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      Type 1 Diabetes Mellitus: Pediatric Team-Based Learning Module

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          Abstract

          Introduction

          Type 1 diabetes mellitus (T1DM) is an autoimmune disease that impacts roughly 200,000 youths in the United States. Many patients have limited access to specialist care. Therefore, general pediatricians are expected to be skilled in the management of diabetes. Recent studies suggest that an educational gap exists for general practitioners regarding diabetes care. Team-based learning (TBL), an active, learner-centered method of teaching, has been shown to be an effective tool in adult learning and teaching. Here, we outline a TBL activity focused on the education of pediatric residents in the comprehensive management of T1DM.

          Methods

          Learners prepare in advance by reading through a review article on T1DM. They are formed into groups and work through the readiness assurance process first, followed by application exercises. The application exercises focus on choosing and applying an insulin regimen to a patient with a new diagnosis of T1DM, including modification of this regimen based on blood sugar trends, management of diabetes ketoacidosis, and recognition and management of hypoglycemia.

          Results

          Learners showed improvement in their readiness assurance testing, from 81.4% individually to 91% as a group. Eighty percent of learners agreed or strongly agreed this was an effective method for improving diabetes skills and knowledge, and the learning process engaged them.

          Discussion

          TBL may be a valuable educational strategy to enhance knowledge of T1DM care for general pediatricians. Future studies focusing on longitudinal educational outcomes would be beneficial.

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          Most cited references11

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          Team-based learning: a practical guide: AMEE guide no. 65.

          Team-based learning™ (TBL) is an instructional strategy developed in the business school environment in the early 1990s by Dr Michaelsen who wanted the benefits of small group learning within large classes. In 2001, a US federal granting agency awarded funds for educators in the health sciences to learn about and implement the strategy in their educational programs; TBL was put forward as one such strategy and as a result it is used in over 60 US and international health science professional schools. TBL is very different from problem-based learning (PBL) and other small group approaches in that there is no need for multiple faculty or rooms, students must come prepared to sessions, and individual and small groups of students (teams) are highly accountable for their contributions to team productivity. The instructor must be a content-expert, but need not have any experience or expertise in group process to conduct a successful TBL session. Students do not need any specific instruction in teamwork since they learn how to be collaborative and productive in the process. TBL can replace or complement a lecture-based course or curriculum.
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            Diabetes knowledge: are resident physicians and nurses adequately prepared to manage diabetes?

            To assess and compare the diabetes knowledge of nurses and residents in surgery, internal medicine, and family practice. A 21-question survey based on current diabetes standards of care was developed and administered. The results were stratified by type of participant and analyzed statistically. A total of 52 internal medicine residents (IMR), 21 family practice residents (FPR), 42 surgery residents (SR), and 48 registered nurses (RN) participated. The survey had good overall internal consistency (Cronbach a of 0.78) and test-retest reliability (Pearson correlation coefficient of 0.71). The total mean percent correct for all participants was 61%. The total scores of IMR, FPR, and RN groups were similar (69%, 64%, and 66%) and significantly greater (P<0.001) than the SR score (44%). Collectively, all survey participants averaged less than 50% correct on several items. The IMR scored higher than the SR and FPR on several items. The nurses outscored the physicians on items regarding insulin preparations, treatment of hypoglycemia, and perioperative insulin management. A subgroup of 13 RN with additional diabetes training earned the highest total score (82%). Our novel survey was shown to be a statistically valid tool for assessment of diabetes knowledge. IMR, FPR, and inpatient RN have similar but insufficient levels of knowledge about diabetes. SR may have a more profound deficit of diabetes knowledge. Previous additional diabetes training among nurses was associated with greater diabetes knowledge. Most nurses and residents require additional education in order to provide optimal care to patients with diabetes.
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              Geographic distribution of childhood diabetes and obesity relative to the supply of pediatric endocrinologists in the United States.

              To determine the geographic distribution of childhood diabetes and obesity relative to the supply of US pediatric endocrinologists. Estimation of observed and "index" ratios of children with diabetes (by region and division) and obesity (body mass index >/=95th % for age and sex) (by region and state) to board-certified pediatric endocrinologists. At the national level, the ratio of children with diabetes to pediatric endocrinologists is 290:1, and the ratio of obese children to pediatric endocrinologists is 17,741:1. Ratios of children with diabetes to pediatric endocrinologists in the Midwest (370:1), South (335:1), and West (367:1) are twice as high as in the Northeast (144:1). Across states, there is up to a 19-fold difference in the observed ratios of obese children to pediatric endocrinologists. Under conditions of equitably distributed endocrinologist supply, variation across states would be mitigated considerably. The distribution of children with diabetes and obesity does not parallel the distribution of pediatric endocrinologists in the United States, due largely to geographic disparities in endocrinologist supply. Given the large burden of obese children to endocrinologists, multidisciplinary models of care delivery are essential for the US health care system to address the needs of children with diabetes and obesity.
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                Author and article information

                Journal
                MedEdPORTAL
                MedEdPORTAL
                MEP
                MedEdPORTAL : the Journal of Teaching and Learning Resources
                Association of American Medical Colleges
                2374-8265
                2017
                05 July 2017
                : 13
                : 10598
                Affiliations
                [1 ]Clinical Assistant Professor, Division of Pediatric Endocrinology and Diabetes, Michigan State University College of Human Medicine
                [2 ]Assistant Professor, Department of Pediatrics, Virginia Commonwealth University School of Medicine
                Author notes
                Article
                10.15766/mep_2374-8265.10598
                6338205
                30800800
                dc17f23c-c9b9-4d1c-a922-67756a5b3a59
                Copyright © 2017 Miller and Gupta.

                This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.

                History
                : 12 January 2017
                : 05 June 2017
                Page count
                References: 14, Pages: 6
                Categories
                Original Publication

                team-based learning,type 1 diabetes mellitus,pediatric endocrinology,juvenile diabetes,insulin-dependent diabetes

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