Effect of a Multidisciplinary-Assisted Resident Diabetes Clinic on Resident Knowledge and Patient Outcomes

摘要

Editor's Note: The online version of this article contains the Diabetes Awareness Questionnaire and Diabetes Practice Behavior Checklist used in this study.;Introduction With the escalating cost1 and prevalence of diabetes,2 more attention on diabetes management has been directed toward residents-in-training as the new primary care workforce.3 Survey studies reveal residents have negative attitudes4–6 and lack knowledge or comfort in managing diabetes.3,7–9 Lack of structured education, time constraints, and patient-faculty-resident inertia are well-cited barriers.4,10–12 Diabetes management remains suboptimal in large, university-affiliated residency programs,13,14 with 60% of patients not achieving glycated hemoglobin (A1c), low-density lipoprotein cholesterol (LDL-C), or blood pressure (BP) goals.13 Studies show improved patient outcomes during the educational interventions,15–17 but few studies used multidisciplinary teaching or examined subsequent patient care by residents after intervention completion.18 The need for multidisciplinary approaches in residency education has been advocated in diabetes management.19–23 Yet, diabetes team-based teaching remains underused in residency education. Our pilot study assessed the feasibility of an innovative multidisciplinary-assisted resident diabetes clinic (MRDC) on (1) enhancing resident knowledge and subsequent practice behaviors on diabetes management before and after MRDC exposure, and (2) improving future patient and process outcomes among patients with diabetes managed by postgraduate year (PGY)-1 and PGY-2 internal medicine (IM) residents subsequently in their own continuity clinics before and after MRDC exposure.;Methods Study Design Our pilot study (October 2008 to January 2010) incorporated a formal multidisciplinary team into the preexisting, weekly resident diabetes clinic to become an innovative MRDC. Multidisciplinary team experts included certified diabetes educators, IM attendings, pharmacists, an endocrinologist, and the IM residency clinic director. This MRDC group developed a formal diabetes curriculum within the University of Florida IM residency program. The study was approved by the University of Florida Institutional Review Board.;Results Fourteen of 26 residents (54%) completed the study (16 were eligible [62%]; 2 [8%] were excluded due to incompletion of their MRDC rotation from back-up coverage). The MRDC residents demonstrated an increase in DAQ scores from a mean (SD) of 8.2 (2.8) pre-MRDC to 10.9 (2.8) post-MRDC (P??=??.02; Cohen d effect-size??=??0.96). Residents acquired a greater knowledge of diabetes therapy goals and insulin regimens. Examples included A1c and BP goals and the composition of 75% insulin lispro protamine suspension/25% insulin lispro injection (rDNA origin) (Humalog Mix 75/25, Eli Lilly and Company, Indianapolis, IN). Persistently low-scoring questions involved specific details on diabetes treatment rather than general diabetes care. Examples included carbohydrate amounts needed for hypoglycemia treatment and estimated average glucose equivalent to an A1c. The overall mean (SD) percentage of process outcomes performed on the DBPC increased from 74% (18%) before MRDC to 84% (18%) after MRDC (P??=??.004; Cohen d effect-size??=??0.55). There was a statistically significant improvement in 4 process outcomes performed: frequency of A1c checks, foot exams, diet-exercise education, and aspirin prescription (table?1). View larger version (24K) table 1Percentage of Process Outcomes Performed Before and After Exposure to the Multidisciplinary-Assisted Resident Diabetes Clinic (MRDC);Discussion Our pilot study on an innovative MRDC demonstrates modest improvements in resident knowledge and performances of certain process outcomes but had no effect on clinical outcomes in their primary care patients with diabetes. This pilot curriculum has unique and exportable features. First, its design focused on the sustainability of resident knowledge, p