Educating Resident Physicians Using Virtual Case-Based Simulation Improves Diabetes Management: A Randomized Controlled Trial

Sperl-Hillen, JoAnn MD; O’Connor, Patrick J. MD, MA, MPH; Ekstrom, Heidi L. MA; Rush, William A. PhD; Asche, Stephen E. MA; Fernandes, Omar D. MPH; Appana, Deepika; Amundson, Gerald H.; Johnson, Paul E. PhD; Curran, Debra M. MA, RN

Academic Medicine:
doi: 10.1097/ACM.0000000000000406
Research Reports
Abstract

Purpose: To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes.

Method: Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models. Eighteen distinct learning cases (L-cases) were assigned to SimDE residents over six months from 2010 to 2011. Impact was assessed using performance on four virtual assessment cases (A-cases), an objective knowledge test, and pre–post changes in self-assessed diabetes knowledge and confidence. Group comparisons were analyzed using generalized linear mixed models, controlling for clustering of residents within residency programs and differences in baseline knowledge.

Results: The percentages of residents appropriately achieving A-case composite clinical goals for glucose, blood pressure, and lipids were as follows: A-case 1: SimDE = 21.2%, CG = 1.8%, P = .002; A-case 2: SimDE = 15.7%, CG = 4.7%, P = .02; A-case 3: SimDE = 48.0%, CG = 10.4%, P < .001; and A-case 4: SimDE = 42.1%, CG = 18.7%, P = .004. The mean knowledge score and pre–post changes in self-assessed knowledge and confidence were significantly better for SimDE group than CG participants.

Conclusions: A virtual case-based simulated diabetes education intervention improved diabetes management skills, knowledge, and confidence for primary care residents.

Author Information

Dr. Sperl-Hillen is senior research investigator, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Dr. O’Connor is assistant medical director, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Ms. Ekstrom is senior research project manager, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Dr. Rush is research investigator, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Mr. Asche is manager of statistical services, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Mr. Fernandes is research project manager, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Ms. Appana is manager of Web development research, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Mr. Amundson is research info program analyst IV, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Dr. Johnson is professor, Curtis L. Carlson Chair in Decision Sciences, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota.

Ms. Curran is director of educational quality, HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

Funding/Support: This study was funded by an R18 translational research grant from the National Institute of Diabetes and Digestive and Kidney Diseases grant number: 5R18DK079861.

Other disclosures: The authors declare the following potential conflicts of interest: JoAnn M. Sperl-Hillen, MD, Patrick J. O’Connor, MD, MPH, MA, William A. Rush, PhD, and Paul Johnson, PhD, are listed inventors on a U.S. patent related to the intervention developed for this study (# 8,388,348 B2) issued March 5, 2013, titled “Disease Treatment Simulation.” HPIER has a royalty-bearing license agreement with a third party to commercialize the simulation technology for the purpose of broader dissemination. Dr. Sperl-Hillen serves as a nonpaid member of the board of directors for that licensee.

Ethical approval: The study was reviewed in advance, approved, and monitored by the HealthPartners institutional review board.

Previous presentations: Results have been presented in abstract and poster form at Hot Topics in Simulation Education—A New York City Simulation Symposium Sponsored by the New York Simulation Center for the Health Sciences (NYSIM); October 11, 2013; New York, New York.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A225.

Correspondence should be addressed to Dr. Sperl-Hillen, HealthPartners Institute for Education and Research, 8170 33rd Ave. S., Minneapolis, MN 55440; telephone: (952) 967-5009; fax: (952) 967-5022; e-mail: joann.m.sperlhillen@healthpartners.com.

© 2014 by the Association of American Medical Colleges