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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 6-9

Medical students as diabetes educators


1 Department of Medicine, Father Muller Medical College, Mangalore, Karnataka, India
2 Department of Medicine and Endocrinology, Father Muller Medical College, Mangalore, Karnataka, India

Date of Web Publication2-Feb-2017

Correspondence Address:
Smitha Bhat
Department of Medicine, Father Muller Medical College, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.199361

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  Abstract 

Introduction: As in all chronic diseases, an important component of care in diabetes is patient education (diabetes self-management education). Many diabetic care programs have shown that using specially trained diabetes educators – nurses, allied health-care professionals – improves outcomes. In India too, the National Defense Education Program has trained graduates to be diabetes educators. We wanted to use the strength of our institute – an intelligent and motivated student body to function as a diabetes educator. We developed a module to train medical students to be effective diabetes educators. The objective of this was twofold: First, to enhance patient self-management of diabetes; second, studies have shown that even among doctors, lack of knowledge about practical diabetes management was common. We believed that in view of the impending diabetes epidemic in India, it is important that every newly graduating MBBS doctor has sufficient knowledge about diabetes to counsel and manage patients at the primary care level. Materials and Methods: A physician and an endocrinologist developed patient and student training modules. Modules were administered to students by the authors and to patients by the trained students. Improvement in knowledge and attitudes was assessed by improvement in posttest scores and by qualitative analysis of the patient and student feedback. Results: We found that patient knowledge about diabetes and its management improved after contact with the diabetes educator as assessed by a marked increase in posttest scores. Students found that training patients in diabetes care improved the depth and range of their knowledge about diabetes and its management. This method of using students as diabetes educators facilitates both patient and trainer learning. Students who worked with patients using this module noted patient questions and suggested additional points of interest be covered in the module based on patient questions. We are currently incorporating these points into the module. We believe that this module on practical management of diabetes can be included in the curriculum for MBBS students in our university. Conclusion: Using medical students as diabetes educators improves student knowledge and patient self management of diabetes

Keywords: Diabetes, educator, students


How to cite this article:
Bhat S, Sudeep K. Medical students as diabetes educators. Muller J Med Sci Res 2017;8:6-9

How to cite this URL:
Bhat S, Sudeep K. Medical students as diabetes educators. Muller J Med Sci Res [serial online] 2017 [cited 2017 Apr 29];8:6-9. Available from: http://www.mjmsr.net/text.asp?2017/8/1/6/199361


  Introduction Top


As in all chronic diseases, an important component of care in diabetes is patient education. Many diabetic care programs have shown that using specially trained diabetes educators – nurses, allied health-care professionals – improves outcomes. Diabetes management now focuses on patient education and empowerment, which results in better glycemic control and better outcomes.[1] Diabetes self-management education (DSME) is a collaboration between the patient and the health-care professional, through which the patient with diabetes acquires the knowledge, skills, and attitudes required to successfully manage their disease.[2] The American Diabetes Association (ADA) has chosen behavior change as the outcome required after diabetes education.

In the West, diabetes educators play a major role in the education of patients with diabetes. In India too, the National Defense Education Program (NDEP) has trained graduates to be diabetes educators.[3] Allied health-care professionals and graduates in science have been used in various centers as diabetes educators.[4] However, to the best of our knowledge, using medical students as diabetes educators is an innovation not practiced before.

We wanted to use the strength of our institute – an intelligent and motivated student body to function as a diabetes educator. We developed a module to train medical students to be effective diabetes educators. The objective of this was twofold: first, to enhance patient self-management of diabetes; second, studies have shown that even among doctors, lack of knowledge about practical diabetes management was common.[5] We believed that in view of the impending diabetes epidemic in India, it is important that every newly graduating MBBS doctor has sufficient knowledge about diabetes to counsel and manage patients at the primary care level.

Aim

The aim of the study is to improve process of education regarding their disease and its management in patients with diabetes attending an endocrinology outpatient department (OPD) in a medical college in South India.

Objective

  1. To develop a module to train medical students in the basics of diabetes education, including symptoms and signs of hypoglycemia and their management, recognizing imminent emergencies in diabetes, foot care, and frequently asked questions about diet
  2. To enhance education and interaction time with patients by letting trained students interact with diabetes and educate patients with diabetes.



