Abstract TP73: Use Of A Novel Patient Simulation Application To Assess Physicians’ Knowledge In The Management Of Atrial Fibrillation And Stroke Prevention

Abstract

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia that contributes to over 150,000 deaths each year. Hypertension, ischemic heart disease, and smoking are among the leading risk factors for AF. Historically, it is well-accepted that AF is treated by cardiologists and frequently by specialists of heart electrophysiology. However, an overwhelming majority of patients with AF initially present to their primary care physicians (PCP). Yet, the assessment of PCP skills in the management of AF has not been well studied. We used the Edocate® virtual patient simulation platform and smartphone application to test the skills of physicians in a “virtual” clinic where their decisions in selecting diagnostic and management steps over several encounters were used for analysis of their knowledge and as a learning tool. We applied this application to assess the level of knowledge in managing AF in 25 PCP. The virtual patient was a 68-year-old man (an active smoker) with hypertension, hyperlipidemia, myocardial infarction 5 years ago, presenting with a 30-day history of palpitations and shortness of breath. On presentation, his blood pressure was 145/93 mmHg, ECG showed AF with a ventricular rate of 132 bpm. He was on atorvastatin 40 mg/d, aspirin 100 mg/d, and ramipril 5 mg/d. Total cholesterol was 155 mg/dl and LDL 85 mg/dl. Comprehensive analysis of the PCP choices via the Edocate platform revealed that only 62% of the participants elected to refer this patient to cardiology. While 65% addressed smoking cessation, only 38% achieved LDL levels of <75 mg/dl and none achieved better control of hypertension. Eighteen percent started anti-arrhythmic drugs within 3 weeks, (89% amiodarone, while 1 PCP started propafenone and 1 sotalol) and 82% started novel oral anticoagulants (dabigatran, rivaroxaban or apixaban - in approximately equal numbers). These results, albeit in a small sample size, clearly show a superb utility of the Edocate patient simulation application to reveal the level of competency of participating physicians. In the case of AF and stroke prevention, the data demonstrated a significant gap in the guideline-based knowledge in participating PCP and indicated that educational effort must be increased substantially among this group of providers.

Virtual Patient Simulation Offers an Objective Assessment of CME Activity by Improving Clinical Knowledge and the Levels of Competency of Healthcare Providers

“…The VPS platform used in this study, available on mobile devices and desktop computers, brings fundamentally new and distinct advantages to both CME activity itself and the assessment of learner gaps in knowledge, and improvement in clinical competency [ 5 , 6 , 21 , 22 ]. Given the nature of the VPS, as with most simulation platforms, this is not solely a method to assess a CME activity, because in addition to assessing the level of knowledge or competence of a learner it also plays an important dual role in promoting learning.…”