Feature

Focus on Fellows: Immersive summit targets education gap for young physicians

Cassandra Calabrese

The specialty of rheumatology has become increasingly popular over the past several years for physicians who have completed their residencies, which has been attributed to a variety of factors, including lifestyle, job satisfaction, job availability, mentorship opportunities, and intellectual interest.

However, the demands for declarative and procedural learning have accordingly increased as well, placing ever-growing pressures on post-residency physician trainees. Most fellowship programs are small, with 1 to 3 peers within a given training year, and opportunities for fellows to learn collectively outside of the confines of individual programs are limited.

Responding to the Need

Although several independent groups have brought rheumatology fellows together for collective educational opportunities, those have largely focused on the business side of clinical practice — an area where academic programs rarely provide guidance. To address this education gap, an academic-oriented activity for current and prospective rheumatology fellowship participants, devoid of commercial influence, was proposed to allow for peer-to-peer social and professional interaction that could lead to increased professional well-being, in addition to improving didactic and declarative knowledge in both traditional and evolving areas of rheumatology.

 
Leonard Calabrese, DO, and M. Elaine Husni, MD, MPH, along with faculty member, Cassandra Calabrese, DO, and first-year fellows.
Source: Cleveland Clinic

The activity was designed by using highly experienced faculty with broad professional backgrounds and experience to oversee a diverse array of educational and team-building activities. Finally, a strong effort was made to integrate some topic areas that are not traditionally emphasized in current rheumatology training programs, such as exploring the use of advanced communication techniques, the role of empathy in the doctor–patient relationship, and the science and challenges of incorporating wellness education and counseling.

This activity, titled “Rheumatology Summit for Fellows: A Master Class in RA, PsA, and SpA – Optimizing Therapy While Reducing Risks,” was co-chaired by Leonard Calabrese, DO, and M. Elaine Husni, MD, MPH, along with faculty members Neal Birnbaum, MD, Cassandra Calabrese, DO, Jeffrey Kaine, MD, and William Rigby, MD. The course consisted of a live, full-day continuing medical education meeting held in August 2018 in Orlando, Florida.

This event was attended by 52 trainees, who were nominated by fellowship directors from 40 institutions; most participants were current first- and second-year rheumatology fellows. The number of fellow attendees was purposely limited to create an immersive, intimate environment for learning. Vindico Medical Education served as the educational provider, with financial support provided by independent educational grants from AbbVie, Celgene Corporation, Lilly USA, LLC, Merck & Co. Inc. and Pfizer Inc.

An Immersive Experience

The faculty of renowned specialists specifically addressed the clinical aspects of the latest science and how it translates to real-life application in practice, with learning objectives such as:

  • Assess patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or spondyloarthropathy (SpA) for disease activity, prognosis, and comorbidities, such as serious and opportunistic infections, cardiovascular disease, and other complications.
  • Apply the latest treat-to-target guideline approaches for the management of patients with RA, PsA or SpA.
  • Incorporate advanced communication techniques in the rheumatologic encounter to establish stronger relationships with patients, identify cues for empathy and learn how to respond to them during the patient encounter, and engage in productive patient education as well as counseling on lifestyle and wellness behavior to optimize health outcomes.
  • Identify and incorporate best practices for the prevention and monitoring of complications for patients with RA, PsA or SpA, including risk profiling and vaccinations.
  • Summarize the role of an interdisciplinary team of experts, including the patient, to provide optimal care of patients with RA, PsA or SpA.
  • Describe common patient concerns regarding rheumatic disease and its treatment, as well as strategies to address these issues.

 
Source: Healio.com

The summit featured educational formats uniquely designed for the young physician audience to facilitate engagement, peer-to-peer interaction and knowledge transfer.

To prepare for the course, fellows were expected to submit and present clinical cases, which would then be discussed among their peers and facilitated by faculty in small-group settings. Further, articles to be reviewed during the journal club discussions were disseminated to attendees in advance of the summit. During the day-long activity, educational topics were covered in various unique formats (Figure 1), with question and answer sessions spaced throughout. 

A pre-summit survey demonstrated that attendees felt they had received inadequate training regarding the care of patients with common rheumatic conditions (Figures 2-3). In particular, 60% of attendees noted that fewer than 60% of their residency education was devoted to RA, PsA or SpA. Similarly, these disease states, as well as how to incorporate shared decision-making (SDM) into practice, were inadequately addressed in fellowship training.

 
Source: Healio.com

The impact of the education on the specific learning objectives was assessed via a pre- and posttest. The 119% overall relative increase knowledge and competence demonstrated the success of an immersive educational program to address deficiencies in rheumatology training (Figure 4).