  Materials and Methods Top


Institutional review board approval was obtained, and informed consent was taken from all participants.

A module to train the students was framed in consultation with an endocrinologist. Pre- and post-tests for students were framed and piloted.

A pretest was administered to the students using Kahoot, a free online test/quiz site.

A module was framed to be delivered to sixth- and eighth-term students who would in turn educate patients with diabetes. The module included material about the definition of diabetes, the fact that it was a lifelong disease that could be controlled rather than cured, importance of diet, exercise, oral antidiabetic drugs, insulin, symptoms and management of hypoglycemia, and foot care. The module was administered to the students by a professor of medicine using a PowerPoint presentation. After the presentation, questions were solicited and answered.

The students were asked to attend the endocrinology clinic in groups of two. After the consultant had evaluated the patient, the students interacted with the patient. First, the patient answered a pretest, followed by the student administering the module. Patients were encouraged to ask questions and resolve doubts. The patients then answered a posttest. Patient feedback was taken at the end of every interaction.

After 1 batch of students interacted with the patients under the supervision of the endocrinologist, a posttest was administered to them using Kahoot.

Pre- and post-test scores of students were compared. Pre- and post-test scores of patients were compared. Patient and student feedback was recorded and analyzed.


  Results Top


Twenty-five prefinal year students posted to medicine were taught the module and in turn taught 66 patients of diabetes attending the endocrinology outpatient clinic. Student knowledge about diabetes improved as measured by a significant improvement in posttest scores over pretest scores. Average patient posttest scores after interaction with the diabetes educator also improved significantly from 7.10 to 9.24 [Figure 1].
Figure 1: Patient scores after interaction with educator

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Students showed an improvement in average test scores from 3.08 to 7.36 after the module and after interaction with the patient [Figure 2].
Figure 2: Students scores before and after patient interaction

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Patient feedback included statements such as it was informative, needed more information about diet, got to know a lot about diabetes should have been done at the time of diagnosis, learned the importance of foot care, and was good to spend the time waiting outside OPD to learn something new, learned about the importance of diet and lifestyle in the management of diabetes. It was nice to be told clearly the treatment goals that we had to aim for. This information should be made available to all diabetics.


  Discussion Top


This study aimed to find if using trained students as diabetes educators improved patient understanding about diabetes and whether student understanding about diabetes improved as a result of this process. We found that both student and patient understanding about diabetes, its management and complications, improved as a result of the interaction between trained students and patients with diabetes.[6]

Outcomes of Educational Programs

In our study, we found that patients trained by medical student/diabetes educators had a significant improvement in posttest scores over pretest scores. Students showed an improvement in practical knowledge of diabetes management. During the interaction, patients asked the students questions which motivated them to read and understand more about diabetes. Students themselves suggested to widening the net of the student educator program to include more chronic diseases such as hypertension and ischemic heart disease.

Many patients had questions regarding diet, consumption of fruits, and fasting. In spite of having diabetes for many years, the patients were surprisingly unaware of treatment goals they would have to achieve for better outcomes.

Students, in their feedback forms, said that their depth of understanding of diabetes had improved. In addition, many felt that their communication skills had improved.

The ADA has identified seven components as crucial to DSME. They are activity, eating, medications, self-monitoring of blood glucose, management of high and low sugars and sick days, knowledge of the risk of diabetes complications, and the psychosocial aspects of living with diabetes.[6]

Patients with diabetes trained by educators not only have better knowledge of their disease but also have better outcomes – their hemoglobin A1c (HbA1c) being significantly lower.[7]

In type 2 diabetics with higher HbA1c, individual education is more effective than group education in that patients have a better glycemic control.[8] In our project, pairs of students interacted with individual patients, thus fostering a less-threatening atmosphere where patients could clarify all doubts.

The role of diabetes educators is slated to increase, and their reach is predicted to include in the future outpatient clinics, pharmacies, and the community.[9]

When diabetes educators are less didactic, as measured by less time talking, a higher change in patient beliefs about the disease was noted.[10] In our study, after a very brief presentation, the students were encouraged to interact with patients and their bystanders and answer their questions.

