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

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.