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The DREAM Tool -  Dermatology Rheumatology Educational Tool for Autoimmune Manifestations

Excellence in Education Category - Expert Panel Award

The DREAM Tool
  • Lead Dermatologist: Dr. Jan Dutz
  • Project team members: Stephanie Keeling, Kam Shojania, Sheila Au, Elizabeth O’Brien, Simone Fahim, Robert Gniadecki, Peter Green, Chris Keeling, Hermenio Lima, Régine Mydlarski, Kirk Barber, Alain Brassard, Elena Netchiporouk, Joanie Pinard, Marie Hudson
  • Affiliation: Canadian Rheumatology and Dermatology Working Group / Canadian Association of Rheumatologists and Dermatologists (CARD) , Canada

The DREAM TOOL promises to be a unique mobile educational app that caters to practitioners working in the field of autoimmune disease, providing easy-access, practical, timely and specific information on various topics as well as complementary resources.

Executive Summary
The DREAM Tool is proposed as the exciting inaugural project of the Canadian Rheumatology and Dermatology Working Group (CARD). DREAM promises to be a unique mobile educational app that caters to practitioners working in the field of autoimmune disease.
Easy-access, practical, timely and specific information on topics such as systemic lupus erythematosus (SLE), dermatomyositis (DM), mixed connective tissue disease (MCTD), systemic sclerosis (SSC) and psoriasis (PsO)/psoriatic arthritis (PsA) will be available, with clinical pearls, links to registries, recent literature, medication information and clinical photos.
No such centralized and focused online tool currently exists to help manage patients with autoimmune disease.

The Challenge
The team’s combined experience led them to believe that a dearth of collaborative educational tools within dermatology and rheumatology exists. Although multiple separate online resources exist, there is no centralized, disease-specific tool readily available to both specialties and user-friendly to each. Skin morphology can vary within a disease and understanding the nuances of diagnosis is essential. Similarly, diagnostic rheumatologic tests can be misinterpreted if not taken in the correct context. The DREAM tool can provide direction, disease-specific expertise, and is a bridge between the two specialties. The development of the DREAM Tool was discussed at the inaugural CARD meeting and its development was considered a high priority. The group is passionate about education and is committed to the DREAM tool development. We are also proud that the DREAM tool will be a bilingual program, available in English and French, Canada's two official languages. There are currently no other funding sources for the initial development of this tool. CARD is supported by some unrestricted educational grants that will help sustain the project's yearly costs after development.

Project Details

Pre-website/mobile app survey:
The investigators of the grant will develop a draft of questions evaluating the current knowledge for: SLE, DM, MCTD, SSc, and Pso/PsA. A REDcap survey will be circulated to the membership of the CDA and CRA contingent upon their respective organizational approvals. Ethics approval will be secured in anticipation of future reporting of the results.
The survey will be sent by email link and development completed with the technical assistance of EPICORE (Epidemiology Coordinating and Research Centre) at the University of Alberta. The pre- and post-survey will be sent to the target audiences at baseline and one year later. Permission will be requested to re-send the post-survey to those who answered the pre-survey. Similarly, the survey will be sent to trainees if approved by their program directors.

Results of the survey will be collated, reviewed and analyzed using descriptive statistics. Differences in the responses will be analyzed using appropriate chi-square, Fisher’s exact test or t-tests depending on the nature of the question. Specific comparisons will be made between level of training, type of training, academic and community physicians, etc. The working group will then prioritize which diseases should be represented in the first iteration of the DREAM website/mobile app.
The same survey will be re-administered one year later as a way to measure uptake of this tool.
Development of the website/mobile application: At least five subgroups will be created within the CARD working group to develop disease-specific content for DREAM, directed by survey results. Pixel Designs in Edmonton, Alberta will incorporate the content into a functioning, efficient website and mobile application.

The tool will be piloted by rheumatology and dermatology trainees and a random selection of dermatologists and rheumatologists from the CDA and CRA respectively.

After piloting, the tool will be updated with any suggested changes and then go live, with links available from the CDA and CRA subject to their approval.
The website's main page will have a list of subpages representing the chosen autoimmune diseases. For each disease page, the chosen domains will be provided as separate webpages or mobile application screens. This will likely include subpages for: pathophysiology, histology, morphology with relevant pictures, differential diagnosis, treatment approach, current evidence, special pearls, and links to important resources.
The scope of each section will depend on whether there are already resources available that the user can be linked to.
Mobile application: The mobile application would represent an accessible version of the website similar to applications/websites such as UptoDate.
Dissemination: Presentations of the DREAM website and mobile application would be made at regional and national meetings whenever possible, including the annual scientific meetings for the CDA and CRA and others (e.g. Ontario Rheumatology Association, Western Alliance of Rheumatology, Alberta Society of Dermatology).
This study will aim to utilize the expertise of Canadian dermatologists and rheumatologists to create a novel educational tool. This project is both feasible and sustainable.

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