A passion to improve the clinical reasoning skills of future doctors led Maria Dall’Era, MD, associate professor of medicine and director of the University of California San Francisco (UCSF) Lupus Clinic, to create a revolutionary application for smartphones and tablets that could modernize medical education. With funding from the Rheumatology Research Foundation’s Clinician Scholar Educator Award, she is developing an app that exposes medical students to rheumatology, so they are better prepared to care for those living with rheumatic diseases.
“Patients want their doctors to be able to piece together complex information and come up with an accurate diagnosis,” says Dr. Dall’Era. “Although modern technology has enabled students to quickly look up facts, the ability to perform clinical reasoning is a skill that needs to be taught and practiced throughout medical education. The ability to think critically and reason through a difficult case is what ultimately defines a great physician.”
Dr. Dall’Era’s app, Practice Improvement Using Virtual Online Training (PIVOT), is a mobile virtual patient simulation that allows medical students to evaluate a virtual patient’s records, view interviews and exams, and order lab tests just as they would in a clinical setting. Students must sort through all of the information, identify which facts are most relevant and, eventually, diagnose the virtual patient. In the process, they use the app to answer open-ended questions, work in a team with other students and receive real-time feedback from their instructor. All of these features can be accessed on a smartphone, which fits the busy life of a medical student.
“I would often find myself answering questions and looking up relevant clinical information on the shuttle between hospital campuses,” says Jamal Saleh, a UCSF medical student who volunteered for PIVOT’s first trial run. “In comparison to our often lecture-based curriculum, PIVOT was highly interactive.”
Skills to Better Diagnose Patients
Improving clinical skills is especially important for the diagnosis and treatment of rheumatic diseases, because symptoms can differ widely from person to person, making diagnosis difficult. More than half of lupus patients suffered for at least four years and saw three or more physicians before getting the right diagnosis. Dr. Dall’Era believes that meaningful education experiences like PIVOT can help reduce that time by introducing future doctors to rheumatic diseases and helping them develop the skills they need to better diagnose patients.
“By working through the case in the app, students will learn about the symptoms and signs of rheumatic diseases, as well as other diseases that mimic rheumatic diseases,” explains Dr. Dall’Era. “Getting exposure to rheumatology is so critical for medical students at this stage of their education.”
Addressing the Shortage of Rheumatologists
Not only is PIVOT helping students to become better doctors in the future, it also has the potential to address the growing shortage of rheumatologists. Dr. Dall’Era hopes that PIVOT can also help spark interest in rheumatology by introducing students to the field through a meaningful and engaging experience.
Mr. Saleh says using PIVOT definitely increased his interest in rheumatology. “The case-based nature of the application, which unfolded every day like a puzzle and rewarded you for the time that you put into learning more about each sign and symptom, was academically scintillating and one of the most fun modules I had the chance to use in my medical education.”
Building Excellent Educators
Dr. Dall’Era says she is incredibly thankful for her Foundation funding, which has not only allowed her to build PIVOT, but also granted her opportunities to improve her skills as an educator. After receiving the Foundation’s Clinician Scholar Educator Award, she was accepted into UCSF’s rigorous Teaching Scholars Program, which teaches educators about curricular development and educational theory and methodology. She believes the Foundation grant was a key component of her acceptance into the program and is applying her expanding knowledge to PIVOT and her career as a professor.
“It is our responsibility to teach the next generation of doctors, who will take care of rheumatology patients and do research to find the underlying causes of these diseases,” Dr. Dall’Era says. “The Foundation allows people like me to work in the academic environment. The Foundation believed in me, and as a result, I have been able to pursue additional formal training in education, which I am applying to the development of this novel educational app.”
A Platform for the Future
After testing PIVOT in UCSF’s second-year medical school curriculum, Dr. Dall’Era now has plans to expand the use of PIVOT to UCSF’s School of Pharmacy. The expanded program will allow medical and pharmacy students to work together in a team setting on a patient case. Dr. Dall’Era says that this is just one of the ways that PIVOT can be modified to train future rheumatology healthcare professionals from various levels and specialties.
“A lot of this work is building a platform for the future. This app can be scaled up, and we can create cases that end in different diagnoses,” says Dr. Dall’Era. “In the end, we hope to produce better doctors who are able to take the best possible care of their patients.”
