Addressing Gaps in the Treatment of Rheumatoid Arthritis Through Implementation of a Multi-Format Educational Curriculum and Application of Adult Learning Principles

Kathryn Charalambous, PhD, Joseph Markenson, MD, Christopher Viereck, Derek Dietze, MA, FACEHP, CCMEP


Background: Recent gaps we identified in the management of patients with rheumatoid arthritis (RA) were addressed with a CME initiative directed at practicing US rheumatologists, which incorporated a unique curriculum and instructional design, preceded by a knowledge and performance assessment.

Method: The CME initiative encompassed a 28-question pre-activity knowledge and performance assessment and 3 related modules, each of which could be completed separately and in any order for credit. For each module, multiple-choice knowledge and case-based questions were asked prior to and immediately following completion. A 22-question on-line survey, taken pre-participation and approximately 90days after module(s) participation, assessed attitudes, knowledge and clinical use of updated RA guidelines and consensus statements. Statistical tests were used to compare aggregate pretest to posttest to follow-up survey data. Alpha was set at .05, and P values of less than or equal to .05 were considered statistically significant.

Results: The instructional design was well matched with the target audience of practicing US rheumatologists. This was supported by the relatively high number of curriculum components downloaded by participants: Rheumatologists accessed the CME content as print, audio and audio-visual media. Additionally, they downloaded practice aids, which provided them with tools and resources to implement the curriculum into clinical practice. Participation in this CME initiative was associated with large gains in knowledge and competence. Statistically significant changes (P≤0.0115) were found for all pre/post challenge questions indicating that the CME content was highly effective in this target audience.

Conclusion: The unique instructional design of this CME initiative had an immediate positive effect on knowledge and competence. The results of the follow-up on-line survey revealed the presence of significant barriers, issues and challenges in the clinical practices of the participating rheumatologists: knowledge/familiarity/comfort regarding appropriate tools to assess disease activity, cost/reimbursement/managed care issues, and more practical and less time-consuming tools for measuring disease activity. These important gaps should be addressed in future educational initiatives.

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