Common Variable Immunodeficiency: A Standardized Patient Case for Second-Year Medical Students

Abstract

Introduction: Common variable immunodeficiency (CVID) is the most common symptomatic antibody deficiency, with a prevalence of 0.6-6.9 depending on the population studied. In contrast to other primary immunodeficiency diseases (PIDDs), symptoms may not appear until the third decade of life. Lack of recognition of CVID is a persistent problem. Myriad confounding clinical phenotypes and frequent infections, including autoimmunity, malignancy, chronic lung disease, granulomatous disease, and gastrointestinal disease, complicate the diagnosis. Often it is years before a diagnosis is made, leading to irreversible morbidities and mortality. Methods: Second-year medical students are introduced to CVID during their session on PIDDs that occurs during the immunology/rheumatology course. To assess students' recognition of CVID, a 15-minute OSCE encounter was created that included a simulation of lung sounds (rhonchi), physical exam cards (clubbing, otitis media with effusion), and moulage of skin (petechiae). A standardized patient (SP) portrayed a patient requesting antibiotics for a sinus infection. Students were tasked to both interview the patient and perform a hypothesis-driven physical exam. A postencounter exercise queried the students on their differential diagnosis and their rationale. Results: Item analysis of the case showed high levels of difficulty and strong discrimination between high-and low-performing students in both communication skills and clinical reasoning in CVID. Discussion: This SP encounter can be used in both formative and summative assessments to measure the recognition of CVID.

Current trends in medical education affecting allergy and immunology physicians and learners

“…30−33 A creative use of simulation is illustrated in the use of SPs in the evaluation of common variable immunodeficiency disorder when introducing the topic to second-year medical students. 34 Another novel use of simulation has been the development of a virtual simulation scenario using a high-fidelity pediatric manikin for the parents of children with asthma. 35 In this study, parents were assessed on their ability to treat an asthma exacerbation in a learning environment that resembled the home environment.…”

Common Variable Immune Deficiency: An Outpatient Experience

“…C ommon variable immune deficiency (CVID) is a poorly described and often overlooked diagnosis that can have severe consequences for affected individuals, in spite of effective treatment modalities. 1,2 It is one of the most common primary immunodeficiencies, and is characterized by low levels of immunoglobulin (Ig) subtypes IgG, IgM, and IgA, which not only results in frequent upper respiratory tract infections but also is associated with an increased risk of a variety of chronic autoimmune conditions ranging from chronic lung disease, inflammatory bowel disease, lymphoid hyperplasia, and malignancy. 3,4 Although the published incidence of CVID ranges from 1 in 25,000 to 1 in 50,000, it has been frequently stated that the true incidence is vastly underreported.…”