Virtual Patient Simulation in DKD: Successful Strategy for Improving Recognition and Management

Abstract

Intro: we sought to determine if virtual patient simulation (VPS)-based continuing medical education (CME) intervention could improve performance of diabetologists/endocrinologists related to recognition and management of diabetes kidney disease (DKD). Methods: The intervention comprised a patient presenting at two different time points in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a McNemar’s test to determine P values. The activity posted August 30, 2019; initial data was collected through November 7, 2019. Results: 270 diabetologists/endocrinologists completed the activity (all decisions within at least 1 case) and were included. Significant improvements were observed after CG: 1st Patient: • Diagnose CKD stage 3b: 29% absolute improvement (5% pre-CG vs 34% post-CG; P<.01) • Initiate SGLT2 inhibitor: 50% improvement (24% pre-CG vs 74% post-CG; P<.01) • Order patient education: 19% improvement (52% pre-CG vs 71% post-CG; P<.01) • Order follow-up appointment: 18% improvement (53% pre-CG vs 71% post-CG; P<.01) 2nd Patient: • Diagnose CKD stage 3a: 49% absolute improvement (10% pre-CG vs 59% post-CG; P<.01) • Initiate SGLT2 inhibitor: 36% improvement (51% pre-CG vs 87% post-CG; P<.01) • Initiate ACE inhibitor: 11% improvement (85% pre-CG vs 96% post-CG; P<.01) • Order patient education: 12% improvement (66% pre-CG vs 78% post-CG; P<.01). Conclusion: VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of DKD.