Rachel M. Wolfe, MD, on Launching a Virtual Rheumatology Objective Structured Clinical Examination
The Carolinas Fellows Collaborative (CFC) is a unique collaboration among rheumatology fellowship training programs from North and South Carolina initially founded in 2004 by program directors from Duke University, Durham, N.C.; Medical University of South Carolina, Charleston; University of North Carolina at Chapel Hill; and Wake Forest Baptist Health (WFBH), Winston-Salem, N.C.
Here, the great coach shares territory with the great rheumatologist: The nuances of the patient’s history & exam inform the skilled clinician’s approach to the diagnosis & treatment plan.
The CFC began as a collective summer conference to enhance rheumatology fellow education through shared resources, expanding to include a Winter Symposium in 2006. The summer conference is held annually at WFBH, culminating in a cadaver lab experience. The Winter Symposium rotates among the other participating institutions, highlighting each institution’s exceptional educational strengths. Massachusetts General Hospital, Boston, began participating in the Winter Symposium in 2014.
During each Winter Symposium, the CFC conducts a Rheumatology Objective Structured Clinical Examination (ROSCE), providing formative assessments of fellow performance, which has been well received by fellow participants. With the COVID-19 pandemic, the traditional face-to-face ROSCE was transformed into a virtual format (vROSCE) in February 2021.
The vROSCE was conducted using a Zoom platform and comprised six stations, duplicated in parallel to accommodate 12 fellows at a time. Utilizing breakout rooms, fellows progressed through virtual stations, with performance assessments under direct observation receiving immediate feedback from rheumatology faculty.
Highlighting the relevance of virtual patient care delivery, one station assessed fellows’ skills in conducting a virtual new patient visit. The other five stations included:
- Dual-energy X-ray absorptiometry (DXA) interpretation and resultant treatment recommendations;
- Phone communication with a primary care provider regarding concern for giant cell arteritis;
- Recommendations to another rheumatologist for a patient with lupus, newly pregnant, currently taking mycophenolate mofetil;
- Renal pathology interpretation with associated treatment recommendations; and
- X-ray interpretation of musculoskeletal disorders.
Each station was 10 minutes in length, with an additional two minutes for feedback. One minute was allotted for transitioning fellows between virtual stations (breakout rooms).
Twenty-three fellows from five institutions participated, with half the fellows initially engaged in the vROSCE stations, while the other half completed a crystal analysis assessment quiz and a station devoted to writing an insurance appeal letter. After this initial 90-minute period, the two groups switched to complete the other half of the vROSCE. Evaluations, structured using the ACGME core competencies, were provided to each fellow’s program director upon completion. Responses from faculty and fellow participants were overwhelmingly positive regarding educational value and virtual format.
In contrast to the traditional ROSCE, the virtual format led to considerable cost savings. Previously, significant cost was associated with travel and accommodations, in addition to the facility cost for the space to perform the ROSCE. With only the Zoom account and faculty time, the cost of the vROSCE was minimal, making this valued educational activity practical for all rheumatology fellowship programs.
Although the vROSCE had minimal cost and enabled robust evaluation of fellows, stations requiring physical contact, such as application of splints or counseling for assistive devices were not easily translatable into a virtual format.
The vROSCE is an innovative, feasible and well-received educational tool to enrich fellows’ education and competency assessment, easily implemented across institutions.
