Improvement in clinician confidence in and knowledge of Diabetic Ketoacidosis management following a case-based curriculum in Kenya

Abstract

Abstract Background Diabetic ketoacidosis (DKA) is a common emergency associated with significant morbidity and mortality in low resource settings. Prompt diagnosis and correct management improves outcomes. To improve clinician knowledge and confidence in DKA management, we designed a novel curriculum for training local clinicians in a low-resource setting. This curriculum aligned to international guidelines, adapted for local resources. Our aim was to assess if the curriculum improved clinician knowledge and confidence. Methods Participants included physicians and nurses in the Emergency Department (ED) at a tertiary academic center in Nairobi, Kenya. Participants completed pre/post-tests of knowledge, which permitted prospective curriculum evaluation based on the second level Kirkpatrick hierarchy, knowledge retention. The cases focused on local evidence-based DKA management pathways. They were delivered using novel in-person with virtual (recorded) teaching techniques, permitting both conventional and independent learning. Outcome measures related to knowledge improvement were analyzed using independent t-tests; clinician confidence was assessed via self-reported survey and analyzed using descriptive statistics. Results 125 clinicians (79.8% nurses and 20.2% physicians) completed pre-training assessment; 104 completed post-training assessment. Prior to training, 53.6% of all trainees reported that they were “highly confident” compared with 61.5% of all trainees post-training (p=0.16). Post-training, there were statistically significant increases in knowledge scores related to DKA diagnosis (14% increase, p=0.03), electrolyte management (41% increase, p<0.0001), fluid administration (28% increase, p=0.01) and insulin administration (24% increase, p=0.01). There was a significant increase in overall clinician knowledge scores with 34.4% (n=43) attaining a knowledge score of 7 or above correct responses out of the 10 cases presented pre-training versus 65.4% n=68 post-training (p<0.0001). Conclusion Our pretest-posttest results demonstrate that our DKA management course improved clinical knowledge among physicians and nurses working in low-resource ED. Future research is underway to evaluate clinical practice changes and patient care outcomes related to this improved knowledge.

Keywords

• Diabetic ketoacidosis
• Medical education
• Emergency care