Clinician Training to Promote Diabetic Group Visits | BMC Medical Education

setting

The training was conducted at two nonprofit community clinics in Houston, Texas. Each site hosted separate training sessions, with a total of two training sessions being conducted. The clinic served uninsured individuals who were primarily Hispanic (>80%) and were largely undocumented immigrants (>50%). Each site expressed interest in improving type 2 diabetes care through group visits, but did not establish a program.

Eligibility, human ethics, and consent to participate

Learners must be clinicians who prescribe medical therapy with basic medical knowledge of type 2 diabetes, demonstrating the active qualification status at each clinic and seeing patients with type 2 diabetes practiced. Learners were not paid during training. They will be paid if they participate in subsequent group visits. Facilitators conducting educational sessions for clinicians were primary care physicians with at least five years of experience, were active in clinical care, and had experience in conducting group visits in low-income settings.

This study is part of a large clinical trial that evaluates the use of telementering to support clinical teams, including clinicians and community health workers, when implementing diabetes programs for uninsured, low-income Hispanic participants (#NCT04835493). Study participants will use the consent form to provide informed consent to participate in the study. This work was carried out in accordance with relevant guidelines such as the Declaration of Helsinki and was approved by Baylor University School of Medicine and University of Texas Medical Branch Institutional Review Board (IRBS) #49,672 and #22–0224, respectively.

Research Design and Data Analysis

Curriculum planning and development

We used the analysis, design, development, implementation, and evaluation (ADDIE) model as a theoretical and practical framework for designing and developing curriculum and training (Figure 1). [10]. With roots in military practice, the ADDIE model provides clear instructional procedures, enables subsequent adoption of medical curricula, and remains an important mechanism for organizing educational content decades after its inception. [10]. The current curriculum includes a comprehensive approach to diabetes, including testing, dietary interventions, exercise/activation programs, and drugs, to enable learners to provide effective and personalized patient care.

Analysis Steps

The analysis step outlined educational goals and their objectives. The aim was to teach learners how to promote group visits by achieving the following objectives: (1) an overview of logistics that promote multidimensional diabetes group visit programs, and (2) is designed to provide patient encounter therapy for patient encounter therapy for diabetes, hypertension and hypertension encounter therapy, utilizing drug algorithms designed for low-income populations. Access to barriers of care in underserved populations, both cultural and through case studies and role-playing. To address the limitations and provide flexibility in time, we chose to effectively carry out training and held training sessions after work hours [11].

Design Steps

In the design step, we developed training content. Evidence-based literature was used, including guidelines from the American Diabetes Association, the American Clinical Endocrine Association, the 8th Joint National Committee, and the American Prevention Task Force. [12,13,14,15]. The training was divided into two main sections. It's a smoother group visit and the patient's encounter. We created a slide presentation to include training content, as well as additional items to enhance learner motivation, such as initial icebreaker questions, questions/answers sections at the end of the training, and a 10-minute break between each section.

Developmental steps

Development Step provided content to training. For facilitation, we used previous studies to describe in detail the model of group visit structure. [16,17,18,19]. We provided questions to learners to ask patients while waiting for individual patients to meet. These questions focused on how diabetes affects the whole body and disassembled the system by system (Appendix 1). We also included the roles of other healthcare and clinical staff, such as nurses and community healthcare workers, who may promote the social and educational portion of group visits.

To address the group, we created a drug algorithm for a low-income setting to visit patient encounters. Our team utilized current guidelines (i.e., the American Diabetes Association) as a framework for creating three algorithms designated for low-income people: glucose lowering, antihyperhemophilic, and antihydrolipidating drugs (Figure 2). [12,13,14,15]. Instead of list classes where drug prices may vary, the algorithm was named a specific low-cost drug therapy. They also notified clinicians of personalised availability of high-cost medications (such as documenting status, income level), and warned the clinic to work with the patient support program if these medications were needed.

Implementation Steps

The implementation steps consisted of learner instruction and materials. The training was three hours, with the first hour dedicated to facilitating group visits, second time to patient encounters and third time to questioning. Specific components were icebreakers, referrals, pre-tests, diabetes and algorithm education, case studies, and post-tests. Learners were instructed to turn on camera for training, and interaction was encouraged throughout the session. Increased interaction by promoting the use of secure, encrypted apps for chat features, text messaging, and health insurance portability and accountability law (HIPAA) during training [20]. Training sessions were limited to 10 individuals to improve learning quality in a virtual setting.

Evaluation Steps

The assessment step allowed us to assess the success of the course as measured by quantitative (learner recruitment, knowledge change) and qualitative (learner feedback) outcomes. For recruitment, clinic leadership (i.e., medical director) identified clinicians of interest. We aimed to provide 6-10 individuals for the clinic to participate in training for each clinic. For knowledge, we compared pre-test and post-test scores. To standardize training, the tests were identical and ensured consistent assessment of learning. The test consisted of 10 questions with six multiple choices and four fill blanks (Appendix 2). The tests were not reviewed until all individuals completed the posttest. The t-test was used for dichotomous results (correct versus false) with statistical significance set at P <0.05. For feedback, the facilitator contacted the learners via email to obtain input after training. Learners sent tests and survey responses electronically. The authors (MA, LAJ, KS) categorized survey responses into themes. Contradictions were addressed by the Advanced Author (EMV). We followed clinicians who attended a group visit one year after training and gathered opinions on their experiences. We asked for positive feedback, program suggestions, and additional comments they would like to provide.