Knowledge gaps from new medical graduates could impact management of type 1 diabetes in children

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A recent study in Jordan found that some new medical graduates had knowledge gaps in diagnosis and basic management of type 1 diabetes (T1D).

Representing approximately 2% of the estimated total global cases of diabetes, prevalence of T1D is increasing, according to the study. Assessment of knowledge regarding T1D for new medical graduates is necessary to identify weaknesses, defects, and flaws, authors wrote. With a lack of global studies, and no such studies previously done in Jordan, investigators developed a cross-sectional, questionnaire-based study aimed to assess knowledge of diagnosis and basic management of T1D in new medical graduates in Jordan.

The study, conducted from August 1, 2021, to October 31, 2021, approached recent medical school graduates from Jordanian universities that grant a bachelor's degree in medicine. Being a graduate from a Jordanian university school of medicine 3 months preceding collection of the questionnaires were inclusion criteria for the study. Questionnaires were distributed in paper form personally and online using Google Forms. Questionnaires included demographic characteristics and knowledge sections. Gender, name of university, family history of diabetes, number of lectures and seminars regarding T1D, and an estimate of number of persons with T1D seen during clinical training were data collected on the questionnaires.

The 28 questions featured on the questionnaire were presented with the correct answer, 1 incorrect answer, and the option of “I do not know,” and in multiple choice format. According to authors, knowledge questions asked were diverse and evaluated different aspects of T1D such as pathophysiology, diabetic ketoacidosis (DKA), insulin management, hypoglycemia, basic knowledge about using technology, basic guidelines for exercise, screening for diabetes complications, insulin management in patients planned for surgery, and types of food that contain carbohydrates.

Of 1676 total new graduates from 6 schools of medicine in Jordan, 358 responded to the questionnaire. Female respondents (55.6%) were higher than male respondents (44.4%) (P = 0.035). According to the results, there was no correlation between the number of lectures attended by students during study years and their respective knowledge scores (Pearson Correlation = 0.078 [P = 0.142]).

The percentage of correct, incorrect and “I do not know” answers were identified for all questions separately. Certain aspects of DKA, hypoglycemia, pathophysiology, and screening for diabetes complications are sections that saw a high percentage of correct answers from students.

Ninety-one (25.4%) graduates did not know that hypoglycemia could be a cause of decreased consciousness while treating DKA, 56 (15.7%) did not know the symptoms of hypoglycemia and 15.1% did not know accurate management of severe hypoglycemia. In relation to hyperglycemia, 12% of graduates believed they could not give rapid-acting insulin to correct it unless it was during mealtime, while 18% thought that long-lasting insulin should be given to correct hyperglycemia.

The incorrect answer that an individual with T1D should be advised to exercise whenever blood glucose is more than 270 mg/dL was observed in 27.6% of graduates. For basic information regarding the administration of insulin prior to a scheduled surgery, 33.2% mistakenly believed that a patient should not receive long-acting insulin the night before a minor surgery, while 23.5% did not know if they should give it or not. There were 23.7% of graduates who thought that sulfonylurea can be added to insulin for treating adolescents with T1D.

Possible predictors of knowledge were assessed using linear regression, and two variables (gender and expected degree of self-knowledge of diabetes) were statistically significant in the multivariate model. Results demonstrated that the male knowledge scores were significantly lower than female scores. Male graduates had a lower knowledge score of 1.099 (P = 0.008) compared to females. Extent of knowledge of T1D were self-evaluated by graduates. Compared to graduates that identified themselves with poor knowledge, those that evaluated themselves with good or excellent knowledge had increased scores of 3.223 (P < 0.001) and 3.924 (P < 0.001) respectively, according to authors.

In Jordan, pediatric endocrinologists that have experience and knowledge in providing care for children and adolescents with T1D are limited, and most children with the disease are seen by general practitioners and pediatricians. The study noted inconsistencies in endocrinology education in the curricula during preclinical years in the United States and issues of confidence from training doctors in the United Kingdom when dealing with diabetes issues.

Authors concluded continued studies to evaluate knowledge of new medicine graduates is essential to evaluate curricula, experiential education, and clinical experience offered to students. “Identifying gaps and possible predictors of poor knowledge will help members of educational boards, and policy makers to develop and implement changes in the curricula and promote requirements for graduation,” authors wrote. “These modifications will enhance knowledge in areas where deficit is detected and reflect on the quality of patient care and health care services provided to individuals with [T1D],” they concluded.

Reference

Alassaf A, Gharaibeh L, Abuna’meh,. et al. Adequacy of knowledge of new medical graduates about diagnosis and management of children and adolescents with type 1 diabetes in a developing country. BMC Med Educ 23, 234 (2023). https://doi.org/10.1186/s12909-023-04234-z