Lack of confidence among trainee doctors in the management of diabetes: the Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study

Abstract

Background: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care.Aim: To determine levels of confidence of doctors in training in the management of diabetes and establish their training needs in this area of clinical practiceDesign: A national online survey of trainee doctors in the UK using a pre-validated questionnaire.Methods: A four-point confidence rating scale was used to rate confidence in the management of diabetes and comparators. A six-point scale was used to quantify how often trainees would contribute to the management of patients with diabetes and trainees were asked about their training in managing diabetes.Results: A total of 2149 doctors completed the survey. The percentage ‘fully confident’ in diagnosing diabetes was 27%, diagnosing and managing hypoglycaemia 55%, diagnosing and managing diabetic ketoacidosis 43%, managing intravenous (IV) insulin 27%, prescribing IV fluids for patients with diabetes 39% and altering diabetes therapy prior to surgery/other procedure 18%. In comparison, 66% and 65% were ‘fully confident’ in the management of angina and asthma, respectively (P < 0.05). Forty-one percent would take the initiative to optimize glycaemic control for patients under their care >80% of the time. Respectively, 19% and 35% of respondents reported that their undergraduate and postgraduate training had prepared them adequately to optimize treatment of diabetes. The majority (>70%) wanted further training in managing all aspects of diabetes care.Conclusions: Trainee doctors in the UK lack confidence in the management of diabetes, are unlikely to take the initiative to optimize glycaemic control and report a need for further training.

National survey of the management of Diabetic Ketoacidosis (DKA) in the UK in 2014

“…Discharge summaries are most often filled out by the most junior members of the medical team -doctors who are only 1 or 2 years postqualification. As mentioned, the data show that a large number of admissions had no contact with the diabetes specialist team, and with the previous work showing low confidence among junior staff when managing diabetes, it may well be that this combination led to these omissions [29].…”

Assessing the relationship between admission glucose levels, subsequent length of hospital stay, readmission and mortality

“…9 Conversely, those people admitted with high blood glucose under other specialty teams are often looked after by junior doctors who have little or no knowledge of diabetes or confidence in its management, which may contribute to the longer length of stay and poorer outcomes. 10 Despite the importance of the level of blood glucose on admission for length of hospital stay and short-term readmission and mortality and as a long-term risk factor for a range of diseases, this study demonstrates that the follow up of unexpected hyperglycaemia in individuals without an existing diagnosis of diabetes remains poor for most medical specialties. However, the results should be interpreted with some care, as, for example, patients admitted to the oncology service were typically beginning end-of-life care and therefore further investigation of hyperglycaemia would be inappropriate.…”

YDEF training survey 2014

“…12 As these junior doctors progress through the specialist training programme, a clear emphasis has to be placedon the acquisition of specialist skills in D&E. Our survey suggests that the pressures of service commitments in GIM adversely affect the opportunities and ability to acquire these vital skills.…”