We conducted a cluster-randomized trial to evaluate the impact of an online virtual diabetes educational experience on resident physician knowledge and ability to care for patients with diabetes mellitus.
Nineteen primary care residency programs with 341 consented residents were randomly assigned to receive (n=177) or not receive (n=164) the intervention. The intervention included 18 virtual learning cases 3 of which were performed each month for 6 months. Each unique learning case required about 15 minutes to complete using a Web-based interactive electronic health record-like interface that challenged providers to take clinical actions to bring patients to evidence-based care goals within 6 months of simulated time. Physiologic modeling simulated realistic outcomes of provider actions and providers received learning feedback designed to critique and guide them between simulated encounters in each learning case. After the intervention period all residents were assigned a 10-question knowledge test and 4 virtual assessment cases. Generalized linear mixed models were used to test for study-arm differences in knowledge scores and the proportion of residents bringing each assessment case to composite goals for glucose blood pressure and lipids. A total of 232 residents (97 intervention 135 control) completed at least 1 case. Residents were 52% female 52% white mean age 31 44% family medicine 53% internal medicine and in postgraduate years 1 (34%) 2 (35%) and 3 and 4 (28.5%). The proportion of residents bringing patients to composite goal using case-specific pre-determined appropriate and safe treatment criteria was significantly higher in the intervention group than in controls: case 1: 21.2% vs.1.8% P=.002; case 2: 15.7% vs. 4.7% P=.02; case 3: 48.0% vs. 10.4% P<.001; case 4: 42.1% vs. 18.7% P=.002. Diabetes simulation-based training significantly improved resident knowledge scores and ability to achieve care goals using virtual patients.