RheumMadness combines brackets, peer-teaching to find most impactful paper ‘ever written’
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What concept represents the most important and transformational article ever written in all of rheumatology?
As it turns out, coming to a consensus on the answer — and, yes, there was a consensus — can be a very effective teaching tool.
Enter RheumMadness, rheumatology’s own bracket-filling answer to the NCAA March Madness basketball tournament. Each March for the past 3 years, the rheumatology event has pitted concepts and articles in the field against each other, allowing participants to complete their own bracket and compete with friends and colleagues alike over which concepts have been more influential. Based out of Duke University, RheumMadness gives “everyone crazy about rheumatology” a place to connect, learn and compete, according to its organizers.
It is also an example of a specific theory of learning, called social constructivism, as well as a framework called the community of inquiry. Here, instead of telling participants what they are to learn, the participants themselves — more than 100 attending physicians, fellows and students this year — “create the learning themselves” by suggesting concepts, writing scouting reports and engaging with each other, said David Leverenz, MD, of Duke University, the creator and director of RheumMadness who adapted the bracket tradition for rheumatologists.
To dig into what makes RheumMadness a success, Healio spoke with Leverenz about its format, the learning theories behind it, and why cortisone may represent the most important article ever written in the field of rheumatology.
Healio: Where did you get the idea for RheumMadness?
Leverenz: The idea for RheumMadness actually came from an existing curriculum that has been made in nephrology, called NephMadness. That was made by my colleague here at Duke, Matt SparksMD, as well as some other leaders in nephrology. When we started RheumMadness, NephMadness had already been going on for at least 7 years and had garnered a lot of collaborative learning amongst the nephrology community all over the world.
When I learned about NephMadness, I was also in a Masters of medical education course through the University of Cincinnati and Cincinnati Children’s Hospital, and was learning about a learning theory called social constructivism, as well as a framework called the community of inquiry (CoI) to understand that. I thought that creating a rheumatology version of NephMadness would be a really fun and impactful educational initiative, and would also be an interesting way of applying what I was learning about social constructivist learning theory and bringing that to learners in rheumatology.
Healio: What kind of role did your nephrology colleagues play in developing RheumMadness?
Leverenz: We absolutely could not have done this without their mentorship and support. I met with Dr. Sparks several times before we created RheumMadness, and really got his input and was thankful. They were more than happy to share ideas, give mentorship, etc.
We realized early on, that if we were going to make RheumMadness, it was going to have to look a lot different than NephMadness. By the time we were getting involved with RheumMadness, NephMadness had a leadership team of about 100 people. They had a budget, they worked together, etc.
To start RheumMadness, we would need to take a different approach, as we had a much smaller team. We decided to ask our participants to create a lot of the learning materials for the tournament, which is concordant with the learning theory of social constructivism, in which learners co-create knowledge together. From an educator’s perspective, that was the dream. In addition, we were incredibly fortunate to receive the Clinician Scholar Educators Award from the Rheumatology Research Foundation to support the creation of RheumMadness. This is our third year on that grant.
Essentially, we modified the curriculum of NephMadness to fit what was feasible for us and accomplish our educational goals.
Healio: How long has RheumMadness been going on for, and how does it work?
Leverenz: This is our third official year of RheumMadness, but before the current version we have now, we ran 2 years of the tournament internally at Duke, amongst our own fellows, before disseminating.
The basic idea is to take learning concepts in rheumatology and turn those concepts into teams in the tournament. We treat these learning concepts as if they were basketball teams in a single-elimination tournament, just like March Madness. For example, in the first year, of RheumMadness, we had teams like avacopan (Tavneos, Chemocentryx) for ANCA-vasculitis, as well as voclosporin (Lupkynis, Aurinia Pharmaceuticals) for lupus nephritis.
