Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial

Abstract

Purpose: To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes.

Method: Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models. Eighteen distinct learning cases (L-cases) were assigned to SimDE residents over six months from 2010 to 2011. Impact was assessed using performance on four virtual assessment cases (A-cases), an objective knowledge test, and pre-post changes in self-assessed diabetes knowledge and confidence. Group comparisons were analyzed using generalized linear mixed models, controlling for clustering of residents within residency programs and differences in baseline knowledge.

Results: The percentages of residents appropriately achieving A-case composite clinical goals for glucose, blood pressure, and lipids were as follows: A-case 1: SimDE = 21.2%, CG = 1.8%, P = .002; A-case 2: SimDE = 15.7%, CG = 4.7%, P = .02; A-case 3: SimDE = 48.0%, CG = 10.4%, P < .001; and A-case 4: SimDE = 42.1%, CG = 18.7%, P = .004. The mean knowledge score and pre-post changes in self-assessed knowledge and confidence were significantly better for SimDE group than CG participants.

Conclusions: A virtual case-based simulated diabetes education intervention improved diabetes management skills, knowledge, and confidence for primary care residents.

Figure 1

Consort diagram outlining residency program participation, resident subject recruitment, randomization, participation, and analysis, from a randomized study of virtual, case-based simulation improves diabetes management, 2010–2011 ^aResidency programs that participated in the study were Good Samaritan Hospital Internal Medicine (IM), Cincinnati, OH; Mankato Family Medicine (FM), Mankato, MN; University of Minnesota IM, Minneapolis, MN; Smiley’s FM, Minneapolis, MN; Monmouth Medical Center IM, Long Branch, NJ; Baystate Medical Center IM, Springfield, MA; Drexel University College of Medicine/Hahnemann University Hospital, FM, Philadelphia, PA; Wesley FM, Wichita, KS; Oklahoma University, Tulsa FM, Tulsa, OK; University of Missouri FM, Columbia, MO; North Memorial FM, Minneapolis, MN; Methodist Hospital FM, St. Louis Park, MN; Banner Good Samaritan/Phoenix VA IM, Phoenix, AZ; St. Joseph’s Hospital and Medical Center IM, Phoenix, AZ; Baptist Health System IM, Birmingham, AL; Sioux Falls FM, Sioux Falls, SD; United FM, St. Paul, MN; Fairview Hospital/Cleveland Clinic FM, Cleveland, OH; Conroe FM, Conroe, TX. ^bOut of 28 residents who responded to phone and e-mail inquiries about reasons for not completing learning and assessment cases, reasons included: lack of time due to resident duties (22), lack of time due to studying for board exams (2), lack of time due to personal/family commitments (1), lack of satisfaction with the learning program (1), being on an overseas clinical rotation (1), and battling with an illness (1).