Clinical Training in Ambulatory Diabetes (CTAD)

Clinical Training in Ambulatory Diabetes


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  The Institute for Studies on Diabetes Foundation, Inc. conducts regular workshops and short-term courses for Doctors with interest in Diabetes (DWID). These educational activities are intended to augment their abilities to manage their patients, with the assumption that complications, disabilities and deaths may be reasonably reduced, if not avoided. Observations however, tend to suggest that continuity of care management will need longer and formal periods of training.

For Doctors who have undergone formal training in Diabetes (DIABETOLOGIST), desired outcomes of chronic care may be expected. However, not many Doctors can afford to take “time-off” from their practice; yet there are many who are seeking alternatives.

A clinical training program has been designed to formally train Doctors in out-patient settings; without removing them from their practice environment, and in fact, making use of their practice as part of the application of what they learn during training sessions.

A brief, comprehensive description of this program follows:
A. Goal:
A Clinician
    – skilled in continuous, long term preventive medical management of Diabetes and its’ complications.
    – capable of contributing to studies in Health Promotion and chronic care of Diabetes.
B. Expected outcomes at end of training:
    • Would have developed the skill of assessment of Diabetes control in the contexts of primary, secondary and tertiary preventive medical care.
    • Would have developed the skill of rational management of patients’ needs using evidence- based, compliance-appropriate interventions.
    • Would have developed the skill of effective communication for attainment of desired treatment outcomes.
    • Would have acquired an attitude of inquiry in the appreciation of treatment outcomes.
    • Would have develop an appreciation of the role of team (approaches and strategies) in chronic care.
C. Core Competencies:
Medical Knowledge – Concepts of preventive medical care (vs. preventive health care)
• as Primary-early diagnosis and treatment of Diabetes for possible return to normal, or preventing onset of complications;
• as Secondary-delay onset or progression of complications
• as Tertiary-post major complication, prevention of recurrence and avoidance of life- shortening disabilities
    – Principles of management based on outcomes studies in chronic care
    – Principles of communication, health promotion
Patient care and Professionalism –Comprehensive
• Diabetes-oriented history-taking
• Complete physical examination for detection of diabetes related impairments and complications
• Identification of psycho-social and cultural barriers and constraints
• Problem-solving aimed at determining causes of problems
• Decision-making based on evidence and cost effectiveness of diagnostic test and therapeutic interventions
• Due regard for patient preferences
• Determined and serious efforts at ensuring continuity of care with use of effective communication tools-media, support personnel; including provision of records for transfer of care.

System-based practice – Provision of care appropriate for availability of resources to patient: limited, recommended, comprehensive.

Practice-based training – Complete documentation of patient records to serve as source of reviews of treatment outcomes,
Analysis of outcomes for possible inquiries on unsatisfactory results
Initiatives for inquiry as: case studies for collaborative participation with study groups
* Entry competence; Primary Health care (screening for Diabetes)
D. Content and Learning Objectives:
Phase 1.1: At the end of 4 clinical training sessions, the trainee must be able to (demonstrate):
    a. Complete presentation of a patients diagnosis as DM type and control status, co- morbidities, complications
    b. Explain clearly the data-base support for the diagnosis and consistency with pathophysiologic mechanisms
    c. Define problems arising from diagnostic needs and treatment plans and discuss proposed solutions
    d. Discuss management decisions and how they were arrived at
    e. Describe how decisions were offered to the patient and how it was received
    f. Describe follow-up and problems arising therefrom
    g. Complete patients records
Phase 1.2: At the end of 4 clinical training sessions, the trainee must be able to (demonstrate):
    a. Post (demonstration) presentation, the trainee must be able to identify (from question asked by Trainors) which of the 6 objectives can be improved upon
    b. Trainors/evaluator may need to amplify, supplement trainees self-assessment
    c. Trainee will be expected to practice on his own patients in his clinic and report when he will wish to enroll for phase 2 and succeeding phases
Phases 2 – 4: Repeat of same as phase 1, with emphasis on Primary, Secondary, Tertiary management cases he has seen in 4 clinical training sessions/phase

Phase 5: Participative observation on:
    a. Nutrition consults
    b. Diabetes self-management education consults/sessions
    c. Insulin management
    d. Team management
Phase 6.1: Trainee demonstration of proficiency in:
    a. Primary preventive medical care
    b. Secondary preventive medical care
    c. Tertiary preventive medical care
Phase 6.2: Presentation of case study
Training Activities:
1.1: Clinic sessions – trainee sees 2-3 patients over a 3 hour period, using
    a. Schemata for approaching patient consultations
    b. Clinical forms for data gathering
    c. Format for presentation to Trainor for patient disposition
1.2: Brief interaction between trainee – trainor and patient for disposition (10 minutes per patient)

1.3: Evaluative feedback session with 2-3 trainors (1 hour)

1.4: At 4th session – placement evaluation

2.1: Trainee applies training inputs to own patients and returns after 1 month for presentation of own clinic experience (before proceeding to next phase)

2.2: Present at conference in-aid-of clinical problem-solving, decision making

2.3: Cycle 1 and 2 (above) are repeated until end of phase 4

2.4: Inter-active sessions with consultants in phase 5

2.5: Regular reviews of accumulated records for:
    a. Identifying materials for conference

    b. Case studies
Assessments:
  1. Formative – at 4th hour of each session day
    1. evaluative feedback
  2. Placement – at end of phase 1
  3. Progress/problem – at ends of phase 2-4
  4. Promotion: 3 separate summative evaluations for 1°, 2°, 3° mx
    1. : Sum of all evaluations, plus performance at conference plus documents and case study