Mila Kostic (Perelman School of Medicine at the University of Pennsylvania); Serena Cardillo, MD (Perelman School of Medicine at the University of Pennsylvania); Zalman Agus, MD (Perelman School of Medicine at the University of Pennsylvania); David McCulloch, MD (University of Washington, Group Health Cooperative); Laura Young, MD, PhD (University of North Carolina); David Miller, MD (University of British Columbia); Paul Roberts (Simation Global Technology, Ltd)
Synopsis
Clinical inertia related to insulin initiation and titration leads to suboptimal glycemic control in patients with diabetes in primary care settings. A multimodal teaching approach focused in the virtual simulation curriculum was developed and successfully used in Canada and USA and its long-term impact on practice change, improved confidence and patient health outcomes are studied.
Purpose
Primary care physicians lack confidence and often competence to safely order diabetes medications, especially insulin. Studies indicate that this is an important contributor to delays in the initiation and intensification of therapy in patients with sub-optimal glycemic control.
Methods
To overcome these barriers a modular, selfstudy, virtual preceptorship was developed. The experiential simulation curriculum currently consists of 16 unique T1D or T2D cases of varying complexity. Assessment, instruction and feedback are balanced with self-discovery and experimentation for a unique learning experience. Participants must prescribe the most appropriate management plan to stabilize each patient twice to complete the case and advance to the next level.
Results
Initial data indicate that 53% of users were unable to control a patient requiring only bedtime basal insulin on their first attempt. However, after achieving control of this simulated patient twice, 91% felt they could confidently start a patient with T2D on bedtime insulin. Ninety percent rated the patient scenarios as realistic and relevant to practice. Eighty-four percent intended to alter their practice behavior. Ninety-one percent enjoyed this discovery learning format, felt to be an important component of engagement and ultimately contributing to learning retention.
Applications / Future Directions
A multi-center research study was designed to measure benefits of this type of simulation approach to changes in clinical performance and patient health outcomes. We will also assess the value of specific additional and cost-effective instructional design elements on outcomes, such as the initial use of moderated small-group instructional learning in practice teams, longitudinal use of case –based reminders and virtual RSSs. Perceived barriers to practice change will also be analyzed.
We expect our findings will benefit other CME/CPD educators and increase the adoption of virtual simulations as an effective tool in transitioning medical knowledge to clinical practice.
Funding Source
This project was partially funded by an educational grant from sanofi-avantis.