Moreover, the overall effect size of the program was 0.98, meaning that participants were 54% more likely to administer evidence-based care because of the education received. Based on the average of 7 patients with rheumatic disease seen per week by attendees, approximately 1,400 patients seen per month are 54% more likely to receive evidence-based care as a result of this program.

 
Source: Healio.com

The success of the program is also highlighted by participant satisfaction; all attendees reported that the activity increased their competence in managing patients, and 98% believed that attending the summit will improve their ability to communicate with patients and caregivers. Moreover, all attendees noted that the activity provided an opportunity to interact with peers and faculty. Additionally, 98% of participants reported that the activity addressed and provided strategies for overcoming barriers to optimal patient care.

Follow-up Feedback

To assess the summit’s impact on clinical practice as well as sharing of knowledge, attendees were sent an email questionnaire 60 days after the educational activity. The findings indicated that all participants had implemented practice changes, including any or all the following: Using SDM and educating patients; using treat-to-target approaches, and; assessing patients with rheumatic disease for comorbidities. Due to these changes, all attendees reported improvements in patient health, including enhanced disease control, improved adherence, greater self-esteem and mental health, and enhanced patient engagement. Additionally, all attendees reported sharing the educational content with colleagues, potentially leading to systems-based changes toward improved patient care.

 
Source: Healio.com

This unique 1-day activity was developed to educate rheumatology trainees on clinical rheumatology, with an emphasis on RA, PsA and SpA, as well as advanced communication techniques, with an emphasis on empathy and on counseling patients about wellness behavior. Small-group discussion, interactive sessions, and challenging case presentations created an intimate learning environment for the exchange of knowledge among attendees and faculty, in addition to providing an opportunity for the trainees to meet and interact with their peers from across the U.S.

The inclusion of training around empathy for the patient was unique and well-received by the attendees. The activity greatly improved attendees’ knowledge of the topics and resulted in practice changes, sharing of best practices, and improvements in patient health. Future activities in this format, with a focus on clinical aspects as well as communication, empathy and wellness, will play a crucial role in cultivating the next generation of rheumatologists.

— Cassandra Calabrese, DO, is a rheumatologist in the department of rheumatic and immunologic diseases at the Orthopaedic and Rheumatologic Institute at
Cleveland Clinic.

Disclosure: Calabrese reports no relevant financial disclosures.

Cassandra Calabrese

The specialty of rheumatology has become increasingly popular over the past several years for physicians who have completed their residencies, which has been attributed to a variety of factors, including lifestyle, job satisfaction, job availability, mentorship opportunities, and intellectual interest.

However, the demands for declarative and procedural learning have accordingly increased as well, placing ever-growing pressures on post-residency physician trainees. Most fellowship programs are small, with 1 to 3 peers within a given training year, and opportunities for fellows to learn collectively outside of the confines of individual programs are limited.

Responding to the Need

Although several independent groups have brought rheumatology fellows together for collective educational opportunities, those have largely focused on the business side of clinical practice — an area where academic programs rarely provide guidance. To address this education gap, an academic-oriented activity for current and prospective rheumatology fellowship participants, devoid of commercial influence, was proposed to allow for peer-to-peer social and professional interaction that could lead to increased professional well-being, in addition to improving didactic and declarative knowledge in both traditional and evolving areas of rheumatology.

 
Leonard Calabrese, DO, and M. Elaine Husni, MD, MPH, along with faculty member, Cassandra Calabrese, DO, and first-year fellows.
Source: Cleveland Clinic

The activity was designed by using highly experienced faculty with broad professional backgrounds and experience to oversee a diverse array of educational and team-building activities. Finally, a strong effort was made to integrate some topic areas that are not traditionally emphasized in current rheumatology training programs, such as exploring the use of advanced communication techniques, the role of empathy in the doctor–patient relationship, and the science and challenges of incorporating wellness education and counseling.

This activity, titled “Rheumatology Summit for Fellows: A Master Class in RA, PsA, and SpA – Optimizing Therapy While Reducing Risks,” was co-chaired by Leonard Calabrese, DO, and M. Elaine Husni, MD, MPH, along with faculty members Neal Birnbaum, MD, Cassandra Calabrese, DO, Jeffrey Kaine, MD, and William Rigby, MD. The course consisted of a live, full-day continuing medical education meeting held in August 2018 in Orlando, Florida.

This event was attended by 52 trainees, who were nominated by fellowship directors from 40 institutions; most participants were current first- and second-year rheumatology fellows. The number of fellow attendees was purposely limited to create an immersive, intimate environment for learning. Vindico Medical Education served as the educational provider, with financial support provided by independent educational grants from AbbVie, Celgene Corporation, Lilly USA, LLC, Merck & Co. Inc. and Pfizer Inc.

