Karume Agnes Karingo, Sugut Janet, Sankei Pirirei, Kimathi Philemon Mwongera, Guleid Amina, Kimonge Damaris, Ebert Eric, Wanjiku Grace, Myers Justin Guy, Beck Andrew
Division of Training, Research and Innovation, Kenyatta National Hospital, Nairobi, Kenya.
Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya.
BMC Med Educ. 2025 Mar 8;25(1):352. doi: 10.1186/s12909-025-06898-1.
Diabetic ketoacidosis (DKA) is a common emergency associated with significant morbidity and mortality in low resource settings. Prompt diagnosis and correct management improves outcomes. To improve clinician knowledge and confidence in DKA management, we designed a novel curriculum for training local clinicians in a low-resource setting. This curriculum aligned to international guidelines, adapted for local resources. Our aim was to assess if the curriculum improved clinician knowledge and confidence.
Participants included physicians and nurses in the Emergency Department (ED) at a tertiary academic center in Nairobi, Kenya. Participants completed pre/post-tests of knowledge, which permitted prospective curriculum evaluation based on the second level Kirkpatrick hierarchy, knowledge retention. The cases focused on local evidence-based DKA management pathways. They were delivered using novel in-person with virtual (recorded) teaching techniques, permitting both conventional and independent learning. Outcome measures related to knowledge improvement were analyzed using independent t-tests; clinician confidence was assessed via self-reported survey and analyzed using descriptive statistics.
125 clinicians (79.8% nurses and 20.2% physicians) completed pre-training assessment; 104 completed post-training assessment. Prior to training, 53.6% of all trainees reported that they were "highly confident" compared with 61.5% of all trainees post-training (p=0.16). Post-training, there were statistically significant increases in knowledge scores related to DKA diagnosis (14% increase, p=0.03), electrolyte management (41% increase, p<0.0001), fluid administration (28% increase, p=0.01) and insulin administration (24% increase, p=0.01). There was a significant increase in overall clinician knowledge scores with 34.4% (n=43) attaining a knowledge score of 7 or above correct responses out of the 10 cases presented pre-training versus 65.4% n=68 post-training (p<0.0001).
Our pretest-posttest results demonstrate that our DKA management course improved clinical knowledge among physicians and nurses working in low-resource ED. Future research is underway to evaluate clinical practice changes and patient care outcomes related to this improved knowledge.
糖尿病酮症酸中毒（DKA）是资源匮乏地区常见的一种急症，具有较高的发病率和死亡率。及时诊断和正确处理可改善治疗结果。为提高临床医生对DKA管理的知识水平和信心，我们设计了一种新颖的课程，用于在资源匮乏地区培训当地临床医生。该课程符合国际指南，并根据当地资源进行了调整。我们的目的是评估该课程是否提高了临床医生的知识水平和信心。
参与者包括肯尼亚内罗毕一家三级学术中心急诊科的医生和护士。参与者完成了知识的课前/课后测试，这允许根据柯克帕特里克二级层次结构（知识保留）进行前瞻性课程评估。病例聚焦于当地基于证据的DKA管理路径。它们通过新颖的面对面与虚拟（录制）教学技术进行授课，允许传统学习和自主学习。使用独立t检验分析与知识提高相关的结果指标；通过自我报告调查评估临床医生的信心，并使用描述性统计进行分析。
125名临床医生（79.8%为护士，20.2%为医生）完成了培训前评估；104名完成了培训后评估。培训前，所有学员中有53.6%报告称他们“非常有信心”，而培训后所有学员中有61.5%（p = 0.16）。培训后，与DKA诊断相关的知识得分有统计学显著提高（提高14%，p = 0.03），电解质管理（提高41%，p < 0.0001），液体输注（提高28%，p = 0.01）和胰岛素给药（提高24%，p = 0.01）。临床医生的总体知识得分有显著提高，培训前呈现的10个病例中，34.4%（n = 43）的知识得分达到7分或以上正确答案，而培训后为65.4%（n = 68）（p < 0.0001）。
我们的课前/课后测试结果表明，我们的DKA管理课程提高了在资源匮乏的急诊科工作的医生和护士的临床知识水平。正在进行进一步研究，以评估与这种知识提高相关的临床实践变化和患者护理结果。
