Emami Zahra, Kouhkan Azam, Khajavi Alireza, Khamseh Mohammad E
Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran, No. 10, Firoozeh St, Vali-asr Ave, Vali-asr Sq, Tehran, Iran.
Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
BMC Med Educ. 2020 Oct 20;20(1):374. doi: 10.1186/s12909-020-02212-3.
To explore the impact of an online continuing medical education (CME) program on physicians' knowledge about the management of type two diabetes.
An online CME program was designed and uploaded in the CME platform, Department of Education, Ministry of health, Iran. A 28-item questionnaire was used for the assessment. In the beginning, a case scenario was introduced. Then, participants were asked to follow and answer to a pretest assessment. Details of the educational content were provided afterward. Finally, the participants took part in the same post-test exam 4 weeks later. The Wilcoxon matched-pairs signed-ranks test was used to compare the measurements. In addition, the Mann-Whitney test was applied to compare knowledge indices between the general practitioners (GPs) and internists.
Five hundred twenty-six primary care physicians participated in this study. There was a significant positive effect regarding diagnosis confirmation (10.3% difference, P = 0.0001). Moreover, a smaller effect was observed in relation to the importance of glycosylated hemoglobin (HbA1c) at diagnosis (5.2% difference, P = 0.0006). The effect was positive in relation to the self-reported HbA1c testing frequency: more than 90% of the participants answered correctly in the post-test exam (7.6% difference, P = 0.0001). Considering improved knowledge in the treatment of diabetes, there was a very significant difference in response to questions targeting advice on a healthy diet, and physical activity; 27.7% (P = 0.000), and 18.7% (P = 0.000), respectively. In addition, the program had a positive impact on various aspects of treatment with oral glucose-lowering drugs (OGLDs). Moreover, the intervention difference was 25, and 34.4% for the questions targeting the appropriate type of insulin, and insulin initiation regimen after OGLD failure. Subgroup analyses revealed that the intervention increased the rate of correct responses among the GPs in various domains of knowledge in diagnosis and treatment. The initial differences between the GPs and internists no longer remained significant after the intervention.
Knowledge of Iranian primary health care professionals in diabetes management has significant shortcomings. This is concerning because they are at the front line of patient care. We demonstrate the effectiveness of online CME on improving GPs knowledge in the management of type 2 diabetes.
探讨在线继续医学教育（CME）项目对医生关于2型糖尿病管理知识的影响。
设计一个在线CME项目并上传至伊朗卫生部教育部的CME平台。采用一份包含28个条目的问卷进行评估。开始时，介绍一个病例场景。然后，要求参与者进行并回答一项预测试评估。之后提供教育内容的详细信息。最后，参与者在4周后参加相同的后测试考试。采用Wilcoxon配对符号秩检验比较测量结果。此外，应用Mann-Whitney检验比较全科医生（GPs）和内科医生之间的知识指数。
526名初级保健医生参与了本研究。在诊断确认方面有显著的积极效果（差异为10.3%，P = 0.0001）。此外，在诊断时糖化血红蛋白（HbA1c）的重要性方面观察到较小的效果（差异为5.2%，P = 0.0006）。在自我报告的HbA1c检测频率方面效果为阳性：超过90%的参与者在后测试考试中回答正确（差异为7.6%，P = 0.0001）。考虑到糖尿病治疗知识的改善，在针对健康饮食建议和体育活动的问题回答上有非常显著的差异；分别为27.7%（P = 0.000）和18.7%（P = 0.000）。此外，该项目对口服降糖药（OGLDs）治疗的各个方面有积极影响。而且，针对合适的胰岛素类型和OGLD治疗失败后胰岛素起始方案的问题，干预差异分别为25%和34.4%。亚组分析显示，干预提高了GPs在诊断和治疗的各个知识领域的正确回答率。干预后，GPs和内科医生之间最初的差异不再显著。
伊朗初级卫生保健专业人员在糖尿病管理方面的知识存在显著不足。这令人担忧，因为他们处于患者护理的第一线。我们证明了在线CME在提高GPs对2型糖尿病管理知识方面的有效性。
