Background We present a knee injection and aspiration course, with simulated rheumatology clinical scenarios targeting core medical trainees. Simulation should be a core part of the curriculum, providing a safe learning environment, as hands on rheumatology exposure is often limited.
Objectives 1. To review and compare two different rheumatology practical teaching courses.
2. To highlight important rheumatology cases presenting on the acute medical take, and achieve the requirements on the core medical training curriculum.1
3. With training emphasis on service provision, to provide organised targeted teaching.2
Methods Eight core medical trainees were recruited to a knee aspiration and injection course at a cardiothoracic specialist centre (no on-site rheumatology). There was a pre-course assessment, pre-course handout, followed by a practical demonstration on a knee manikin3 by a competent teacher. Each trainee underwent assessement: Directly Observed Procedures – DOPs assessment. Pre- and post- course surveys evaluated confidence. Six months later, a second cohort of eight trainees were recruited, and the session was delivered by a rheumatology registrar. There was a brief lecture, followed by a demonstration. Trainees also underwent one-to-one assessment with SimMan® (scenarios: prosthetic joint septic arthritis and haemoptysis secondary to TB reactivation following anti-TNF treatment).
– Trainee experience prior to teaching: Cohort 1: 12.5% no experience. 37.5% seen but not attempted. 50% performed with supervision only. Cohort 2: 25% no experience. 37.5% seen but not attempted. 37.5% performed with supervision only.
– Confidence pre- and post teaching: Cohort 1: Initially only 40% had confidence in aspirating a knee joint. Increased to 80%. Cohort 2: Initially 34% had confidence in aspirating a knee joint. Increased to 85%.
– 100% trainees identified correct anatomical landmarks, proving that clinicians possess the knowledge but are limited by experience and resources.
– Outcomes were suprisingly largely unchanged despite involving a rheumatology registrar.
Conclusions - Opportunities to gain practical experience are infrequent. This affects trainees rotating through multiple training centres. Trainee confidence is increased through simulation, however simple organised teaching sessions are currently not readily available.
– Limitations: Small cohorts, inconsistent outcomes due to two sessionsbeing delivered by different people. It is dfficult to directly compare the cohorts, as cohort 2 included SimMan®. However confidence was slightly increased with this, showing that simulation is an effective learning tool.
– This program may be targeted at rheumatology specialist trainees too.
Joint Royal Colleges of Physicians Training Board. Specialty training curriculum for core medical training. http://www.jrcptb.org.uk/sites/default/files/FINAL%202009%20CMT%20Curriculum%20%28AMENDMENTS%20Aug%202013%29.pdf (accessed March 2015).
Tasker, F et al. 2014. Survey of core medical trainees in the United Kingdom 2013 – inconsistencies in training experience and competing with service demands. Clinical Medicine Vol 14, No 2: 149–56
Limbs and Things UK. Knee for Aspiration Mk 2. https://www.limbsandthings.com/uk/products/knee-for-aspiration-mk-2 (accessed March 2015).
Disclosure of Interest None declared