Improving Management of Short Bowel Syndrome Through Simulation-Based Education

Abstract

Introduction: Despite recent advances in short bowel syndrome (SBS), related guidelines have not been updated in nearly a decade, challenging clinicians to remain current in their management. This study aimed to determine if online medical simulation-based education could improve competence of gastroenterologists making clinical decisions in management of SBS. Methods: Education was delivered online via a simulation-based platform that modelled real-life clinical encounters. Physicians were presented with 2 patient cases of SBS, including their electronic health records. Following virtual interaction to learn more about patients, physicians were challenged to select from numerous available assessments, strategies for dietary adherence, and pharmacologic therapies. Physicians received clinical guidance (CG) on the accuracy of their choices employing current evidencebased and expert recommendations through a decision engine in the simulation. Educational impact was measured by comparing participant decisions pre- and post-CG using a 2-tailed paired T-test where P < 0.05 was statistically significant. Results: From pre- to post-CG in the simulation, gastroenterologists (n=200) were more likely to make evidence-based practice choices related to: - Applying patient monitoring/assessment strategies to optimize nutritional adaptation in patients with SBS such as ordering colonoscopy (34% pre-CG to 51% post-CG, P < 0.001), ordering methylmalonic acid, serum (24% pre-CG to 46% post-CG, P < 0.001), ordering upper gastrointestinal series (25% pre-CG to 42% post-CG, P < 0.001), and diagnosing small intestine bacterial overgrowth (14% pre-CG to 47% post-CG, P < 0.001). - Selecting appropriate pharmacologic therapy, such as teduglutide, as part of intestinal rehabilitation in SBS (33% improvement post-CG, P < 0.001). - Implementing strategies, such as registered dietician referral, to improve patient adherence with dietary/nutritional requirements (38% pre-CG vs 54% post-CG, P < 0.001). Conclusion: Gastroenterologists who participated in online medical simulation-based education significantly improved their clinical decisions in SBS management. Further education to bolster evidencebased clinical decisions in SBS related to patient assessment, optimization of nutritional adaptation, and managing patient expectations/goals could be delivered in similar consequence-free medical simulation formats to improve gastroenterologists' knowledge and competence and lead to optimized patient outcomes.