Oral Themed Presentation
Context: : Type 1 diabetes is the leading childhood metabolic disorder, affecting nearly 1/400 children. Clinical studies show that patients who switch from multiple daily injections to insulin pumps and continuous glucose monitoring may improve their control, prevent or delay long-term complications while increasing their quality of life.
In Quebec, patients and families must undergo structured training to be eligible and fully financed for the program. Despite the quality of teaching delivered during which families report understanding the theory behind hypo/hyperglycemia, a lack of confidence in identifying such complications in practice contribute to major knowledge gaps in recognizing and managing actual basic diabetic emergencies by patients and their families. Simulation has been identified as an interesting teaching method for patients/families to transfer theory into practice.
The objective of our innovation project was tointegrate mandatory simulation sessions to the current teaching curriculum for diabetic patients newly on insulin pumps.
Description: : A needs analysis consisting of audits of calls to the diabetes clinic and patient questionnaires revealed: major gaps in managing hypoglycemia and hyperglycemia, and the need for additional pump programming training. Simulation facilitators also experts in diabetes developed a half-day patient-centered simulation curriculum. Learning objectives targeted management of diabetic emergencies, demonstration of pump programming skills and communication skills.
Scenarios were elaborated accordingly: (1) hypoglycemic patient needing assistance; (2) severe hypoglycemia evolving from altered level of consciousness (ALOC) to seizures requiring glucagon; (3) vomiting patient with hyperglycemia and ketones. Scenarios were followed by structured debriefing sessions targeting medical management and communication skills. A pump programming workshop covered basic pump functions. To increase emotional involvement, patient roles were played by the actual patients who were briefed prior to the scenario. Debriefing evaluation grids were elaborated for performance ratings.
Observation/Evaluation: : Between May 2017 and June 2018, a total of 70 families were involved in the new 6-week diabetes insulin pump curriculum integrating mandatory simulation training during week 5. Five families participated in each half-day session at a tertiary-care hospital-based simulation center. Sessions consisted of three 10-minute simulation scenarios followed by a 20-minute debriefing session, and a 30-minute pump programming workshop. A total of 8 instructors were involved during each session.
Performances were rated for each family using the evaluation grid for each scenario.
Simulation sessions were evaluated by all families involved. Families reported a high level of satisfaction. They suggested introducing simulation early, even before the pump program.
Discussion: : The simulation program proved innovative on many aspects.
It was based on actual needs which led the diabetes team to achieve buy-in from major stakeholders to support simulation integration within the current curriculum. Patients played their own roles which contributed to emotional buy-in and reflection on what should be done in real-life situations. Efforts in monitoring the management of actual emergencies by simulation cohorts exploring knowledge transfer and retention from this program could lead to optimization of patient self-care.