Lo Margaret C, Freeman Morganna, Lansang M Cecilia
J Grad Med Educ. 2013 Mar;5(1):145-9. doi: 10.4300/JGME-D-12-00065.1.
Despite the rising prevalence of diabetes, there is a paucity of diabetes curricula in residency training. The multidisciplinary diabetes team approach is underused in residency education.
To assess the feasibility of an innovative multidisciplinary resident diabetes clinic (MRDC) in enhancing (1) resident diabetes knowledge via a Diabetes Awareness Questionnaire, and (2) subsequent process and patient outcomes in patients with diabetes via a Diabetes Practice Behavior Checklist.
From October 2008 to February 2010, 14 internal medicine residents managed patients with uncontrolled diabetes in a weekly half-day MRDC for 1 month (total 4-5 half-day sessions/resident), with a collaborative team of internists, diabetes educators, an endocrinologist, and a pharmacist. The curriculum included didactic sessions, required readings, and patient-specific case discussions. A 20-question Diabetes Awareness Questionnaire was administered to each resident prerotation and postrotation. Records of 47 patients with diabetes in the residents' own continuity clinics (not the MRDC) were audited 6 months before and after the MRDC for Diabetes Practice Behavior Checklist measures (glycated hemoglobin, blood pressure, low-density lipoprotein cholesterol, retinal referral, foot exam, microalbumin screen). Pre-MRDC and post-MRDC data were compared via paired t test.
The MRDC residents exhibited a modest increase in mean (SD) scores on the Diabetes Awareness Questionnaire (before, 8.2 [2.8]; after, 10.9 [2.8]; P = .02) and a modest mean (SD) performance increase in overall process outcomes from the Diabetes Practice Behavior Checklist (before, 74% [18%]; after, 84% [18%]; P = .004). No improvements occurred in patient outcomes.
Multidisciplinary diabetes teaching may be useful in fostering certain resident knowledge and performance measures but may not alter clinical outcomes. Further large-scale, longitudinal studies are needed to understand the effect of our curriculum on residents' diabetes knowledge and future practice behavior.
尽管糖尿病的患病率不断上升，但住院医师培训中的糖尿病课程却很少。多学科糖尿病团队方法在住院医师教育中未得到充分利用。
通过糖尿病认知问卷评估创新型多学科住院医师糖尿病诊所（MRDC）在提高（1）住院医师糖尿病知识方面的可行性，并通过糖尿病实践行为清单评估其对糖尿病患者后续诊疗过程及患者结局的影响。
从2008年10月至2010年2月，14名内科住院医师在每周半天的MRDC中管理血糖控制不佳的糖尿病患者，为期1个月（每位住院医师共4 - 5个半天课程），团队成员包括内科医生、糖尿病教育者、内分泌科医生和药剂师。课程包括理论授课、必读材料以及针对患者的病例讨论。在轮转前和轮转后，对每位住院医师进行一份包含20个问题的糖尿病认知问卷测试。在MRDC开展前后6个月，对住院医师自身连续性诊所（而非MRDC）中47例糖尿病患者的记录进行审核，以获取糖尿病实践行为清单指标（糖化血红蛋白、血压、低密度脂蛋白胆固醇、视网膜转诊、足部检查、微量白蛋白筛查）。通过配对t检验比较MRDC开展前和开展后的数据。
MRDC的住院医师在糖尿病认知问卷上的平均（标准差）得分有适度提高（之前为8.2 [2.8]；之后为10.9 [2.8]；P = 0.02），并且在糖尿病实践行为清单的总体诊疗过程结局方面平均（标准差）表现也有适度提高（之前为74% [18%]；之后为84% [18%]；P = 0.004）。患者结局未得到改善。
多学科糖尿病教学可能有助于培养住院医师的某些知识和诊疗技能，但可能不会改变临床结局。需要进一步开展大规模的纵向研究，以了解我们的课程对住院医师糖尿病知识和未来实践行为的影响。
