Author: Shantha Joseph
Joseph, Shantha, 2017 STEPPING FORWARD - KEEPING PACE TEACHING JUNIOR DOCTORS THE MANAGEMENT OF DIABETES IN HOSPITALISED PATIENTS, Flinders University, School of Medicine
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The increasing prevalence of diabetes mellitus in the Australian population has led to an increasing number of patients being admitted to hospitals with diabetes, either as a primary problem or as a comorbidity. Medical errors in diabetes management lead to excessive morbidity, complications, and even death. Doctors practicing within any clinical field of medicine in hospitals, where they care for acutely unwell patients, are faced with managing diabetes related issues. Prevocational junior doctors working within teaching hospitals are at the bed face of managing these patients and are the first line of clinicians who handle diabetes related issues within the hospital. The actual performance of junior doctors in managing diabetes has been shown to be sub-optimal, potentially leading to poor patient outcomes.
The sub-optimal performance of junior doctors has been attributed to multiple reasons, including lack of confidence and lack of knowledge. Efforts have been made at various sites around the world to address the need for greater knowledge and confidence among junior doctors in managing diabetes care of acutely unwell patients, and some of these have been documented in the medical literature. This study sought to explore the literature to understand the efforts taken at different sites across the world, to find out what methods worked and what could be adapted to an Australian teaching hospital environment. It then explored the needs of the doctors working within the local health system and developed a customised educational intervention to suit the needs of the local situation while looking more broadly to address the issue on a larger scale by exploring design principles for future interventions.
The study was a tri-phasic design-based research project. It was targeted at prevocational trainees working within one local health network in the first two years following completion of a university medical degree. Consistent with design-based research, mixed methods were used, combining qualitative and quantitative data gathering and analysis. In the first phase, a detailed learning needs analysis was done through questionnaires and focus groups. The second phase involved design and development of a customised educational intervention and assessment tool. The final phase included delivery of the intervention and evaluation of the outcomes.
Learning needs analysis revealed that some of the most pertinent challenges faced by junior doctors were that of transitions in diabetes care of patients admitted to hospital, and knowledge of types of insulin. A case based workshop was developed which incorporated these concepts. Assessment of learning was done through a combination of different written assessment methods to provide a comprehensive measure of the achievement of listed learning objectives, and to provide feedback to guide modification and refinement of the process. The case based workshop was trialed and analysis of the outcome data suggested a significant gain in learning as measured in confidence, knowledge and application, and successful design of the educational intervention. The next iteration will see the intervention being refined and delivered to a broader group of trainee doctors.
Keywords: Junior doctors, Medical education, Inpatient diabetes management, case based workshop, questionnaire
Subject: Medicine thesis
Thesis type: Masters
Completed: 2017
School: School of Medicine
Supervisor: Associate Professor Linda Sweet