Managing patients using telerheumatology: Lessons from a pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to rheumatology provision. Measures to control the pandemic have limited face-to-face contact with rheumatology healthcare professionals. One innovation has been the widespread adoption of telerheumatology to assist in the care of patients with rheumatic and musculoskeletal diseases, building on an existing evidence base in rheumatology. Widespread adoption has only occurred following the COVID-19 pandemic. We discuss the evidence supporting telerheumatology adoption prior to the pandemic, and outline several innovative approaches used to assist in the care of rheumatology patients that have been introduced. Alongside the advantages of these interventions, we discuss the limitations and regulatory challenges. Advances must be balanced, considering wider issues of equity of access, implementation, adoption, and sustainability of telerheumatology post-pandemic. We propose it is not 'if', but 'how' rheumatologists embrace newer telerheumatology technology, outlining practice points and future research agenda.

Are telephone consultations here to stay in rheumatology?

OBJECTIVES: During the COVID-19 pandemic, face-to-face rheumatology follow-up appointments were mostly replaced with telephone or virtual consultations in order to protect vulnerable patients. We aimed to investigate the perspectives of rheumatology patients on the use of telephone consultations compared with the traditional face-to-face consultation. METHODS: We carried out a retrospective survey of all rheumatology follow-up patients at the Royal Wolverhampton Trust who had received a telephone consultation from a rheumatology consultant during a 4-week period via an online survey tool. RESULTS: Surveys were distributed to 1213 patients, of whom 336 (27.7%) responded, and 306 (91.1%) patients completed all components of the survey. Overall, an equal number of patients would prefer telephone clinics or face-to-face consultations for their next routine appointment. When divided by age group, the majority who preferred the telephone clinics were <50 years old [χ2 (d.f. = 3) = 10.075, P = 0.018]. Prevalence of a smartphone was higher among younger patients (<50 years old: 46 of 47, 97.9%) than among older patients (≥50 years old: 209 of 259, 80.7%) [χ2 (d.f. = 3) = 20.919, P < 0.001]. More patients reported that they would prefer a telephone call for urgent advice (168, 54.9%). CONCLUSION: Most patients interviewed were happy with their routine face-to-face appointment being switched to a telephone consultation. Of those interviewed, patients >50 years old were less likely than their younger counterparts to want telephone consultations in place of face-to-face appointments. Most patients in our study would prefer a telephone consultation for urgent advice. We must ensure that older patients and those in vulnerable groups who value in-person contact are not excluded. Telephone clinics in some form are here to stay in rheumatology for the foreseeable future.

Exploring the relationship between examiners' memories for performances, domain separation and score variability.

Background: OSCE examiners' scores are variable and may discriminate domains of performance poorly. Examiners must hold their observations of OSCE performances in "episodic memory" until performances end. We investigated whether examiners vary in their recollection of performances; and whether this relates to their score variability or ability to separate disparate performance domains. Methods: Secondary analysis was performed on data where examiners had: 1/scored videos of OSCE performances showing disparate student ability in different domains; and 2/performed a measure of recollection for an OSCE performance. We calculated measures of "overall-score variance" (the degree individual examiners' overall scores varied from the group mean) and "domain separation" (the degree to which examiners separated different performance domains). We related these variables to the measure of examiners' recollection. Results: Examiners varied considerably in their recollection accuracy (recognition beyond chance -5% to +75% for different examiners). Examiners' recollection accuracy was weakly inversely related to their overall score accuracy (R = -0.17, p < 0.001) and related to their ability to separate domains of performance (R = 0.25, p < 0.001). Conclusions: Examiners vary substantially in their memories for students' performances which may offer a useful point of difference to study processing and integration phases of judgment. Findings could have implication for the utility of feedback.