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Improving Medical Training for the Care of Chronic Conditions

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT00676208
First received: May 7, 2008
Last updated: April 6, 2015
Last verified: August 2014

May 7, 2008
April 6, 2015
April 2008
September 2008   (final data collection date for primary outcome measure)
Change in Confidence in Ability to Perform Teamwork [ Time Frame: Pre-intervention and Post-Intervention at 1 month ] [ Designated as safety issue: No ]
A three item scale was used to assess confidence in ability to convey logic of recommendations to other providers, explain one's distinctive perspective, and be accountable to patients for a decision made by a colleague from another discipline. The responses for each item ranged from 'not at all confident' (0) to 'very confident' (4), with higher values indicating more confidence. The total scale ranged from 0 to 16 with higher being more confident. Difference scores were analyzed (post-pre) with positive and higher values indicating more favorable change.
Evaluate the impact of SMAs on residents' and medical students' confidence, attitudes, comfort and beliefs regarding chronic care issues and management of diabetes compared to other ambulatory training experiences. [ Time Frame: 4 Months ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT00676208 on ClinicalTrials.gov Archive Site
Change in Professionals' Attitudes About Diabetes [ Time Frame: Pre-intervention and Post-intervention at 1 month ] [ Designated as safety issue: No ]
The University of Michigan's Research and Training Center's Diabetes Attitude Scale was used. There are 33 items and the response format is a 5 point Likert Scale ranging from 'strongly disagree'(1) to 'strongly agree'(5). A higher score means more positive attitudes toward diabetes and its treatment (e.g., psychosocial impact of diabetes; value of tight glucose control).The total score is computed by summing individual items and ranges from 0 to 165. Post-pre total scores were used with positive and higher values indicating greater favorable change.
To assess the feasibility of using direct observation to accurately measure and compare time utilization patterns and diabetes management issues covered by trainees during patient encounters, and to identify how traditional encounters with patients with [ Time Frame: 4 months ] [ Designated as safety issue: No ]
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Improving Medical Training for the Care of Chronic Conditions
Improving Medical Training for the Care of Chronic Conditions
While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) implemented a weekly Diabetes Shared Medical Appointment (SMA). SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. In order to equip physicians with needed resources to manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined.
: Most physicians receive training in and about an acute care-oriented health care system that cannot adequately address the challenges of chronic care management. While medical training has increasingly included chronic care management, quality care necessitates education approaches that go farther. In April 2005, the Louis Stokes Cleveland VAMC implemented a weekly Diabetes Shared Medical Appointment (SMA). Results indicate that SMAs are sustained and, as such, SMAs offer an important opportunity to improve chronic care and a unique setting for training physicians. SMAs offer the potential to provide training in crucial skills that have to date remained less amendable to traditional educational practices. In order to equip physicians with resources to effectively and efficiently manage chronic care, the ways in which SMA experiences are processed and integrated into learning about interdisciplinary approaches and expanding trainees' understanding of chronic care issues need to be examined. Without addressing this gap, it is not possible to develop a comprehensive care model that links education and patient outcomes for chronic conditions, such as diabetes. Building on previous pilot work, we continued to address evaluating and validating instruments. The proposed pilot project included using a think-aloud protocol to evaluate and validate new items and scales assessing interdisciplinary team and chronic care/diabetes beliefs, and evaluating and adjusting direct observation coding tools for chronic condition care.
Interventional
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Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Diabetes Mellitus
Behavioral: Shared Medical Appointments
Participated in shared appointments for patients as part of interprofessional team providing care for diabetes
  • Experimental: Shared Medical Appointments
    Medical students participated in shared medical appointments for patients with diabetes for one month.
    Intervention: Behavioral: Shared Medical Appointments
  • No Intervention: No shared medical appointments
    Medical students in this arm did not participate in shared medical appointments.
Watts SA, Gee J, O'Day ME, Schaub K, Lawrence R, Aron D, Kirsh S. Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointments/group visits. J Am Acad Nurse Pract. 2009 Mar;21(3):167-72. doi: 10.1111/j.1745-7599.2008.00379.x.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
33
February 2012
September 2008   (final data collection date for primary outcome measure)

Inclusion Criteria:

Medical Students:

Inclusion: All medical students participating in diabetes Shared Medical Appointment sessions or other training experiences during the course of the study.

Exclusion Criteria:

medical students who have participated in SMAs for patients with diabetes at the Cleveland VAMC in the past.

Both
20 Years to 75 Years   (Adult, Senior)
Yes
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT00676208
SHP 08-141
No
Not Provided
Not Provided
VA Office of Research and Development
VA Office of Research and Development
Not Provided
Principal Investigator: David C Aron, MD MS Louis Stokes VA Medical Center, Cleveland, OH
VA Office of Research and Development
August 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP