Virtual Simulation-based Continuing Medical Education Improves Management Of Patients With Infiltrative Cardiomyopathy

Abstract

Introduction

The ability of virtual patient simulation (VPS) case-based interventions to improve clinical decision making for patients with infiltrative cardiomyopathy is unknown.

Methods

Two patient cases were presented using a VPS platform where learners could order tests, make diagnoses, and order treatments in a manner matching the scope and depth of actual practice. Clinical decisions were analyzed, and learners received clinical guidance (CG) based on current evidence and expert recommendations. Learners could modify their decisions post-CG. Pre-(baseline) vs. post-CG decisions were compared using McNemar's test. The intervention launched May of 2023 and data were collected through February, 2024.

Results

Overall, 714 physicians participated (399 case 1, 315 case 2). Physician specialties included cardiologists (59%), primary care physicians (PCPs) (30%), and neurologists (11%). Significant improvements were seen for appropriate patient assessment and diagnosis of transthyretin cardiomyopathy (ATTR-CM) and treatment selection in the overall learner population (Table). Despite improvements, approximately 2/3 of learners were still unable to make appropriate diagnosis of ATTR-CM or treatment selection post-CG, respectively (Table). Learners who ordered the appropriate patient assessments were more likely to tailor appropriate treatments for patients (67% post-CG vs 17% post-CG). For those who ordered appropriate treatment, 63% appropriately selected transthyretin stabilization therapy and 72% selected gene silencer therapy for case 1; 84% correctly selected transthyretin stabilization therapy for case 2.

Conclusion

Case-based infiltrative cardiomyopathy intervention employing VPS was associated with improvements in diagnosis of ATTR-CM and therapeutic decision-making among cardiologists, PCPs, and neurologists. Despite the observed improvements, gaps remain in diagnosing and selecting appropriate treatment strategies for patients with infiltrative cardiomyopathy.