recently noted the 61% increase in incidence of adult onset diabetes from 1991 to 2000. patient education are essential components of diabetes. management. …
Diabetes
Family Medicine Clerkship Curriculum Resources OVERVIEW
Diabetes is one of the most commonly seen chronic conditions in primary care The CDC recently noted the 61 increase in incidence of adult onset diabetes from 1991 to 2000 Treatment focuses on partnering with the patient and family to stabilize the disease and prevent complications Teamwork and patient education are essential components of diabetes management Most students should have abundant opportunities to care for patients with diabetes and to develop needed competencies ACGME Competencies Clerkship Objectives organized by ACGME FM Themes FM Principles Core Topics
Pick a Topic
Diabetes
LEARNING GOALS AND OBJECTIVES Organized by ACGME Competencies
Patient Care
GOAL: Students will accurately assess signs and symptoms of diabetes OBJECTIVES: Students will be able to:
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Perform appropriate examination of the eyes and feet Interpret laboratory data related to diabetic control and end organ damage
Special Topics General Resources Clerkship Setting Faculty Development Glossary FMCR Members Users Guide
GOAL: Students will appropriately discuss diabetes with patients OBJECTIVES: Students will be able to:
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Explain indicators of control and complications of diabetes to their patients Describe to patients the risks of diabetes and goals of management
GOAL: Students will incorporate individual and cultural differences in the development of treatment plans OBJECTIVES: Students will be able to:
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Discuss with patients and families the importance of lifestyle changes, such as diet and exercise, in the management of diabetes Develop treatment plans in the context of each patients life, environment, and culture Teach and motivate patients to monitor blood glucose at home
GOAL: Students will recommend appropriate prevention and health maintenance plans for patients with diabetes OBJECTIVES: Students will be able to:
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Ensure that patients with diabetes receive appropriate immunizations eg, pneumococcal and influenza vaccination Screen patients for cardiovascular disease
Medical Knowledge
GOAL: Students will understand the impact of diabetes on the US population OBJECTIVES: Students will be able to:
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Discuss the epidemiology of diabetes, including ethnic and socioeconomic
differences Compare and contrast ADA and USPSTF recommendations for screening for diabetes
GOAL: Students will understand the pathophysiology of diabetes OBJECTIVES: Students will be able to:
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Describe the end organ complications of untreated or incompletely treated diabetes mellitus Describe how to make the diagnosis of diabetes, and differentiate Type I from Type II Discuss and defend the initial evaluation and ongoing management of a patient with a new diagnosis of diabetes Describe the management of patients with comorbid conditions, such hypertension and hyperlipidemia
GOAL: Students will understand the rationale for treatment plans of diabetes OBJECTIVES: Students will be able to:
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Describe the use of oral agents and insulin for diabetes Discuss the evidence for the role of lifestyle changes: diet, exercise, and weight loss Discuss the side effects and costs of commonly used medications
Practice-Based Learning and Improvement
GOAL: Students will understand the role of monitoring diabetic patients in practice settings OBJECTIVES: Students will be able to:
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Describe how care of patients with diabetes is monitored in the assigned clerkship site Consider
the impact of environment and neighborhood on adherence to treatment plans and lifestyle changes Describe the patient education protocols and programs for diabetes mellitus at their assigned clerkship sites
GOAL: Students will understand the role of practice-based improvement OBJECTIVES: Students will be able to:
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Recognize the importance of practice analysis for a population with diabetes
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Design an intervention to improve the practices care of its population of patients with diabetes
GOAL: Students will bring up to date evidence to the point of clinical care OBJECTIVES: Students will be able to:
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Identify gaps in their own knowledge and frame appropriate clinical questions in regard to diabetes Use best evidence to answer clinical questions
Interpersonal and Communication Skills
GOAL: Students will understand the importance of effective communication with patients and families in the management of this progressive, often asymptomatic, chronic illness OBJECTIVES: Students will be able to:
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Describe the long-term treatment plan for diabetes Include patients and families, as
appropriate, in the development of treatment plans Demonstrate effective listening skills and empathy to improve patient adherence to diet, exercise, and medications
GOAL: Students will understand the importance of effective, culturally sensitive communication with patients and their families OBJECTIVES: Students will be able to:
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Discuss with patients and their families what the diagnosis of diabetes means, including the necessary lifestyle changes Collaborate effectively with other members of the health care team, such as a nutritionist, nurse, or health educator
