Durability of the effect of online diabetes training for medical residents on knowledge, confidence, and inpatient glycemia

Tamler, Ronald; Green, Dina E.; Skamagas, Maria; Breen, Tracy L.; Lu, Ko‐Ting; Looker, Helen C.; Babyatsky, Mark W.; LeRoith, Derek

doi:10.1111/j.1753-0407.2012.00189.x

Cited by 18 publications

(12 citation statements)

References 35 publications

(73 reference statements)

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“…They noted that topics that were not included in the refresher and not frequently encountered on the wards had declining scores over time. Their study supports our data and suggests that the addition of a refresher course could be one way to improve the durability of our initial knowledge gains [30]. …”

Section: Discussionsupporting

confidence: 83%

Can a single interactive seminar durably improve knowledge and confidence of hospital diabetes management?

Bodnar

Iyengar

Patil

et al. 2016

Clin Diabetes Endocrinol

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BackgroundSafe and effective diabetes management in the hospital is challenging. Inadequate knowledge has been identified by trainees as a key barrier. In this study we assess both the short-term and long-term impact of an interactive seminar on medical student knowledge and comfort with hospital diabetes management.MethodsAn interactive seminar covering hospital diabetes management and utilizing an audience response system was added to the third-year medical student curriculum. Students were given a multiple choice assessment immediately before and after the seminar to assess their comprehension of the material. Students were also asked to rate their confidence on this topic. Approximately 6 months later, students were given the same assessment to determine if the improvements in hospital diabetes knowledge and confidence were durable over time. Students from the preceding medical school class, who did not have a hospital diabetes seminar as a part of their curriculum, were used as a control.ResultsFifty–three students participated in the short-term assessment immediately before and after the seminar. The mean score (maximum 15) was 7.7 +/- 2.7 (51%) on the pre-test and 11.4 +/- 1.8 (76%) on the post-test (p < 0.01). 75 students who attended the seminar completed the same set of questions 6 months later with mean score of 9.2 ± 2.3 (61%). The control group of 100 students who did not attend seminar had a mean score of 8.8 ± 2.5 (58%). The difference in scores between the students 6-months after the seminar and the control group was not significantly different (p = 0.30).ConclusionsDespite initial short-term gains, a single seminar on hospital diabetes management did not durably improve trainee knowledge or confidence. Addition of repeated and focused interactions during clinical rotations or other sustained methods of exposure need to be evaluated.Electronic supplementary materialThe online version of this article (doi:10.1186/s40842-016-0038-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 83%

Can a single interactive seminar durably improve knowledge and confidence of hospital diabetes management?

Bodnar

Iyengar

Patil

et al. 2016

Clin Diabetes Endocrinol

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“…Learners included in the majority of these studies were trainees from internal medicine residency programs (34, 36, 39, 42, 44–46, 49), while fewer participants were from other disciplines. A smaller number were faculty staff, nurses, and other allied health service providers.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the clinical outcomes associated with the different educational interventions reported in this critical review suggest that achieving goals of care and adherence to clinical practice guidelines may be facilitated by providers’ education. In these studies, the overall reductions in blood glucose levels (35, 64), the increase in number of patients achieving glycemic targets (34, 46, 64), and the improvement of hypoglycemia management (41) collectively signal advancements toward achieving better and safer glucose management. The repercussions of hyperglycemia and hypoglycemia among critically ill, noncritically ill, and perioperative patients is widely recognized (10–13, 15, 65, 66).…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, diabetes often remains underrecognized among hospitalized patients, in part due to inadequate documentation of hyperglycemia and/or lack of follow-up with confirmatory testing, thus potentially jeopardizing adequate continuity of care after discharge (72–74). An unfavorable outcome, such as hypoglycemia in the process of training for better glycemic control in hospitals, is not uncommon (35, 46). Hypoglycemia among hospitalized patients receiving insulin therapy is linked to increased morbidity, mortality, and utilization of hospital resources (14, 69, 75–77).…”

Section: Discussionmentioning

confidence: 99%

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Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

2017

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Objective The management of inpatient hyperglycemia and diabetes requires expertise among many healthcare providers. There is limited evidence about how education for healthcare providers can result in optimization of clinical outcomes. The purpose of this critical review of the literature is to examine methods and outcomes related to educational interventions regarding the management of diabetes and dysglycemia in the hospital setting. This report provides recommendations to advance learning, curricular planning, and clinical practice. Methods We conducted a literature search through PubMed Medical for terms related to concepts of glycemic management in the hospital and medical education and training. This search yielded 1,493 articles published between 2003 and 2016. Results The selection process resulted in 16 original articles encompassing 1,123 learners from various disciplines. We categorized findings corresponding to learning outcomes and patient care outcomes. Conclusion Based on the analysis, we propose the following perspectives, leveraging learning and clinical practice that can advance the care of patients with diabetes and/or dysglycemia in the hospital. These include: (1) application of knowledge related to inpatient glycemic management can be improved with active, situated, and participatory interactions of learners in the workplace; (2) instruction about inpatient glycemic management needs to reach a larger population of learners; (3) management of dysglycemia in the hospital may benefit from the integration of clinical decision support strategies; and (4) education should be adopted as a formal component of hospitals’ quality planning, aiming to integrate clinical practice guidelines and to optimize diabetes care in hospitals.

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“…In contrast, GPs might not see patients as often and, when they do, the patient might have several problems they wish to discuss in a single appointment, while GPs only have a short time available to update patient records, diagnose and prioritize next actions; therefore, the above‐mentioned restructuring of primary care might help divide time efficiently without sacrificing or sabotaging the patient's trust in their HCP and propagating non‐compliance. There is also a wealth of evidence that education, in the form of either specialist feedback or computer‐based learning/reminders, facilitates timely intensification by primary care physicians and, therefore, improved glycaemic control in patients. For example, a recent meta‐analysis showed that information technology‐based interventions were associated with statistically significant HbA1c reductions (mean treatment difference − 0.33% [95% CI –0.40; −0.26], −3.6 mmol/mol [95% CI –4.4; −2.8], P < .001) in people with T2D .…”

Section: Inertia With Initiation Of Insulin Treatmentmentioning

confidence: 99%

Identification of barriers to insulin therapy and approaches to overcoming them

Russell‐Jones

Pouwer

Khunti

2017

Diabetes Obesity Metabolism

188

161

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Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose‐lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients’ long‐term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years. Patient‐ and physician‐related factors both contribute to this resistance at the stages of insulin initiation, titration and intensification, impeding achievement of optimal glycaemic control. The present review evaluates the evidence and reasons for this delay, together with available methods for facilitation of insulin initiation or intensification.

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Durability of the effect of online diabetes training for medical residents on knowledge, confidence, and inpatient glycemia

Cited by 18 publications

References 35 publications

Can a single interactive seminar durably improve knowledge and confidence of hospital diabetes management?

Can a single interactive seminar durably improve knowledge and confidence of hospital diabetes management?

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

Identification of barriers to insulin therapy and approaches to overcoming them

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