Implementation of Computer Based Learning Modules in Diabetes for First Year Internal Medicine Residents: a review of the first year of use

Renée E. Amori, MD1, Allison Ferris, MD2, Richard Paluzzi, MD2, Barbara Simon, MD1

1- Division of Endocrinology, Drexel Univ COM, Philadelphia, PA2- Division of General Internal Medicine, Drexel Univ COM, Philadelphia, PA

References1. Cheekati V, et al. Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital. J Hosp Med. Jan 2009;4(1):E1-8.2. Powers BJ et al. Comparison of medicine resident diabetes care between Veterans Affairs and academic health care systems. J Gen Intern Med; Aug 2009;24(8):950-955.3. Cook CB, McNaughton DA, Braddy CM, et al. Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians. Endocr prac. Mar-Apr 2007;13(2):117-124.4. Tamler R, Green DE, Skamagas M, et al. Effect of case-based training for medical residents on inpatient glycemia. Diabetes Care. Aug 2011;34(8):1738-1740.6. Cook CB et al. Development of computer-based training to enhance resident physician management of inpatient diabetes. J Diabetes Sci Technol. 2009; Nov 1;3(6):1377-87.6. Sisson SD, Hughes MT, Levine D, Brancati FL Effect of an Internet-based curriculum on postgraduate education. A multicenter intervention. J Gen Intern Med. 2004 May;19(5 Pt 2):505-97. Minasian-Batmanian LC. Guidelines for developing an online learning strategy for your subject. Med Teach. 2002;24(6):645–6478. McKimm J, Jollie C, Cantillon P. ABC of learning and teaching: web based learning. BMJ.2003;326(7394):870–873

I am confident in: Strongly Agree Agree Neither Agree

nor Disagree Disagree Strongly disagree

‘my ability to diagnose a patient with T1DM.' 1 6 5 0 0

‘my ability to diagnose a patient with T2DM.' 4 7 1 0 0

'in managing Diabetes (T1 or T2) in the inpatient setting' 1 7 4 0 0

‘beginning a diabetes regimen that includes insulin in a hospital setting.' 0 10 2 0 0

‘managing T2DMin the outpatient setting.' 0 9 3 0 0

‘my ability to begin a regimen that includes insulin in an outpatient setting.' 0 4 7 1 0

‘selecting appropriate oral and non-insulin anti-diabetes agents for a patient with T2DM' 0 5 5 2 0

Figure 1: Number of Unique Module Accesses by Day of WeekTotal # accesses: 1,002

Figure 2

Table 1: Residents Survey Responses on Confidence in Diabetes Management, N= 12

IntroductionDiabetes mellitus and its complications reach throughout internal medicine (IM), and IM residents see an increasing number of diabetic patients in both inpatient and outpatient training experiences. Education of IM trainees in diabetes is not uniform, and literature describes variable levels of exposure in both inpatient and outpatient diabetes management [1-4].

Today, residents have more demands and limitations on their time due to work hour rules. Lectures remain a major teaching modality, but many residents cannot attend due to scheduling constraints. Computer based learning activities may facilitate medical knowledge in diabetes with acceptance by trainees [5-6]. Here we describe the development and initial implementation year of our online curriculum for diabetes.

Development•Followed known strategies for computer based learning [7-8]. •Identified our target learners as incoming first year categorical medicine residents•Created eight modules on fundamentals of diabetes care, and mapped these to the ACGME competencies

Introduction, Diagnosis and Glycemic Goals, Patient Education, Basic Nutrition, Non-insulin Therapies, Insulin Therapies, Complications, Finances/Costs

•Received feedback from learners on modules in development •Selected the learn Blackboard software platform for the “Diabetes for Residents” curriculum•Performed a 6mo pilot for students and trainees (all levels) rotating on the endocrinology elective

Implementation: Academic Year 2013-2014

•July 2013: Enrolled 40/42* first year categorical internal medicine residents in the “Diabetes for Residents.

* Two incoming residents participated in the pilot phase as DUCOM students

•Program Directors (PD) required completion by December 31st, 2013

•PDs received monthly updates of class progress

•Emails sent monthly to class members not yet finished

•Reminders sent from course director, PDs and Chief Medical Residents until 100% completion rate achieved

DiscussionDiabetes mellitus is one of the most common conditions treated by IM residents. Our survey shows that residents have extensive exposure to patients with diabetes, but lack confidence in management even after one year of post-graduate training in IM.

Residents accepted computer based learning strategy for basic diabetes knowledge. Modules were accessed primarily in the afternoon and early evening, but also overnight. Most access occurred during weekdays. We feel this demonstrates the flexibility of computer based learning.

Program directors supported this initiative and required completion of the curriculum. However, repeated reminders from the course director, Chief Medicine Residents and the PDs were required to achieve this for a portion of the residents.

Our data has limitations. This is a single residency program, and a limited number of topics are covered. In fact, residents did request additional topics, including hyperglycemic emergencies, to be added. Objective scoring and clinical outcomes are not included here. We are conducting a 3 year assessment of this curriculum which includes additional clinical and educational outcomes.

ConclusionsResidents accepted a computer based curriculum for diabetes mellitus. A self-reported sampling of residents generally felt that the content was appropriate. First year residents could benefit from an additional module in hyperglycemic emergencies. Significant support from the course director and the program directors is needed to ensure completion.

Survey: Residents FeedbackResidents gave feedback in the form of a voluntary survey disseminated via RedCap in the last three months of the academic year. We felt an anonymous, voluntary survey would promote open responses. Thirty percent (12/40) of first year residents responded. Of the twelve respondents: 10 were male and 5 rotated on the endocrinology service in their first year of training.

Curriculum learning goals:•10/12 responded that the modules contained the “correct amount of information•10/12 responded that it was “adequate for learning needs”•11/12 responded that it “enhanced my understanding of diabetes”

Clinical exposure to diabetes:•9/12 had diagnosed T2DM versus 1/11 who diagnosed T1DM•11/12 had managed diabetes in the inpatient setting•11/12 had managed diabetes in the outpatient setting•12/12 had started insulin in the inpatient setting versus 3/12 in outpatient•7/12 selected non-insulin agents in an outpatient setting