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AIM: The purpose of this study was to document in people with type 2 diabetes (T2DM) in Barbados, attitudes and beliefs that may result in psychological insulin resistance. METHODS: A representative, population-based, sample of 175 eligible people with T2DM 25 years of age and over was surveyed by telephone. The 20-item insulin treatment appraisal scale (ITAS) was administered (score range 20 to 100 for positive to negative perceptions). RESULTS: 117 people participated (67% response rate, 32% male, mean age 66 years, 90% Black, 22% on insulin). Of non-responders, 52 were not contactable and 6 were difficult to communicate with. Negative perceptions about insulin use included - meant a worsening of diabetes (68%), would worry family (63%), feared self-injection (58%), meant a failure in self-management (57%), injections were painful (54%), would be seen as being sicker (46%), increased hypoglycaemia risk (38%), required effort (34%), causes weight gain (27%), causes a deterioration in health (14%), and would have to give up enjoyable activities (10%). Positive perceptions were - helps good glycaemic control (78%), would prevent complications (61%) and improves health (58%). Mean total ITAS score (61.6, SD = 7.7) was lower for those on insulin compared to those not on insulin (53.7 vs. 63.8, p < 0.0001). Sex, age and diabetes diagnosis duration were not significant predictors of ITAS score. CONCLUSIONS: Multiple factors related to patient beliefs and attitudes need to be considered and addressed when initiating insulin in order to minimise psychological insulin resistance and delay. Patients using insulin had less negative perceptions than those not on insulin.
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BACKGROUND: Transitions in medical education are emotionally and socially dynamic; this may affect learning. Students transitioning from preclinical to clinical training may experience negative consequences. Less is understood about students' experiences during transitions within clinical training and influential factors. METHODS: The authors used organizational socialization theory to explore a transition within the clinical years. Final-year medical students experienced a nine-week internal medicine clerkship; willing students participated. Students (n = 101; 97 %) completed a questionnaire with open-ended questions at the beginning and end of the clerkship and participated in six consecutive focus groups, until data saturation occurred (n = 37). Data were thematically analyzed. RESULTS: Socialization was challenging. Many students experienced difficulty developing relationships with team members. Students with a positive attitude experienced a smoother transition. Many students were uncertain of their roles, concerned about the workload and desired guidance to meet clerkship demands. This transition resulted in varied outcomes from enjoyment, increased confidence and student development through to disinterest. CONCLUSION: Transitions within clinical training are complex. Faculty should focus on adequate socialization in a new clerkship as this may facilitate a smoother transition. This may necessitate orientations, staff training, and formal student support. Further research is needed on the impact of these recommendations on learning and well-being.
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Academic pursuits are inseparable from the medium within which they take place - life. The lives of medical trainees can present many challenges that are independent of academic demands. Poor psychological health has been found to develop in medical trainees. Can medical educators minimize this decline in well-being? Positive education - learning skills for traditional academia and to foster happiness - has been shown to improve students' well-being. This piece considers the application of 'positive education' to medical training. By using this approach, we may optimize the lives of our trainees, potentially enhance learning and improve their academic and personal outcomes.
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BACKGROUND: Junior doctors require training to adequately manage the increasing numbers of adult, hospitalized patients with diabetes whom they encounter. AIMS: Junior doctors experiencing the intervention acquire knowledge and skills that improve their management of inpatients with diabetes. METHODS: We designed and administered, a one-hour, classroom-based, educational intervention to 242 juniors doctors. This resulted in a 49% reduction in insulin prescription errors and an increase in their confidence in the delivery of care. A number of key steps were taken to develop the intervention. First, aims, objectives, methods and assessment were carefully aligned with learning objectives at the appropriate level of Bloom's Taxonomy. Clarity was enhanced through the structuring of the introduction, body and conclusion. Clinically authentic active learning methods were used to increase engagement and provide an opportunity for junior doctors to reflect and make connections with their own clinical practice. Additionally, refinement was integrated into the process of administration. RESULTS: Qualitative analysis from 205 trainees (85%) revealed that trainees liked a number of design features, their ability to be interactive, and immediacy behaviors of facilitators. CONCLUSION: Classroom-based training can impact clinically delivered care. Achieving this goal requires well-thought-out content design and evaluation.
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In this study, we evaluated the burden and quality of adult inpatient diabetes care in Barbados. Inpatients were reviewed over 2 days to identify those with diabetes. Data were collected and analysed from identified patients, their notes and management charts using an audit methodology developed in the UK. Inpatient diabetes prevelance was found to be 42.5% (111 of 261 beds audited). Insulin-treated type 2 diabetes affected 41.8% of the patients. Diabetic foot disease accounted for 30% of admissions and 89% of diabetes-related admissions. Of the patients admitted without diabetic foot disease, 13.9% had their feet examined and 2.8% developed foot lesions during their stay. Medication errors were experienced by 41.4% of patients. We recorded the prevalence of inpatient diabetes in the English medical literature (42.5%) and this was significantly driven by diabetic foot disease. Care needs were complex and areas of potential improvement were identified.