Evaluation of the knowledge of inpatient management of hyperglycaemia and insulin use among foundation doctors

Abstract

Introduction: Suboptimal glycaemic control in hospitalised patients is associated with an increased risk of complications, mortality, and extended hospital stays. Managing and treating high blood sugar readings is a common task that junior doctors often encounter. This project was designed to assess and improve the skillset of foundation doctors in managing hyperglycaemia and insulin use in hospitalised patients at a district general hospital. Method: A survey was conducted to evaluate the self-rated confidence of foundation doctors in managing hyperglycaemia. To evaluate their knowledge of hyperglycaemia management, a quiz was conducted with clinical scenarios based on hyperglycaemia. The quiz consisted of five questions, and a score of 80% or higher (at least four correct answers) was deemed satisfactory. Following the first Plan-Do-Study-Act (PDSA) cycle, an interactive teaching session based on Joint British Diabetes Society (JBDS) guidelines1 was provided to all foundation doctors in the trust. This session was designed around clinical scenarios to ensure maximum engagement. In the second PDSA cycle, a local protocol based on JBDS1 and GIRFT (Getting It Right First Time)2 guidelines was developed for the inpatient management of hyperglycaemia. The quiz was repeated after each cycle to measure the efficacy of the intervention. Results and discussion: 35 foundation doctors took part in the survey to rate their confidence in managing high blood sugar levels in inpatients independently. 68.5% of the participants reported being slightly confident in their abilities while 22.8% expressed no confidence at all.In the first cycle of this project, 23 foundation doctors participated in the quiz on inpatient management of hyperglycaemia and insulin use. Only 6 (26.085%) scored 80% or higher, indicating suboptimal knowledge. After the clinical scenario-based teaching session, 19 of the 23 participants (82.6%) scored 80% or higher, demonstrating the significant impact of this teaching approach in improving management of inpatient hyperglycaemia.In the second cycle, 22 junior doctors participated. Following the introduction of newly developed hospital guidelines for inpatient hyperglycaemia management, the results of the study were overwhelmingly positive, with 86.3% of the participating doctors, (19 out of 22), scoring 80% or higher, providing a compelling demonstration of the importance of implementing well-designed guidelines for effectively managing inpatient hyperglycemia in hospital settings. Conclusion: Effective management of hyperglycaemia is a critical clinical skill that requires both teaching and practice. However, junior doctors often lack the necessary knowledge and confidence to effectively manage hyperglycaemia. Incorporating clinical scenario-based teaching sessions into foundation year training programmes can help bridge knowledge gaps where the use of polls and quizzes encourages active participation from all participants. Additionally, clear and concise local guidelines on inpatient hyperglycaemia management and insulin use would be imperative. By utilising these approaches in tandem, we can equip our junior doctors with the skills and knowledge necessary to provide optimal care for their patients with diabetes.