RheumMadness ’24: Pinpointing the most ‘practically perfect’ pearls for clinical use
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Key takeaways:
- The NORD-STAR trial of biologics vs. conventional synthetic DMARDs for RA won this year’s RheumMadness tournament.
- The tournament is seeking new sources of funding for next year.
The power of biologics in treating rheumatoid arthritis bested the benefits of the Mediterranean diet in this year’s RheumMadness tournament, coming out ahead as the most “practically perfect” nugget to carry forward into practice.
In the rheumatology-themed, March Madness-style online tournament, 16 trials went head-to-head through four rounds of voting to reveal which contained the most useful findings for everyday clinical practice. The tournament culminated in the NORD-STAR biologics trial halting the Cinderella run of ADIRA, a study of the Mediterranean diet in RA.
The trials in the tournament were picked by an international group of 90 rheumatology trainees and attendings, who collaborated on “scouting reports” making the case for each one. New this year were visual aids from each team summing up the key takeaways of their trial for future reference in the clinic. More than 100 people submitted brackets predicting which would win, and a “blue ribbon panel” of seven rheumatologists voted to decide their fate.
To discuss this year’s RheumMadness tournament, its future and a recently released academic study of its success in previous years, Healio sat down with its creator and director, David Leverenz, MD, MEd, assistant professor of medicine at Duke University.
Healio: Your study of responses to the first 2 years of RheumMadness was recently published in ACR Open Rheumatology. What did you learn from the results?
Leverenz: Our overall goal is to engage people in learning together. We don't have a set number of learning objectives. It's kind of a fluid thing, so we want to make sure we’re maintaining a strong learning environment from year to year.
In this study, we compared people's educational experience in the tournament from 2021 to 2022 using a shortened version of a validated survey, called the Community of Inquiry survey, to assess different components of the tournament. It showed that, really, there was no major difference — we maintained a strong learning experience. If anything, engagement grew.
However, then we focused on two particular subsets of our learners. First, the scouting report creators themselves. These are the people who volunteer their time to create these fun little reviews of each team, and, honestly, that’s the bulk of the learning experience. We were really encouraged to see that more than 85% of them agreed it was a valuable educational experience. And then what really brought joy to my heart was the vast majority of them also agreed that it was fun. I mean, I'm a fellowship program director — it's rare to find opportunities to make learning fun.
Then we also focused on early learners. What about those medical students and residents that had not yet committed to rheumatology? Is this tournament somehow attracting people to the field? And 85% of early learners said that this increased their interest. It did not decrease the interest in anybody.
One of the survey questions in which there was more agreement among early learners was that it gave them a sense of belonging in the rheumatology community. That's another thing that makes my heart happy, that the tournament is helping these residents and medical students feel connected to rheumatology, even before they become a fellow.
Healio: The study highlighted some potential for improvement, such as making the March Madness concept more accessible, involving more pediatric content, and the possibility of offering CME credits. Has there been movement on those?
Leverenz: People like games that are complex, so March Madness is a complex concept to understand. That’s good, but it’s also bad, because even if you live in the United States, but you've never filled out a March Madness bracket before, this doesn't make any sense to you. So, we really made an effort to create higher quality explainer videos each year that take people through how this works.
Pediatric rheumatology is also challenging, especially because we're often dependent on fellowship groups to write scouting reports, and sometimes the topics that pediatric and adult rheumatologists are interested in are very different. Finding a way to kind of engage both of those groups is still an opportunity for growth.
We don’t offer CME, but in the last couple of years, we've partnered with a really fantastic organization called theMednet.org. We've developed a partnership where theMednet will create questions related to concepts in the tournament, and they offer CME if you engage in those questions. We love it, because it's another opportunity for people to engage with the concepts in the tournament, and it's especially useful for those people who are not on social media, but still want to get a bit of the discourse that's happening.
Healio: How did this year’s tournament go?
Leverenz: This year was really fun. Our theme was “Practically Perfect,” meaning we focused on the most practical papers that we can find, things that we are going to actually implement. That fit with creating visual aids for people not just to learn better, but for them to print them out, download them, post them in their work rooms, to help people actually apply evidence in their in their practice. The feedback from that was really positive, and I think that's a big win from this year's tournament.
We had more than 100 people participate, and we had 90 people participate in creating the scouting reports. I think in my ideal scenario, we would have grown more. However, I think maintaining that strong engagement in this current era of social media, and what it's like to be in social media spaces these days, is great.
Healio: How did the ups and downs of the tournament play out?
Leverenz: There were some big upsets. The blue ribbon panel made some controversial choices, which is always good. I think people learn more about the studies when there’s cognitive dissonance that’s like, ‘What are they doing?’ It's all in good fun.
However, ADIRA, I think, surprised everyone. ADIRA was a great team in the tournament because it reflects a common part of our practice that is neglected, but that patients absolutely want, which is: How can they live healthier? How can they take care of themselves with dietary changes? Let's face it: American medicine is often all about pharmaceuticals. I think that’s OK — we have to have effective pharmaceuticals — but ADIRA was a practical paper that surprised everyone in terms of how it can actually be implemented. The flip side is the findings were only in the univariate analysis. It wasn't super strong, and so I think eventually when we got to the championship, we realized, OK, you know, NORD-STAR is really impactful.
I always have my own two cents. NORD-STAR, for me, was an interesting choice, because, really, they found what’s been known since prior studies that were done in the early 2000s, which we highlighted in last year’s tournament — ie, the BeST study. Namely, if you use stronger medicines for rheumatoid arthritis earlier, it turns out more people do better. The question really is just, what’s the risk-benefit ratio and the cost?
I’m looking forward to seeing how these concepts live on in future years of the tournament. Thinking back, the first winner of RheumMadness was avacopan (Tavneos, Amgen). And several years later, people are using avacopan. I think there’s been some additional controversy about how to interpret the original trial, and I think it’s been fun to kind of look back and see what happens.
Healio: Do you have any ideas brewing yet for next year?
Leverenz: The visual aids were a huge win. I think we have an opportunity to expand our visual aids. RheumMadness will be entering a new phase of its life when it is no longer supported by the Rheumatology Research Foundation Clinician Scholar Educator award, which will end in June 2024.
As we partner with new funders and grow, could we partner with a graphic design artist to make these beautiful? Can we bring back the podcast? That was something that had to go this year, because we just didn't have enough time to put it on. However, with additional funding and investment in RheumMadness, I think we could bring that back and make it even stronger.
We need to continue to adapt to this shifting tide of social media. I think there are lots of places for us to invest and connect, it just may not be as much on X or Twitter. I think that’ll still be there, but we need to find people on Instagram and other places, the newsletter, theMednet, and diversify our footprint so that more people can get this content in a way that they feel comfortable engaging with it.
References:
He L, et al. ACR Open Rheumatol. 2024;doi:10.1002/acr2.11661.
Final results and thank you! https://sites.duke.edu/rheummadness/2024/03/28/final-results-and-thank-you-2/. Published March 28, 2024. Accessed April 10, 2024.
For more information:
David Leverenz, MD, MEd, can be reached at david.leverenz@duke.edu; X (Twitter): @DavidLeverenz.
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