743 - Comparing Facilitated Vs. Independent Case-Based Learning Tools on Improvement of Diabetes Knowledge Among Pediatric Residents

Publication Number: 3719.743

Brianna Leyden, CHOC Children's Hospital of Orange County, Santa Ana, CA, United States; Juliana Biro, CHOC Children's Hospital of Orange County, Orange, CA, United States

Background: Most research which examines case-based learning about diabetes has involved utilizing curricula which take place over multiple weeks and require facilitation from trained faculty which can be barriers to widespread implementation. However there is some research indicating that even a single intervention can be effective in improving diabetes knowledge.

Objective: This study aims to determine whether a single case-based learning session improves residents' clinical knowledge and comfort with managing diabetes, and analyzes whether the presence of a facilitator has a significant impact on knowledge retention.

Design/Methods: 26 incoming pediatric residents completed a pre-test to evaluate their knowledge of diabetes topics including determining initial insulin dosing for a newly diagnosed patient, adjusting insulin dosing based on blood glucose trends, basics of diabetes device management, and appropriate use of glucagon. The residents then reviewed two clinical cases containing scenarios describing the management of insulin-dependent diabetes patients. Half were randomly assigned to complete the cases in small groups led by pediatric endocrinology fellows and half completed the cases without a facilitator. Immediately afterwards they completed a post-test identical to the pre-test. Approximately 3 months later, residents completed a second identical post-test. Mean performance was compared using paired t-tests.

Results: There was a significant difference in mean performance on the pre-test compared to the immediate post-test (0.48 ± 0.14 vs. 0.85 ± 0.17, p= <.001). At the time of the second post-test, scores dropped significantly however there remained a small but significant difference compared to pre-test scores (0.48 ± 0.14 vs. 0.56 ± 0.16, p=0.042). No significant difference was noted in mean knowledge performance between the facilitated group and the non-facilitated group at either the immediate post-test (0.85 ± 0.16 vs. 0.86 ± 0.18, p=.886) or the delayed post-test (0.55 ± 0.14 vs. 0.58 ± 0.18, p=.653). There was no significant difference in confidence scores between the two groups at the immediate post-test, however at the time of the second post-test confidence scores were significantly higher for the facilitated group compared to the non-facilitated group on 2 out of 5 measures.

Conclusion(s): Results suggest that retention of knowledge from a single clinical case exposure is not dependent on interaction with a content expert, however that knowledge fades significantly after several months. Future studies will aim to determine effective methods to ensure clinical knowledge retention over time.

Diabetes Clinical Cases
Summary of the clinical cases and reflective questions utilized in facilitated and independent learning sessions