We feel that this project worked precisely because of the youth and enthusiasm of the trainers, i.e., the medical students. While they probably did not have the experience of senior consultant physicians, diabetologists, and endocrinologists, they did bring to each patient interaction enthusiasm and friendliness. More importantly, they were definitely less condescending and patronizing than their teachers.

The students were administered the module over 4 h. In the NDEP, the module lasted for 40 h. However, the NDEP dealt with science graduates.[3] Since our project was prefinal and final year medical students, the time required was relatively less as the students already had core concepts of diabetes pathophysiology and management.

Some effects were unexpected. Trying to answer patient questions raised some questions in the student mind – when they could not find answers to these questions in the published literature, they proposed to their guide that these areas might merit further research.

With the epidemic of diabetes in India, ideal management of the disease and prevention of complications becomes important. The literature shows that DSME is pivotal in better outcomes for diabetics.[7] In view of time constraints, it may not be possible for the treating physician to spend sufficient time educating every patient with diabetes – thus, the role of the diabetes educator emerges. We found that there were some advantages of using students as diabetes educators [Figure 3]. The extra time given by students encouraged patients to come out with more questions ones they would have probably hesitated to ask a doctor. The students were motivated to study diabetes in depth to answer patient questions. Some of the questions were an eye opener to us – these facts which we thought were very basic and that the patient would know already – a lesson not to make assumptions. The patient feedback was a reminder to treating physicians to make the goals of treatment – blood sugar targets, blood pressure targets, low-density lipoprotein targets – clear to the patient.
Figure 3: Outcomes of educational programs

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In our study, as in the many regarding diabetes educators done before ours, the patient knowledge significantly increased after interaction with the educator. However, the authors believe that the crucial difference in this study is the fact that using medical students as educators is instrumental in producing a cadre of newly qualified doctors who are well versed in the practical management of diabetes and are able to interact with patients of diabetes in a way which is meaningful to them.


  Conclusions Top


Using medical students as diabetes educators improves patient knowledge about diabetes self-management as measured by a significant improvement in posttest over pretest scores. Students also show a significant improvement in knowledge about the practical management of diabetes as assessed by improvement in posttest scores. Feedback from patients and students about the process is encouraging. Communication skills also improve.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA. Diabetes patient education: A meta-analysis and meta-regression. Patient Educ Couns 2004;52:97-105.  Back to cited text no. 1
    
2.
Burke SD, Sherr D, Lipman RD. Partnering with diabetes educators to improve patient outcomes. Diabetes Metab Syndr Obes 2014;7:45-53.  Back to cited text no. 2
    
3.
Joshi S, Joshi SR, Mohan V. Methodology and feasibility of a structured education program for diabetes education in India: The national diabetes educator program. Indian J Endocrinol Metab 2013;17:396-401.  Back to cited text no. 3
    
4.
Kawaguchi T. Certified diabetes expert nurse and nurse educators in Japan. Diabetes Res Clin Pract 2007;77 Suppl 1:S205-7.  Back to cited text no. 4
    
5.
Rätsep A, Kalda R, Oja I, Lember M. Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: Cross-sectional study. BMC Fam Pract 2006;7:36.  Back to cited text no. 5
    
6.
Peeples M, Mulcahy K, Tomky D, Weaver T; National Diabetes Education Outcomes System (NDEOS). The conceptual framework of the National Diabetes Education Outcomes System (NDEOS). Diabetes Educ 2001;27:547-62.  Back to cited text no. 6
    
7.
Kiblinger L, Braza NL. The impact of diabetes education on improving patient outcomes. Insulin 2007;2:24-30.  Back to cited text no. 7
    
8.
Duke SA, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2009;4:CD005268.  Back to cited text no. 8
    
9.
Martin AL, Lipman RD. The future of diabetes education: Expanded opportunities and roles for diabetes educators. Diabetes Educ 2013;39:436-46.  Back to cited text no. 9
    
10.
Skinner TC, Carey ME, Cradock S, Dallosso HM, Daly H, Davies MJ, et al. 'Educator talk' and patient change: Some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial. Diabet Med 2008;25:1117-20.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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