The research, led by Juliet Aizer, Sarah P. Gottesman, Kirana Gudi, Xiaoyue Ma, Julia T. Nguyen, Stephen A. Paget, and Lisa A. Mandl at Weill Cornell Medicine and the Hospital for Special Surgery in New York, set out to answer a question that has long troubled medical educators. Previous studies had shown that providing primary care physicians with education about knee osteoarthritis improves their confidence in the knowledge and skills needed to care effectively for these patients. What remained unknown was whether educational programs could be similarly effective in medical trainees, who are at an earlier stage of professional development and whose schedules are notoriously packed.

The team developed an online program specifically designed to improve learners’ knowledge, skills, and confidence in their abilities to recognize, diagnose, and manage patients with or at risk for knee osteoarthritis. The program was offered to Internal Medicine trainees during their rheumatology rotation in the 2023–2024 academic year at a large urban residency program. This timing was deliberate: the rheumatology rotation is where trainees are most likely to encounter joint disease, making it a natural window for targeted learning about a condition they will later manage far more often in primary care settings than in specialty clinics.

To measure the program’s effects, the researchers used a validated 27-item instrument administered both before and after the educational intervention. The primary outcome was the change in confidence related to the knowledge and skills involved in caring for patients with or at risk of knee osteoarthritis. Confidence, in this context, is not a vague feeling but a measurable construct that medical education researchers track because it influences whether clinicians apply what they know in practice. Pre- and post-program scores were compared using the Wilcoxon signed rank test, a non-parametric statistical method well suited to paired data that do not follow a normal distribution, which is typical of small before-and-after studies in residency training environments.

The results were unambiguous. Of the 36 Internal Medicine residents enrolled, 24 completed the online program between October 2023 and June 2024. Confidence in all knee osteoarthritis related domains showed statistically significant improvements after program completion. Every participant agreed or strongly agreed that the program content was useful and relevant to their scope of practice. In medical education research, where interventions often produce mixed or marginal effects, uniform improvement across all measured domains is a notable technical achievement and speaks to the precision with which the curriculum was matched to the trainees’ actual learning needs.

The significance of these findings extends beyond a single residency program. Primary care physicians are frequently responsible for recognizing and managing patients’ knee osteoarthritis, a condition that affects hundreds of millions of people worldwide and is a leading cause of chronic pain and disability. Yet studies consistently show that these physicians often feel underprepared for the task. If trainees graduate with greater confidence in managing the condition, the argument runs, they may be better equipped to deliver guideline-based care from the first day of independent practice, potentially improving outcomes for an enormous patient population.

The online format itself carries important implications for how medical education may evolve. Web-based curricula can be scaled across institutions, completed at times that fit around clinical duties, and standardized so that every learner receives the same high-quality content regardless of where they train. In a large urban residency program, where trainees rotate through demanding clinical services and formal teaching time is scarce, an asynchronous online module offers a practical route to competency-based learning that traditional lecture formats struggle to match. The study’s authors note that the program was designed to improve knowledge, skills, and confidence together, reflecting a modern understanding that competence in medicine depends on all three elements working in concert.

The researchers are careful about the limits of what their study demonstrates. The instrument measured confidence, not clinical performance, and the authors explicitly state that whether the observed gains translate into improved patient care deserves further study. The completion rate of 24 out of 36 residents, while respectable, also means that a third of eligible trainees did not finish the program, and the study was conducted at a single institution during one academic year. Confidence gains measured immediately after an intervention may also fade over time, a phenomenon known in the education literature that would require follow-up assessment to rule out.

Nevertheless, the study offers a technically rigorous proof of concept that online education can move the needle for trainees, not just for practicing physicians. The work was supported by the Pfizer 2020 Osteoarthritis and Osteoarthritis Pain Virtual Learning Competitive Grant Program, the Hospital for Special Surgery Academy of Medical Educators, and the Weill Cornell Medicine Clinical and Translational Science Center. The study was conducted in accordance with the Declaration of Helsinki, approved and granted an exemption by the Hospital for Special Surgery’s Institutional Review Board, and all responses were de-identified, with no individual participation metrics shared with residency program leadership.

For a condition that will dominate the future caseload of nearly every primary care physician, the message of this research is quietly powerful. A well-targeted online program, delivered at the right moment in training, can give young doctors the confidence to recognize, diagnose, and manage knee osteoarthritis before they ever face it alone. The next step, the authors suggest, is to determine whether that confidence becomes better care for the millions of patients whose knees hurt when they walk, climb stairs, or simply get out of a chair in the morning.

Subject of Research: Medical Education

Article Title: Assessing an online program’s effects on residents’ confidence to care for patients with or at risk of painful knee osteoarthritis

Article References: Aizer, J., Gottesman, S. P., Gudi, K., Ma, X., Nguyen, J. T., Paget, S. A., & Mandl, L. A. (2026). Assessing an online program’s effects on residents’ confidence to care for patients with or at risk of painful knee osteoarthritis. BMC Medical Education. https://doi.org/10.1186/s12909-026-10209-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10209-7

Keywords: knee osteoarthritis, medical education, online learning, Internal Medicine residents, primary care, rheumatology, confidence, BMC Medical Education, Assessing, online, program, effects