Provider Experience Drives Clinical Decision Making in T2DM—Insights from Realistic Training Simulations

Abstract

Rationale: Given the vast number of individual clinical scenarios and treatment options for patients with T2DM, clinical decision making is challenging. However, there is little evidence regarding the patient and provider characteristics that drive treatment selection. Methods: Vindico Medical Education and Syandus partnered to create a virtual clinical training environment designed to identify and address drivers of treatment selection for patients with T2DM. The program featured three learner-centric clinical scenarios and evaluated participants in real-time, providing immediate, conversational feedback on the appropriateness of their decisions. Results: For a newly-diagnosed patient with T2DM in need of treatment beyond metformin monotherapy, most providers selected an appropriate add-on agent with a preference for oral compounds [22% DPP-4 inhibitor, 26% SGLT2 inhibitor, 27% sulfonylurea (SU), 6% thiazolidinedione (TZD)], with the remainder selecting a GLP-1 RA (19%). The preference for oral agents persisted in a simulation of a patient with newly-diagnosed heart failure of which there were two most appropriate options based on patient characteristics (SGLT2 inhibitor, 63%; 37% GLP-1 RA 37%). Notably, when several classes of therapy were appropriate, providers with more clinical experience prefer newer agents (e.g., SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 RAs) vs. older agents (e.g., TZDs and SUs). Conclusion: Providers prefer to treat patients with oral antidiabetes medications. More experienced providers prefer newer antidiabetes medications vs. their less-experienced colleagues, demonstrating the need for targeted education to junior providers on newer treatment options. Realistic clinical training simulations are an impactful tool to both educate providers on optimal clinical decision-making and identify drivers of clinical decision-making toward improved patient care. Disclosure K. Robinson: None. R.A. Esgro: None. D. Seifert: None.