Abstract
This prospective study examines the influence of an online curriculum in residents’ knowledge of cutaneous manifestations of vasculitis and autoimmune connective tissue diseases.
Dermatologists must be experts in the diagnosis, evaluation, and management of the cutaneous manifestations of vasculitis and autoimmune connective tissue diseases (ACTDs). However, the rarity of these conditions limits the acquisition of clinical expertise during dermatology residency training.1,2
Case-based online dermatology curriculums have proven successful in increasing the knowledge base of all levels of medical learners.3,4 The objectives of the present study were to determine the baseline knowledge of dermatology residents on the diagnosis, evaluation, and management of vasculitis and ACTDs and to determine dermatology residents’ knowledge acquisition after participating in an interactive, case-based, online vasculitis and ACTD educational curriculum.
Methods
The institutional review board at Oregon Health and Science University approved this study. Participants received a written consent form at the start of the study, and participation in the study was used as implied consent. The approach to curriculum development described in Curriculum Development for Medical Education: A Six-Step Approach, including a needs assessment for dermatology educators and residents, was used for curriculum construction. The vasculitis and ACTD curriculum was created with 3 sections: cutaneous lupus erythematosus and dermatomyositis, morphea and systemic sclerosis, and vasculitis. Each case-based section is composed of 5 PowerPoint (Microsoft) modules focused on clinical presentation, histology, pathophysiology, systemic complication screening, therapeutic ladders, medication monitoring, treatment during pregnancy, and outcome measures. Experts from diverse institutions reviewed the modules for accuracy and clinical consensus. The Association of Professors of Dermatology mailing list was used for dermatology resident recruitment through program leadership. Participants accessed the curriculum through Sakai software (Apereo Foundation). Completion of a pretest was required prior to starting each of the 3 sections of the curriculum. Posttests and satisfaction surveys were required on completion of each of the 3 sections of the curriculum. Pretest and posttest assessments were formulated based on curriculum objectives.
Descriptive statistics were performed to summarize participants’ demographics. Knowledge acquisition was estimated by comparing the mean percentage of correct answers between pretests and posttests using 2-tailed paired sample t tests. Analysis of variance was used to examine differences in means. All statistical analysis was performed using Stata version 13.1 (StataCorp).
Results
All 47 participants (12 men and 35 women; postgraduate year [PGY] range, 2-5) completed at least 1 entire topic section of the curriculum. Participant demographics are summarized in Table 1. All PGY levels and 28 unique universities were represented. Pretest and posttest scores are summarized in Table 2. Pretest scores did not differ based on sex, PGY level, or region. As supported by the data in Table 2, knowledge acquisition was statistically significantly improved in all 3 portions of the curriculum. Survey results indicated that all participants agreed or strongly agreed that the curriculum was engaging, usable, and contributed to their knowledge base (data are available from the authors).
Table 1. Characteristics of the Study Group.
| Characteristic | No. (%) |
|---|---|
| Total No. of participants | 47 |
| No. of participants who completed entire curriculum | 32 (68) |
| Sex | |
| Male | 12 (26) |
| Female | 35 (74) |
| Postgraduate year | |
| 2 | 17 (36) |
| 3 | 20 (43) |
| 4 | 9 (19) |
| 5 | 1 (2) |
| Total No. of universities represented | 28 |
| Regions of United States represented | |
| Midwest | 10 (21) |
| Northeast | 20 (43) |
| Southeast | 2 (4) |
| Southwest | 8 (17) |
| West | 7 (15) |
Table 2. Dermatology Residents’ Test Scores.
| No. of Participants | Test and Education Level | Average Correct, % (Range) | P Value | |
|---|---|---|---|---|
| Pretest Score | Posttest Score | |||
| 46 total | Cutaneous lupus erythematosus and dermatomyositis | 68.2 (31.3-93.8)a | 90.9 (70.0-100)a | <.001 |
| PGY2 | 64.0 (31.3-93.8) | 89.6 (70.0-100) | ||
| PGY3 | 70.3 (50.0-93.8) | 91.3 (80.0-100) | ||
| PGY4 | 70.8 (31.3-87.5) | 92.2 (86.7-100) | ||
| 36 total | Morphea and systemic sclerosis | 61.3 (25.3-90.5)a | 88.3 (70.0-97.2)a | <.001 |
| PGY2 | 59.1 (25.3-90.5) | 86.6 (70.0-94.4) | ||
| PGY3 | 58.1 (35.8-78.9) | 89.4 (82.8-100) | ||
| PGY4 | 62.6 (31.6-84.2) | 88.9 (75.0-97.2) | ||
| 32 total | Vasculitis | 61.9 (40.0-100)a | 89.7 (65.2-100)a | <.001 |
| PGY2 | 62.1 (40.0-100) | 90.8 (65.2-100) | ||
| PGY3 | 61.3 (40.0-90) | 89.6 (69.6-100) | ||
| PGY4 | 57.5 (40.0-70) | 88.8 (65.2-100) | ||
Abbreviation: PGY, postgraduate year.
Overall average score.
Discussion
Despite their rarity, vasculitis and ACTDs are associated with considerable morbidity and increased mortality; ergo, the ability to accurately diagnose, evaluate, and manage patients with these conditions is paramount. Online modules increase knowledge and improve the clinical practice of medical students, residents, and practicing physicians.4,5,6 This online curriculum was created to fill a potential knowledge gap for dermatology residents in the diagnoses, workup, and treatment of vasculitis and ACTDs. Pretest scores were not correlated with PGY level, suggesting that dermatology residents are not acquiring this knowledge during standard residency training. Our study supports the efficacy of the online vasculitis and ACTD curriculum for knowledge acquisition by dermatology residents.
Our study has several strengths. Participating residents were distributed across training levels and represented 28 unique universities. The curriculum was developed with standardized methodology and input from multidisciplinary medical educators and experts within each field. The participants were highly satisfied with the curriculum.
Limitations include the small sample size, which limits generalizability, self-selection of participants, lack of delayed testing for learning retention, and lack of assessment of influence on clinical practice.
Conclusions
Vasculitis and ACTDs are rarely encountered during clinical training. This study provides evidence of training knowledge gaps related to diagnosis and management of these disorders across the United States and at all PGY levels. This online vasculitis and ACTD curriculum enhances exposure to these conditions and results in short-term knowledge acquisition. Future studies to assess long-term mastery and improved patient care are needed.
References
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