Survey evaluation of in-hospital diabetes seminars provided by medical professionals, for medical professionals

Introduction

The number of people with diabetes has rapidly increased worldwide. According to the statistics of the International Diabetes Federation, there are 425 million people with diabetes in the world, which is projected to reach 629 million in 2045.¹ To provide appropriate medical care for increasingly more patients with diabetes, and also because of the multifactorial nature of this disease, doctors and all health care providers involved in diabetes care should work together to provide comprehensive and effective diabetes services.^2–7 An interprofessional team approach is essential for adequate patient care; in fact, interprofessional collaboration has been reported to improve outcomes in patients with diabetes.^8–19

To successfully adopt an interprofessional team approach, all team members require continuous professional training to maintain their ability to provide the best diabetes care, adopting up-to-date medical advances in the field that might affect patients’ daily diabetes management.^11,20 In addition, mutual respect and understanding of other professions are necessary for smooth interprofessional collaboration. However, due to the tight schedule of their own daily practice, it is difficult for health care professionals to keep up with the latest diabetes information, especially with issues that are not in their own field; moreover, due to a lack of time and opportunity, the chances to observe other health care professions’ practice or provision of patient education are unfortunately scarce. To address this issue, our hospital conducted periodic educational seminars about diabetes, which were presented by and for medical professionals at our hospital. Here, we report the results of a questionnaire survey evaluating the effect of the seminars on participants and propose a vision for the future education of medical professionals.

Material and methods

From June 2015 to February 2016, a doctor provided three lectures on diabetes in general (pathophysiology, diagnosis, examinations, complications, treatments, and education for patients with diabetes) to medical professionals at Sanno Hospital. After medical professionals acquired basic knowledge about diabetes in these lectures, a series of 10 educational seminars were provided by medical professionals, including a registered dietician, physiotherapist, pharmacist, clinical laboratory technician, and doctor, from May 2016 (1st seminar) to March 2018 (10th seminar). Each seminar included a lecture of approximately 50 mins given by various professionals and short supplementary comments from doctors. The lecturers talked about their own professional field with slides and handouts. Often, the lectures included case studies of real patients with diabetes to help participants better understand the content through a sense of familiarity and practicality. In the 9th seminar, participants practiced self-monitoring of blood glucose (SMBG). Nurses who were certified diabetes educators in Japan (CDEJ) planned and organized the seminars.

Sanno Hospital is a private hospital with multiple clinical departments, which specializes in infertility treatment and pregnancy care; thus, it is recognized as a maternity hospital. The hospital annually treats an average of 1,172 pregnant women, of which 98 (8.36%) are annually diagnosed with gestational diabetes on average. Thus, medical professionals working at this hospital require a certain level of knowledge and experience with gestational diabetes. Therefore, gestational diabetes was included in the lecture topics (Table 1), and midwives participated in the seminars.

Table 1 Seminar topics and professions of lecturers

The seminar participants were asked to complete a questionnaire comprising 8 questions (Q1–Q8) (Table 2). Q2 was only answered by participants attending the 1st to the 5th seminar. In addition to Q1 and Q3–Q5, participants attending the 6th to the10th seminar were asked to answer Q6, which required a “yes/no” response. Those who answered “yes” to Q6 were asked to answer Q7, which required a “yes/no/not sure” response. Those who answered Q7 also answered Q8. All the seminars were conducted in a free-for-all style. The questionnaire was anonymous and completion was voluntary. Substantially similar answers for Q2 were grouped and categorized into themes. Similar answers to Q5 and Q8 were also grouped.

Table 2 Questions included on the questionnaire form

The survey has been approved by the Ethics Committee of Sanno Hospital. Informed consent was obtained from all participants.

Results

Table 1 shows the seminar topics and professions of lecturers for all 10 seminars. Each seminar was attended by 29–50 (average 36.7) participants, and among the 367 total participants (ie, the cumulative total number of 10 seminars), 332 completed the questionnaire (respondents). The response rates to the questionnaires for each seminar were 83.9–97.6%. According to the answers to Q1, the number and percentages of each occupation of respondents were as follows: nurses, 158 (47.6%); pharmacists, 44 (13.3%); physiotherapists, 34 (10.2%); clinical laboratory technicians, 28 (8.4%); midwives, 28 (8.4%); dieticians, 20 (6.0%); and doctors, 20 (6.0%).

The answers to Q2 (reasons to attend seminars) for all professions were grouped and categorized (Table 3). The answers to Q3 were varied (data not shown), suggesting that participants were interested in and impressed by diverse topics in the lectures. Regarding Q4, the typical (top 5) preferred seminar topics from each profession are listed in Table 4. The representative answers to Q5 (general comments about seminars) for each profession are shown in Table 5.

Table 3 Answers of all professionals to Q2 (“Why did you decide to attend this seminar?”)

Table 4 Answers of each profession to Q4 (“What topics do you prefer for the next seminar?”)

Table 5 Representative answers of each profession to Q5 (“Please write your free and general comments for today’s seminar”)

As for Q6 (attended previous seminar), among all the participants of the 6th to the 10th seminar (151 respondents in total), 88 (58.3%) answered “yes.” Among those 88, a total of 64 (72.7%) (in all professions) answered “yes” to Q7 (changes in practice/attitude). Answers to Q7 for each profession are shown in Table 6. Substantially similar answers to Q8 (reasons for answering Q7) were grouped, and representative answers of each profession are shown in Table 7.

