Division of Endocrinology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Postgrad Med. 2011 Jul;123(4):99-106. doi: 10.3810/pgm.2011.07.2309.
To determine whether a brief, case-based educational intervention improves resident confidence, knowledge, and management of glycemia in hospitalized patients.
All 116 medical residents at a large academic medical center were offered a case-based curriculum on the management of inpatient glycemia in fall 2008. Residents on ambulatory and elective rotations were taught in small groups, whereas all others underwent online training. All participants were offered a brief online refresher course in spring 2009. We assessed resident confidence across 9 domains of treating inpatient dysglycemia, knowledge based on 4 questions before the course, a 23-part questionnaire after the intervention, and changes in resident behavior as documented in chart abstractions.
One hundred eight (93.1%) residents completed initial training, and 102 (87.9%) completed the refresher course. The share of scores indicating that residents felt "somewhat comfortable" or "completely comfortable" treating inpatient dysglycemia increased from 62.5% before the course to 94.3% (P<0.001) after the initial intervention and 92.8% (P<0.001) after the refresher. Knowledge scores improved from 72.2% correct answers to 88.9% (P<0.001) for the 4 questions asked before and after the course. Across all 23 questions posed after the initial course, residents answered 86.1% correctly and maintained a score of 85.5% after the refresher course. Online-trained residents, at 89.7%, outscored their classroom-trained peers (82.3%; P<0.001) after the initial course. Chart abstractions did not show any significant changes in managing glycemia.
A curriculum on the management of inpatient glycemia was broadly adopted by medical residents at a large academic medical center and led to greater confidence and knowledge among residents. Further expansion to other health care providers and hospitals using a Web-based format and incorporation of updated guidelines is needed to confirm and build on these encouraging results.
确定一个简短的、基于案例的教育干预是否能提高住院患者血糖管理方面住院医生的信心、知识和管理水平。
2008 年秋季，一家大型学术医疗中心的 116 名住院医师参加了一个基于案例的住院患者血糖管理课程。在门诊和选修轮转的住院医师在小团体中接受教学，而其他所有人则接受在线培训。所有参与者都在 2009 年春季获得了一个简短的在线复习课程。我们评估了 9 个治疗住院患者血糖紊乱领域的住院医师信心，基于课程前的 4 个问题、干预后的 23 个部分问卷以及图表摘要中记录的住院医师行为变化来评估知识。
108 名（93.1%）住院医师完成了初始培训，102 名（87.9%）完成了复习课程。认为自己“有些舒适”或“完全舒适”治疗住院患者血糖紊乱的分数从课程前的 62.5%增加到初始干预后的 94.3%（P<0.001）和复习后的 92.8%（P<0.001）。知识分数从课程前的 72.2%正确答案提高到 88.9%（P<0.001）。在初始课程后的 23 个问题中，住院医师的回答正确率为 86.1%，复习后的分数为 85.5%。在线培训的住院医师在初始课程后得分为 89.7%，高于课堂培训的同伴（82.3%；P<0.001）。管理血糖方面的图表摘要没有显示出任何显著变化。
一个住院患者血糖管理课程在一家大型学术医疗中心的住院医师中得到了广泛采用，并使住院医师的信心和知识有所提高。需要使用基于网络的格式向其他医疗保健提供者和医院进一步扩展，并纳入更新的指南，以确认和建立这些令人鼓舞的结果。
