, and a post- questionnaire.

Results:

No significant difference was seen on the pre-test between the two groups (0.508 vs 0.504, p=0.913), however, the rheumatology group had a significantly higher score on the post-test (0.716 vs 0.598, p=0.011). On the OSCE, the rheumatology group had a significantly better performance on all four stations, including arthrocentesis (0.776 vs 0.519, p<0.0005), lower extremity exam (0.684 vs 0.553, p=0.019), upper extremity exam (0.615 vs 0.479, p=0.039), and clinical cases (0.628 vs 0.424, p=0.001). On the questionnaires, the rheumatology group had a significantly greater change in confidence in their ability to treat arthritis compared with the controls (1.393 vs 0.167, p=0.004). Similarly, the rheumatology group had greater increase in confidence in their ability to treat as a specialist (1.014 vs 0.089, p = 0.016). No significant differences were found for questions relating to who should treat arthritis (primary care physicians or rheumatologists) or enthusiasm for the field of rheumatology.

Conclusion:

In this small study, we found that integrating active learning techniques based upon Kolb's experiential theoretical framework into a rheumatology elective had a significant impact on interns' rheumatology knowledge as measured on a multiple choice examination, MSK clinical skills as measured on a 4 station OSCE, and confidence in treating arthritis based on a questionnaire.

Funding for this project was provided by the American College of Rheumatology Research and Education Clinician Scholar Educator Award.

To cite this abstract, please use the following information:
Scheers-Masters, Joshua, Blumenthal, David R., Macrae, Jeanne, Avitable, Matthew, Lazaro, Deana M.; A Controlled Pilot Study On the Use of Active Learning Techniques During a Rheumatology Elective for Medical Residents. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1593
DOI:

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