Simulated Diabetes Training for Resident Physicians

描述(由申请人提供)：糖尿病治疗在过去十年中没有实质性改善，尽管有新的药物类别和充足的证据支持更积极的治疗。糖尿病护理缺乏改善的一个因素是初级保健住院医师计划如何提供门诊糖尿病护理的培训和经验的差异。导致缺乏持续培训以提供有效和安全的门诊糖尿病护理的因素包括对住院培训的强烈重视、有限的纵向门诊经验、住院医生工作时间的限制以及支持教师教学时间的资金减少。 该项目开发和实施了一种标准化方法，通过为全国各地的初级保健居民设计的基于网络的学习干预，教授有效和安全的糖尿病护理原则。这一干预措施被称为模拟糖尿病培训(SDT)，通过一系列个性化的模拟患者案例向住院医生传授糖尿病护理的基本原则，这些案例提供对一系列门诊接触的反馈。通过SDT，居民学习如何适当地设定治疗目标，启动药物治疗，加强药物治疗，以加速实现血糖、血压和血脂控制的循证目标，同时考虑潜在的危险临床情况，避免危险的处方事件。在之前的一项针对执业医生的随机对照试验中，这种学习干预的原型显著改善了血糖控制，并减少了实际患者中有针对性的高风险处方事件。 在这个项目中，我们随机选择了20个初级保健住院医师培训项目，240名住院医师接受(A)模拟糖尿病培训(SDT)或(B)对照条件。SDT干预包括为期六个月的每月三个不同的基于网络的模拟案例。在每次模拟相遇后，该计划根据当前以证据为基础的糖尿病护理原则提供反馈。SDT的影响将使用(A)临床目标实现程度、(B)药物强化比率和(C)由分配到干预组和控制组的居民在模拟评估病例中完成的危险处方事件的衡量标准进行分析。 SDT是实现初级保健住院医师糖尿病培训标准化的重要一步。当新的证据出现时，它很容易适应，并与其他护理提供和患者激活改进策略相辅相成。这种创新的模拟学习干预措施可以提高糖尿病患者的质量和安全性，其优势包括它的经济性和简洁性、可扩展性以及能够通过互联网以标准化的方式向全国居民提供服务。 公共卫生相关性：住院医师糖尿病模拟培训能够以高效、经济和可持续的方式对住院医师进行标准化糖尿病教育。它很容易适应新的临床试验证据，并可以促进A1C、BP和血脂的循证临床护理目标的转换。如果被证明有效，这种学习方法将对全国各地住院医师在初级保健和专科计划中的培训需求产生广泛的影响。

DESCRIPTION (provided by applicant): Diabetes care has not substantially improved in the last decade despite the availability of new drug classes and abundant evidence supporting more aggressive care. One factor contributing to this lack of improvement in diabetes care is variability in how primary care residency programs provide training and experience in outpatient diabetes care. Factors that contribute to lack of consistent training to provide effective and safe outpatient diabetes care include strong emphasis on inpatient training, limited longitudinal outpatient experience, limit on residency work hours, and reduced funding to support faculty teaching time. This project develops and implements a standardized approach to teaching principles of effective and safe diabetes care through a web-based learning intervention designed for primary care residents across the country. This intervention, called Simulated Diabetes Training (SDT), teaches residents fundamental principles of diabetes care through a personalized series of simulated patient cases that provide feedback over a series of outpatient encounters. Through SDT, residents learn how to appropriately set treatment goals, initiate drug therapy, and intensify drug therapy to accelerate achievement of evidence-based goals for glucose, blood pressure and lipid control, while considering potentially risky clinical situations and avoiding risky prescribing events. In a previous randomized controlled trial of practicing physicians, a prototype of this learning intervention significantly improved glycemic control and reduced targeted risky prescribing events in actual patients. In this project, we randomize 20 primary care residency training programs with 240 residents to receive either (a) Simulated Diabetes Training (SDT) or (b) a control condition. The SDT intervention consists of three different web-based simulation cases per month for six months. After each simulated encounter, the program provides feedback based on current evidence-based principles of diabetes care. SDT impact will be analyzed using measures of (a) clinical goal attainment, (b) drug intensification rates, and (c) risky prescribing events in simulated assessment cases completed by residents assigned to the intervention versus control groups. SDT is an important step toward standardizing diabetes training in primary care resident physicians. It is readily adaptable to new evidence as it emerges, and is complementary to other care delivery and patient activation improvement strategies. Advantages of this innovative simulated learning intervention to improve quality and safety for diabetes patients include its economy and brevity, its scalability, and its ability to be delivered over the internet in standardized fashion to residents nationwide. PUBLIC HEALTH RELEVANCE: Simulated Diabetes Training for Resident Physicians has the ability to standardize diabetes education for resident primary care physicians in an efficient, cost-effective, and sustainable manner. It is readily adaptable to new clinical trial evidence and can facilitate the translation of evidence-based clinical care goals for A1C, BP, and lipids. If proven effective, this learning methodology will have broad implications applicable to the training needs of medical residents across the country in both primary care and specialty programs.