Moving Equity into Practice: Evaluation of an Online Asynchronous Continuing Medical Education Program for Rheumatology Care

Abstract

Objectives Persistent health inequities exist in the diagnosis, treatment, and outcomes of rheumatologic diseases among at-risk populations in Canada. Prior research identified barriers and facilitators experienced by at-risk populations in Canada when accessing rheumatology care along with proposed multi-level equity solutions to improve equity in RA care delivery.[1,2] This knowledge informed the development of a 10-part, 3-module asynchronous online continuing medical education (CME) program that employed evidence-based teaching strategies and best practices for online learning that was deployed nationally to rheumatology clinicians. We evaluated the engagement and acceptability of the e-learning strategy, received feedback on areas for enhancement, and gained insight on the effectiveness of the program by documenting intended changes in provider practice behaviors reported after completing the program. Methods Participants were recruited through e-blasts and promotion by the Canadian Rheumatology Association. Participants could elect to complete the entire course, or only modules pertaining to their needs and interests. Module 1 was an introductory chapter focused on basic knowledge related to equity. Module 2 included 7 specific sections addressing the realities and challenges faced by each of the at-risk communities. Module 3 concluded the course with recommendations for equity-oriented practices and policy changes. We evaluated domains of engagement, overall satisfaction with the program, content completeness, the quality of materials, program length, and relevance to practice using descriptive statistics. Free text boxes were provided for comments on program effectiveness and suggestions for individual module and overall program improvement. At program completion, participants were asked to submit Commitment-to-Change Statements which were analyzed using a phenomenological thematic analysis model for exploring how healthcare providers would incorporate equitable care into their RA practice. Results Forty-six participants enrolled (n=43 English and n=3 French language versions) and engaged with the program, with 37% completing all 10 sections. Overall participant satisfaction was high, with 87% indicating increased awareness and an enhanced ability to support equity in practice. Intended changes (Figure 1) included enhancing accessibility to care, implementing trauma-informed and culturally safe practices, and delivering equitable clinical care. One theme highlighted the importance of ongoing professional development and collaboration with local health and social service networks. Recommended improvements were to provide downloadable 1-page summaries for each module and supply more case-based learning experiences. Conclusion The Equity in Rheumatology Care CME program was acceptable and effective. Four domains for practice change offer concrete strategies to reduce disparities in care among underserved populations. References [1.] Pianarosa E. J Rheumatol 2021;48:1793-802. [2.] Barnabe C. J Clin Epidemiol 2021;138:147-55. Supported by a CIORA grant