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Management of diabetes in pediatric resident continuity clinics
K K Kronz1, R A Hibbard, D G Marrero
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
Insights
Pediatric residents require improved training for managing pediatric diabetes care. A structured form did not enhance diabetes-specific care behaviors, indicating a need for new educational strategies.
Area of Science:
- Pediatrics
- Endocrinology
- Medical Education
Background:
- General pediatricians manage children with insulin-dependent diabetes mellitus.
- Assessing and improving ambulatory training for pediatric residents is crucial for diabetes care.
- Current training may not adequately prepare residents for comprehensive diabetes management.
Purpose of the Study:
- To evaluate diabetes-specific care behaviors of pediatric residents in continuity clinics.
- To assess the impact of a structured visit encounter form on improving these care behaviors.
- To identify needs for enhanced training in pediatric diabetes care.
Main Methods:
- A chart audit was conducted to evaluate resident care behaviors based on established guidelines.
- Key performance indicators included glycosylated hemoglobin, cholesterol, urine protein, thyroxine, height plotting, blood pressure, and ophthalmologic referrals.
- A structured visit encounter form was introduced to standardize care documentation and delivery.
Main Results:
- Appropriate measurement rates varied: glycosylated hemoglobin (40%), cholesterol (90%), urine protein (50%), thyroxine (66.7%).
- Documentation of height plotting (23%), blood pressure (66%), and ophthalmologic referrals (60%) was inconsistent.
- Introduction of the structured form did not lead to significant improvements in care behaviors; use of multidisciplinary team support was minimal.
Conclusions:
- Current ambulatory training for pediatric residents in diabetes care is insufficient.
- A structured visit encounter form alone does not improve essential diabetes care behaviors.
- Novel training methodologies are necessary to equip general pediatric residents for optimal pediatric diabetes management.
Abstract:
General pediatricians provide comprehensive care for many children with insulin-dependent diabetes mellitus. To assess and improve our ambulatory training program, we first evaluated diabetes-specific care behaviors by residents in their continuity clinics and then introduced a structured visit encounter form. Based on established guidelines provided to the residents, a chart audit indicated appropriate measurement of glycosylated hemoglobin 40% of the time, cholesterol 90% of the time, urine protein 50% of the time, and thyroxine 66.7% of the time. Height was plotted 23% of the time, blood pressure was noted 66% of the time, and ophthalmologic referrals were documented 60% of the time. Requests for assistance from nonphysician members of a multidisciplinary diabetes team were minimal. After introduction of the structured visit encounter form, care behaviors did not improve. New training approaches to prepare general pediatric residents to provide excellent diabetes care are needed.