OP0366 Ambulatory rheumatology teaching day – a 360-degree evaluation of stakeholder experiences
Authors: L. Ward, S. Stebbings
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The Dunedin School of Medicine, New Zealand, include an ambulatory teaching day for 5th year medical students within their rheumatology curriculum. This day involves clinical lectures, examination skills, and clinical assessment of patient volunteers. This is often the students' first experience of conducting a rheumatology consultation. <h3>Objectives</h3> To evaluate the effectiveness of the Ambulatory Rheumatology Teaching Day from the perspective of all involved stakeholders, to inform on-going development of this teaching programme. <h3>Methods</h3> Independent focus groups of patients (two groups, n=12), consultants/clinical lecturers (one group, n=4), and 5th year medical students (four groups, n=19) involved in ambulatory rheumatology teaching days were conducted. Transcripts were analysed using thematic analysis, and themes compared across the three stakeholder groups. <h3>Results</h3> All stakeholder groups found the ambulatory day well-structured, educational, and inclusive. Patient contact provided a bridging opportunity between theory and practice; students reported a broader perspective on the lived experience of rheumatic conditions, and improved clinical and examination skills. Consultants found the one-day format created scheduling issues with their clinical workload, and suggested two half-day sessions would enable all rheumatology consultants to input into at least one of the sessions. Students and patients supported this format; students further suggested radiology and laboratory diagnostic tutorials prior to the ambulatory day, to aid their clinical assessment experience. All stakeholders observed that student diagnosis was mainly dependent on pronounced clinical presentation. Students were competent in diagnosing rheumatoid arthritis and gout, but failed to diagnose ankylosing spondylitis and calcium pyrophosphate dihydrate crystal deposition (CPPD). Greatest knowledge gains were reported for the conditions of ankylosing spondylitis and psoriatic arthritis. While students reported no interaction issues with the patients, both consultants and patients observed that several students were hesitant to conduct the physical examination, appearing concerned they may cause pain to the patient. Accordingly, students expressed a preference for more clinical supervision during the patient examinations; whereas the consultants favoured the student being independent, developing their questioning skills to improve their examination technique. Patients supported this independent approach to teaching the clinical assessment, and suggested the use of prompt sheets to engage the students in questioning regarding clinical presentation, symptoms, and medications. <h3>Conclusions</h3> The ambulatory rheumatology teaching day provided a supportive and effective learning environment for introducing 5th year medical students to the patient consultation process. Students gained both clinical skills and a valuable understanding of the patient perspective of a variety of rheumatic conditions. Students would further benefit through prior tutorials on diagnostic skills, with a focus on interpretation of radiology and laboratory results. Additionally, enhancing the role of the patient as teacher will aid the examination process, and highlight the importance of both clinical and patient outcome priorities. <h3>Disclosure of Interest</h3> None declared