Arthritis continues to be an outpatient problem that is usually treated by non-rheumatologists. There are, however, notable deficiencies in the rheumatologic training of many internal medicine house officers. A means is needed for providing general internal medicine house officers with rheumatology training in a form that is efficient, transportable, effective, and appealing. The overall goal of this project is to implement and evaluate a computerized, case-based training program in rheumatology for general internal medicine house officers. This computer-based program has been developed and pilot-tested through the University of Michigan Multipurpose Arthritic Center. This training program will be implemented in a series of community hospitals and evaluated through a randomized clinical trial design using multiple methodologies to assess changes in house officer knowledge and problem- solving behaviors related rheumatology. A unique aspect of the study is a controlled evaluation of the relative benefits of a traditional didactic seminar series compared with a series of computerized, case- based patient problems. Our hypothesis is that the computerized format will provide house officers with knowledge that is context-tailored and more relevant to actual patient problems and, therefore, more usable than will be the knowledge gained through didactic seminars. The didactic educational format emphasizes abstract, declarative knowledge that will be more difficult to use in particular clinical situations. The use of computer technology provides additional strengths related to individualized, self-paced instruction, portability, and consistency.
The specific aims of the project include: 1. Make final revisions in the computerized patient problems on the basis of the results of a pilot study conducted using University of Michigan Medical Center internal medicine house officers. 2. Develop a seminar-based training program covering the same rheumatology material as the computerized problems. This program will serve as a comparison group in evaluating the relative efficacy of computerized training programs vs. traditional didactic programs. 3. Revise and finalize existing evaluation instruments developed for this purpose by project staff and develop additional evaluation instruments to assess clinical and cognitive performance in rheumatology for internal medicine house officers. 4. Conduct a randomized clinical trial to evaluate the educational efficacy of both the didactic and the computer-based educational programs in seven community hospitals in Michigan that have general internal medicine residency training programs. We will collaborate with residency program directors at each site to incorporate the computerized problems and didactic seminars as a required component of the training program. 5. Prepare the educational materials for dissemination to educational institutions with similar objectives for purposes of house officer training.
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