Impact of continuing medical education for primary healthcare providers in Malaysia on diabetes knowledge, attitudes, skills and clinical practices

Abstract

Background: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). Objective: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia. Design: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme. Results: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes. Conclusion: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.

Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education

“…Niroomand et al [48] evaluated the knowledge, attitude, and practice of Iranian internists regarding diabetes mellitus and concluded that age and time since graduation were inversely correlated with internists' knowledge and practice, except for physicians who worked in teaching hospitals. Lim et al (2020) reported significant improvements in diabetes-related knowledge, skills, and clinical practice among general physicians and nurses through a six-month training program called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC) [49].…”

<p>Impact of Diabetes Continuing Education on Primary Healthcare Physicians’ Knowledge, Attitudes, and Practices</p>

“… 28 In Malaysia, a CE program on clinical DM care led to significant improvements in DM-related knowledge and clinical skills among general physicians. 29 In their analysis of seven practical diabetology courses for multidisciplinary healthcare professionals, Kapur et al reported a significant improvement in knowledge and positive changes in some attitudes. 30 A systematic review of 13 studies showed that CE programs led to short-term improvements in PHPs’ knowledge about DM; however, long-term improvements in knowledge or patient outcomes were not demonstrated.…”

“…Our findings on the improvement in PHPs' knowledge following the CE program are generally consistent with the literature. [26][27][28][29][30] A study in the UK showed that the implementation of DM-specific education programs significantly improved patient outcomes as well as trainee doctors' confidence and knowledge about DM care. 26,27 Similarly, a study in the US revealed that a CE program (involving both onsite and online program) led to significant improvements in PHPs' DM-related knowledge.…”

“…This finding is consistent with those of Gagliardino et al, Sales et al, Bani-issa et al, and Lim et al, who reported values of between 3.5 and 4.0. 29,31,32,35 The fifth sub-scale measured the participants' perceptions of patients' role in their own care, that is, attitudes towards patient autonomy. As per the results, PHPs had a higher than neutral attitude score (pre-test mean = 3.80, post-test mean = 3.90).…”

“…32,33,35 However, our values are in agreement with findings from the US and Malaysia. 14,29 The PHPs' practices related to HbA1c and weight measurement significantly improved following the intervention. This indicates that the CE program was effective in changing some practices among PHPs, and future training programs need to focus on practices where no substantial improvement was observed.…”