An Immersive Experience

The faculty of renowned specialists specifically addressed the clinical aspects of the latest science and how it translates to real-life application in practice, with learning objectives such as:

  • Assess patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or spondyloarthropathy (SpA) for disease activity, prognosis, and comorbidities, such as serious and opportunistic infections, cardiovascular disease, and other complications.
  • Apply the latest treat-to-target guideline approaches for the management of patients with RA, PsA or SpA.
  • Incorporate advanced communication techniques in the rheumatologic encounter to establish stronger relationships with patients, identify cues for empathy and learn how to respond to them during the patient encounter, and engage in productive patient education as well as counseling on lifestyle and wellness behavior to optimize health outcomes.
  • Identify and incorporate best practices for the prevention and monitoring of complications for patients with RA, PsA or SpA, including risk profiling and vaccinations.
  • Summarize the role of an interdisciplinary team of experts, including the patient, to provide optimal care of patients with RA, PsA or SpA.
  • Describe common patient concerns regarding rheumatic disease and its treatment, as well as strategies to address these issues.

 
Source: Healio.com

The summit featured educational formats uniquely designed for the young physician audience to facilitate engagement, peer-to-peer interaction and knowledge transfer.

To prepare for the course, fellows were expected to submit and present clinical cases, which would then be discussed among their peers and facilitated by faculty in small-group settings. Further, articles to be reviewed during the journal club discussions were disseminated to attendees in advance of the summit. During the day-long activity, educational topics were covered in various unique formats (Figure 1), with question and answer sessions spaced throughout. 

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A pre-summit survey demonstrated that attendees felt they had received inadequate training regarding the care of patients with common rheumatic conditions (Figures 2-3). In particular, 60% of attendees noted that fewer than 60% of their residency education was devoted to RA, PsA or SpA. Similarly, these disease states, as well as how to incorporate shared decision-making (SDM) into practice, were inadequately addressed in fellowship training.

 
Source: Healio.com

The impact of the education on the specific learning objectives was assessed via a pre- and posttest. The 119% overall relative increase knowledge and competence demonstrated the success of an immersive educational program to address deficiencies in rheumatology training (Figure 4).

Moreover, the overall effect size of the program was 0.98, meaning that participants were 54% more likely to administer evidence-based care because of the education received. Based on the average of 7 patients with rheumatic disease seen per week by attendees, approximately 1,400 patients seen per month are 54% more likely to receive evidence-based care as a result of this program.

 
Source: Healio.com

The success of the program is also highlighted by participant satisfaction; all attendees reported that the activity increased their competence in managing patients, and 98% believed that attending the summit will improve their ability to communicate with patients and caregivers. Moreover, all attendees noted that the activity provided an opportunity to interact with peers and faculty. Additionally, 98% of participants reported that the activity addressed and provided strategies for overcoming barriers to optimal patient care.

Follow-up Feedback

To assess the summit’s impact on clinical practice as well as sharing of knowledge, attendees were sent an email questionnaire 60 days after the educational activity. The findings indicated that all participants had implemented practice changes, including any or all the following: Using SDM and educating patients; using treat-to-target approaches, and; assessing patients with rheumatic disease for comorbidities. Due to these changes, all attendees reported improvements in patient health, including enhanced disease control, improved adherence, greater self-esteem and mental health, and enhanced patient engagement. Additionally, all attendees reported sharing the educational content with colleagues, potentially leading to systems-based changes toward improved patient care.

 
Source: Healio.com

This unique 1-day activity was developed to educate rheumatology trainees on clinical rheumatology, with an emphasis on RA, PsA and SpA, as well as advanced communication techniques, with an emphasis on empathy and on counseling patients about wellness behavior. Small-group discussion, interactive sessions, and challenging case presentations created an intimate learning environment for the exchange of knowledge among attendees and faculty, in addition to providing an opportunity for the trainees to meet and interact with their peers from across the U.S.

The inclusion of training around empathy for the patient was unique and well-received by the attendees. The activity greatly improved attendees’ knowledge of the topics and resulted in practice changes, sharing of best practices, and improvements in patient health. Future activities in this format, with a focus on clinical aspects as well as communication, empathy and wellness, will play a crucial role in cultivating the next generation of rheumatologists.

— Cassandra Calabrese, DO, is a rheumatologist in the department of rheumatic and immunologic diseases at the Orthopaedic and Rheumatologic Institute at
Cleveland Clinic.

Disclosure: Calabrese reports no relevant financial disclosures.