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.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZDK1-GRB-1 (M1))
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Staten, Myrlene A
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Healthpartners Institute
United States
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Sperl-Hillen, JoAnn; O'Connor, Patrick J; Ekstrom, Heidi L et al. (2014) Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial. Acad Med 89:1664-73