DOI: 10.1093/bjd/ljad162.015 ISSN: 0007-0963

389 A CME virtual patient simulation activity evaluated the management of adults with atopic dermatitis

Shari J Dermer, Briana Betz, Elaine Bell, Philippe  Guedj, Piyali Chatterjee-Shin
  • Dermatology


Atopic dermatitis (AD) is an inflammatory skin disease with significant burden for patients. Individuals with moderate to severe AD frequently require treatment with systemic agents; however, this does not necessarily occur in clinical practice. This study was intended to evaluate the effect of online virtual patient simulation (VPS)-based CME in improving the management of moderate to severe AD. The educational intervention was designed to close gaps related to (i) underrecognition and undertreatment of patients with AD who would benefit from systemic agents and (ii) improve adoption of new therapies for moderate to severe AD. Case-based interventions in an online VPS platform allowed learners to interview patients via video, order tests, make diagnoses and order treatments supported by an extensive database matching the scope and depth of actual practice. Clinical decisions were analysed, and learners received immediate feedback in a short-form clinical guidance (CG) based on current evidence. Learners were permitted to modify their decisions post-CG. Pre- to post-CG decisions were compared using a McNemar’s test with P < 0.05 as significant. The intervention launched on March 4, 2022, and data were collected through June 2022. We report on data from n = 188 dermatologists and n = 130 allergists who participated in two virtual cases. Significant performance-based improvements were made in Case 1 and Case 2 as a result of education (%pre vs. %post, Case1 and %pre vs. %post, Case2). Assessing appropriateness of systemic AD therapy: ordering evaluation of itch with the NRS (61% vs. 71% and 58% vs. 68%); assessing BSA affected (70% vs. 78% and 70% to 80%); evaluating IGA (39% vs. 54% and 65% vs. 70% [ns]); and asking about itch, sleep and ability to function in daily activities (88% vs. 92% and 91% vs. 99%).Diagnosing moderate to severe AD: 47% vs. 58% and 54% vs. 62%.Selecting an evidence-based AD treatment: start FDA-approved IL-4 receptor blocker (18% vs. 47% and 23% vs. 35%); other treatment choices were topical corticosteroids, topical calcineurin inhibitors, crisaborole, systemic immunosuppressants, systemic steroids, JAK inhibitors (upadacitinib and abrocitinib) and tralokinumab.

This study demonstrated that immediate feedback provided in short-form clinical guidance in a VPS that immerses and engages specialists in an authentic and practical learning experience resulted in changes in performance relating to assessing and treating virtual patients with moderate to severe AD. This initiative also revealed gaps in diagnosing moderate to severe AD, and in selecting evidence-based, FDA-approved systemic treatments. Future education is needed to close these gaps.

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