Participants learned about the teams by reading scouting reports, which are reviews of each concept that are also filled with basketball puns and jokes. To determine the winners of each matchup, we have a blue-ribbon panel of judges — usually seven people. We try to create a diverse panel with a variety of different interests and specialties among the rheumatologists serving on the panel. We try to mix it up and get a variety of different perspectives. Participants play just like they do in March Madness, where people fill out their own brackets and predict which teams are going to win.
Healio: What kind of feedback have you received from rheumatologists who participate?
Leverenz: We have gotten great feedback. We send a survey every year asking people what their experience was like, and we study this using the CoI framework, which is a way of understanding participants’ educational experience in a social constructivist learning activity. Our purpose is not to come to a group of rheumatologists and tell them we would like them to learn something specific.
Instead, what we want is for participants to create the learning themselves by suggesting teams, writing scouting reports, discussing these on social media and engaging with each other. The CoI framework helps us to assess and understand this type of learning experience. So far, our surveys have shown that there are a lot of cognitive and social connections that are made in RheumMadness.
Even more, though, what we have heard is that this is a voluntary activity, and that people are giving up their time to engage with these resources because it is fun and educational. That, to us, makes us so happy. If it isn’t fun and educational, people are just not going to participate.
Healio: What was the winner of this year’s bracket?
Leverenz: This was a very fun year. This year, all of the teams were suggested by the participants, rather than the RheumMadness leadership team.
Our theme was the “All Star Season,” in which we asked participants to submit teams that represented the most important and impactful papers ever written in rheumatology. The winner was cortisone.
The reason people chose it, I think, is because when it was discovered in the 1940s and ‘50s, and it won a Nobel Prize, it absolutely transformed treatment for patients with rheumatoid arthritis. It also taught us about the disease itself. They found that it was not an infection but rather an autoimmune disease. It really inspired our entire field of modifying the immune system to handle autoimmune diseases, including rheumatoid arthritis.
There were a lot of other really amazing teams in the tournament. Cortisone was up against etanercept (Enbrel, Amgen) for rheumatoid arthritis in the final, and there were many people who argued that the introduction of biologics was even more transformational than cortisone. There were a lot of people that said that infliximab (Remicade, Janssen) for RA was actually more transformational because it got that entire area of research started.
In the end, the point is that a new generation of rheumatologists have learned the history behind why and how TNF inhibitors were discovered and how we know they work for RA.
Healio: What determines whether RheumMadness is a success?
Leverenz: A lot of things go into this. RheumMadness is a success because more than 100 people fill out a bracket every year, and those people learn about concepts and connect. In addition, we engage a lot of people to create the learning themselves.
This year, 120 collaborators worked on the creation of the scouting reports, and those scouting reports were read, on average, more than 130 times. This means that we were able to have 120 attending physicians, fellows and students work together from all across the country to teach each other about these concepts in rheumatology. A rheumatologist from the Philippines told us that she uses the information from the scouting reports and puts them into flash cards for her fellows.
This is peer-teaching among rheumatology fellows across the globe, which just makes me so happy. Also, it doesn’t have to be many, but when medical students or residents get involved and start meeting fellows and attendings through social media, and get connected to the rheumatology community, that is great. It helps them get involved in rheumatology and in meeting other rheumatologists.
Healio: Are there any big plans for the future of RheumMadness?
Leverenz: We are absolutely going to continue RheumMadness. The plan is to continue to help it grow, particularly internationally. The March Madness theme tends to be a little bit of a barrier for non-U.S. participants, though. We are making a lot of effort to reduce barriers and increase understanding about what the game is and how to play. If we learned anything from the last 3 years, it is that the more we turned this over to the participants, the better it is.
We have some ideas for some really fun themes based on previous feedback. I am more excited than ever that RheumMadness is going to continue to grow and keep helping people learn and build connections. Our little slogan for it is that it is the place for everyone who is crazy about rheumatology to connect, collaborate, compete and learn together. I think we are accomplishing that.
Healio: How can rheumatologists participate next year?
Leverenz: You can find the website where you can sign up for the newsletter at https://sites.duke.edu/rheummadness/. You can also find us on Twitter using the hashtag #RheumMadness.
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