SAT-269 Insulin 101: Quality Education Strategies for Trainees (QuEST)

Abstract

Background: In 2012, our pediatric hospital transitioned to an electronic medical record system and delegated all inpatient insulin ordering duties to the pediatric endocrine division. This led to a deficit in resident knowledge of blood glucose management, which impacted patient care. To address this gap, we developed a curriculum to facilitate the transition of inpatient subcutaneous insulin ordering privileges to the pediatric residents. Since 2015, several strategies have been implemented to educate the trainees. Our study aim was to identify which strategy optimized retention of this information. Methods: A presentation was developed that included the following topics: types of insulin, formulation of insulin regimens, common pitfalls in dosing, and practice cases. Pre- and posttests with a maximum score of 21 points were distributed. Three separate cohorts completed the curriculum under various settings. Cohort 1 (C1) had residents in groups of 2-15 protected from clinical duties. Cohort 2 (C2) had 27 incoming interns taught during orientation prior to starting clinical duties. Cohort 3 (C3) had trainees of all levels in groups of 4-20 during noon conferences without protection from clinical duties. Data were analyzed with ANOVA using Stata 15 (College Station, TX). Results: Analyses of all the residents (n=162) stratified by level (86 R1, 39 R2, 36 R3) and by cohort (84 C1, 27 C2, 51 C3) were performed. There were baseline differences in knowledge among the trainee levels (mean pretest scores R1 9.8 (0.4), R2 12.1 (0.6), R3 10.9 (0.7), p=0.008); however, after the training session, these differences were mitigated (R1 18.4 (0.3), R2 19.4 (0.3), R3 18.6 (0.5), p=0.1). There was also a slight baseline difference in knowledge among cohorts (mean pretest scores C1 11.2 (0.4), C2 9.2 (0.5), C3 10.1 (0.6), p=0.04). Posttest scores by cohort were significantly different with C1 performing better than C2 and C3 (mean posttest scores C1 19.4 (0.2), C2 18.2 (0.4), C3 17.6 (0.4), p<0.001). There was no difference between C2 and C3 (C1 vs. C2 p=0.04, C1 vs. C3 p <0.001, C2 vs. C3 p=0.6). Discussion: Each cohort attended sessions under different settings, which allowed for evaluation of optimal learning conditions. Notably, there was significant difference in knowledge retention based on the learning environment. C1 had ideal conditions with intimate groups protected from clinical duties and performed the best, whereas C2 and C3 had larger groups with distractions. Thus, effective teaching occurred in small groups in focused settings. Additional posttest analyses may identify knowledge gaps and help customize sessions according to trainee needs. Our experiences highlight the importance of tailoring an environment conducive to learning especially for basic insulin knowledge, which will ultimately improve not only resident training but also quality of patient care.