Background/Aims: Provider performance on diabetes measures is variable, and is at least partially due to differences in provider knowledge and confidence in managing patients with diabetes and multiple co-morbidities.
Objective: To evaluate whether a simulated learning program can improve provider knowledge and self-confidence in diabetes management.
Methods: 19 primary care residency programs and 341 consented residents were randomized to (a) intervention (177 residents) or (b) control (164 residents) conditions. Intervention subjects were assigned 18 learning cases using SimCare Diabetes, a web-based immersive simulation program that challenges providers to achieve blood sugar, blood pressure, and lipid goals in 6 months of simulated time, as well as to address other issues such as severe obesity and insulin resistance, hypoglycemia, depression, obstructive sleep apnea, and non-adherence. Between simulated encounters with a patient, providers receive personalized feedback on progress to goals and treatment actions taken or omitted. 92 intervention and 128 control subjects completed a post-intervention follow-up online survey with 10 multiple choice knowledge and 5 self-confidence assessment questions using a 5-point Likert scale (1=not at all confident, 5=very confident). Mean (95% CI) knowledge test and self-confidence measures, adjusting for residency program clustering, were compared by group.
Results: On knowledge testing, 46% of the intervention group answered more than half the answers correctly compared to 16% of the control group. The mean knowledge score (95% CI) was 5.31 (4.87- 5.75) for intervention and 4.1 (3.69-4.50) for control subjects (p<.001). Self-confidence measures were higher for intervention compared to control subjects for: use of all available drug classes to manage diabetes (3.64 vs. 3.09, p<.001), insulin use (4.12 vs. 3.36, p<.001), interpretation of blood sugars (4.21 vs. 3.58, p< .001), setting individualized treatment goals (4.06 vs. 3.42, p< .001), and overall confidence in managing diabetes (3.97 vs. 3.28, p< .001).
Conclusion: An immersive online simulated diabetes learning program was effective at improving knowledge and self-confidence for diabetes management in primary care residents. Support and partnerships to maintain and spread the technology are desirable.