Table 6 Answers of each profession to Q7 (“After you attended the seminar, do you think there were some changes in your daily work or your attitude towards your patients?”)

Table 7 Representative answers of each profession to Q8 (“Why do you think so? Please explain the reasons for this”)

Discussion

This study involved a questionnaire survey to evaluate educational diabetes seminars provided by and for medical professionals at Sanno Hospital. It was revealed that most of the participants attended the seminar spontaneously with an eagerness to gain knowledge about diabetes, pure interest in the lecture topics, or out of necessity (Table 3). The responses regarding preferred topics for future seminars indicated that almost all professional groups expected case studies, and pharmacists, physiotherapists, dieticians, and midwives listed “gestational diabetes,” probably because they encountered many of these patients in their daily practice (Table 4). Regarding the free and general comments, some respondents strongly realized their lack of knowledge, and some were inspired and encouraged by the seminar to study more about diabetes (Table 5). Some respondents commented that through the seminars, they could understand other professions’ work in diabetes care better than before. This was actually one of the aims of the seminars provided by and for multiple medical professionals. In order to implement effective interprofessional teamwork, medical professionals from different professions need to educate and inform each other.

Besides attending lectures, participants also practiced SMBG. This experience seemed to be impressive for the participants, realizing how painful and troublesome SMBG can be for patients who have to do many times a day for many years. Therefore, interactive participatory seminars like ours will be valuable.

From the participants who attended the latter half of the seminar series, more than 70% in all the professions except pharmacists and clinical laboratory technicians reported that the seminar they had already attended changed their daily work or attitude toward their patients (Q7) (Table 6). Reasons for responding “No” or “Not sure” to this question included lack of experience, shortage of ability, and few chances to use the knowledge acquired in the seminar with real patients (Q8) (Table 7). Given the nature of their profession, clinical laboratory technicians have less opportunities to be directly involved in patients’ diabetes care. Among the various medical professionals, nurses are supposed to be the most involved in patient care. However, the answers of some nurses, such as “Lectures were helpful but I did not have a chance to use the knowledge I gained” or “I am still inexperienced and I haven’t had many opportunities to aid patients with diabetes,” indicate that seminar attendance alone did not change their daily work or attitude toward patients. If the problem is solely their limited personal ability, improvements can be made through individual effort. If the problem is that medical personnel want to care more for patients with diabetes but cannot do so because of mismatched allocation, individual facilities should reconsider the medical professional’s allocation so that they may have more of a chance to see patients with diabetes and to improve their skills in caring for such patients.

The seminars were mainly planned and organized by nurses who were certified diabetes educators of Japan (CDEJ). CDEJ is a qualification awarded in Japan to nurses, dietitians, pharmacists, clinical laboratory technicians, or physiotherapists possessing wide specialist knowledge and experience in diabetes. Currently, there are more than 19,500 CDEJs, mostly nurses (45.9%), dieticians (24.6%), and pharmacists (15.4%).²¹ Incorporating diabetes educators into clinical services is expected to improve clinical and quality-of-life outcomes of persons with diabetes,²² and many medical professionals recognize the need for more diabetes educators such as diabetes specialist nurses.²³ However, according to a previous survey with CDEJs, fewer than 40% of the responding CDEJs were satisfied with the current state of their activities and contributions as CDEJs.²⁴ Many perceived that they were not working sufficiently, and the reasons identified for this included “low awareness of CDEJs” and “insufficient interprofessional teamwork.”²⁴ In the present seminar, CDEJs prepared and disseminated information to other medical professionals, and this might be a good opportunity to improve awareness of CDEJs by other medical professionals. As for “insufficient interprofessional teamwork,” by participating in the seminar, medical professionals might get acquainted with each other, and through the lectures, participants might deepen their understanding of other professions’ skills and activities. All of these possibilities may lead to better interprofessional teamwork so that CDEJs can show their strength sufficiently and effectively in the team.

There are some limitations to the present study. First, because this survey was carried out at a single medical center (maternity hospital), the results of the survey may not be generalizable to other medical institutions. Second, because the questionnaire was completed by the participants of educational diabetes seminars, who might be more enthusiastic and motivated about diabetes care than those who did not attend the seminars, the results might be biased and unrepresentative in general. In addition, because the questionnaire survey was analyzed cumulatively, the answers of participants who frequently attended the seminars might have had a greater influence on the analysis and therefore might bias the results. Third, because there were too few clinical laboratory technicians, midwives, dieticians, and doctors in the sample, our findings may not be representative of these professions.

Conclusion

The educational diabetes seminars implemented by and for medical professionals were well-received in general; however, they were not effective enough to change all the participants’ daily work or attitude toward patients. Knowledge provided in the seminars may not lead to direct improvement in medical care for patients with diabetes; however, it might lead to mutual understanding between professions and thus contribute to better medical care for patients eventually. Because interactive participatory seminars received favorable comments, this format should be adopted to make seminars more attractive. Long-term improvements in the health of individuals with diabetes depend on effective professional development.²⁵ Thus, further research such as longitudinal follow-up studies are required to evaluate the long-term effects of appropriate training of health professionals on the glycemic control of patients.