Professionalism
GOAL: Students will demonstrate the ability to care for patients from diverse patient backgrounds and at different points in their illness OBJECTIVES: Students will be able to:
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Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans Reflect on personal frustrations when patients are not adherent to plans Explain the relationship of diabetes to culture, age, gender, and disabilities
Systems -Based Practice
GOAL: Students will understand the impact of health care systems and environment on the management of
diabetes
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Diabetes
OBJECTIVES: Students will be able to:
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Describe cost-effective strategies for treatment of diabetes Analyze barriers to effective integrated treatment of diabetes Consider the role of other disciplines eg, pharmacy, nursing, social work, and allied health in the treatment of diabetes
EDUCATIONAL METHODS AND RESOURCES
Independent Learning
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Nutrition Toolkit for medical students, University of Washington Nutrition Academic Award
Learning Units
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STFM Group on Nutrition Physicians Curriculum in Nutrition: Primary Care: Nutrition Academic Award Program NHLBI Nutrition Academic Award Program
Published Material
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Nutrition Topics Essential in a Medical School Curriculum in Priority Order r Weinsier RL et al Priorities for nutrition content in a medical school curriculum: a national consensus of medical educators Am J Clin Nutr 1989; 50:707-12 Abstract at PubMed r Hark L, Deen D Taking a nutrition history: a practical approach for family physicians Am Fam Phys1999, 59:1521-1536 Article at AFP r Nutrition Screening Initiative DETERMINE checklist http://wwwaafporg/nsi
Web
Sites
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American Diabetes Association http://wwwdiabetesorg/homepagejsp National Diabetes Information Clearinghouse NIDKK Physicians Committee for Responsible Medicine Nutrition Education-Diabetes Unit PACE Patient Centered Assessment Counseling for Exercise and Nutrition Multicultural Diabetes Resources EthnoMed Diabetes Information in Spanish CDC Diabetes Public Health Resource National Diabetes Information Clearinghouse bibliographic searches on diabetes Titles, abstracts, and availability information for health information and health education resources on specific diabetes topics
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http://diabetesniddknihgov/resources/biosearchhtm National Diabetes Education Program NDEP NDEP is a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations http://ndepnihgov/ Making Systems Change for Better Diabetes Care An easy-to-use, comprehensive website for information and tools to make effective systems changes in the way diabetes is diagnosed, treated, and prevented
http://betterdiabetescarenihgov/ American Association of Diabetes Educators http://wwwaadenetorg/ National Center for Chronic Disease Prevention and Health Promotion Diabetes Public Health Resource http://wwwcdcgov/diabetes/indexhtm Juvenile Diabetes Research Foundation International http://wwwjdforg/ Diabetes dictionary from NIDDK http://diabetesniddknihgov/dm/pubs/dictionary/indexhtm Diabetes Camping Association Lists diabetes camps worldwide http://wwwdiabetescampsorg/ monitoring diabetes happenings everywhere in cyberspace, including links to on-line communities http://wwwdiabetesmonitorcom/indexhtm
Multimedia
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Palmtop BMI Calculator, National Heart, Lung, Blood Institute: NHLBI Obesity Treatment Guidelines University of Pennsylvania School of Medicine Nutrition Education slides, articles, cases
Contact People
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STFM Nutrition Education Group
ASSESSMENT STRATEGIES
Standardized Patient Cases
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Nutrition Cases, University of Washington, contact dambrozy@uwashingtonedu Morgan: A Case of Diabetes -Lisa Rubin and Clyde Freeman Herreid, University at Buffalo, State University of New York on National Center for Case Study Teaching in Science Andrea: The Death of a
Diabetic - Clyde Freeman Herreid, Department of Biological Sciences, University at Buffalo, State University of New York National Center for Case Study Teaching in Science:
Problem-Based Learning Cases
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Medical University of South Carolina Contact Alexander Chessman, MD University of California Los Angeles, Dept of Family Medicine
Web-Based Case
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University of Texas, San Antonio, Dept of Family Medicine Contact Richard Usatine, MD
FACULTY DEVELOPMENT
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Nutrition for Physicians , University of Washington Nutrition Academic Award Program, available online
Lead Authors: William B Shore, MD, Alexander Chessman, MD, and Caryl Heaton, DO Clerkship/Post-Clerkship Workgroup members: Ann OBrien-Gonzales, PhD Chair, Alexander Chessman, MD EC Liaison, Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark E Quirk, EdD, David Schneider, MD, MSPH, William B Shore, MD, Richard Usatine, MD Family Medicine Curriculum Resource FMCR Project HRSA Contract 240-00-0107 Revised November 11, 2003 For questions or comments, please contact Webmaster or Ardis Davis This page last
updated October 21, 2004
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