Game Beats 'Old-School' Tools to Teach Insulin Prescribing

Marlene Busko

June 07, 2015

BOSTON — In a randomized controlled trial that pitted Brazilian primary-care physicians who learned about insulin therapy via a game vs others who learned via traditional continuing-medical-education lectures, both groups improved their knowledge. But the "gamers" came out on top.

"We hope that our game can be an excellent tool for continuing medical education," the game's codeveloper, Dr Leandro A Diehl (Universidade Estadual de Londrina, Brazil), told Medscape Medical News at a poster presentation at the American Diabetes Association (ADA) 2015 Scientific Sessions. Because the game is available online, it can reach a large number of physicians, he noted. "We hope to improve diabetes care with this [educational tool]," he said.

The trial to assess the game's effectiveness was part of Dr Diehl's PhD thesis; the game is currently available only in Portuguese, but the researchers plan to have Spanish and English versions available online in a few months.

A Canadian endocrinologist who was passing by the poster said he looks forward to playing this educational game. "I think it is a novel approach, and I'm anticipating playing it," Dr Thomas Ransom (Queen Elizabeth II Hospital Centre, Halifax, Nova Scotia) told Medscape Medical News.

"A lot of what we do in continuing medical education is dry and comes from tables and doesn't really represent real life," he said. "A game is closer to real life than what comes off your standard slide deck." Moreover, a game will bring out the competitive drive of physicians, Dr Ransom added. "They want to do well, and a game would challenge them."

Fun, Effective, Practice-Changing Education

Worldwide, primary-care physicians are the main providers of type 2 diabetes care, yet they often lack expertise in this area, especially in the use of insulin, according to Dr Diehl and colleagues. "Clinical inertia," or a delay in starting patients on insulin, is a major contributor to poor glycemic control, they note.

The group of clinical endocrinologists, medical educators, and game designers developed InsuOnLine, an educational game to teach primary-care providers "basic rules about providing insulin therapy" to patients with type 2 diabetes, Dr Diehl explained.

"In the game, the player takes on the role of a young physician in a primary healthcare clinic and must assess a series of diabetic patients and decide what to do to improve their glycemic control," usually by initiating or adjusting their insulin," Dr Diehl explained. The cases represent the most typical patient presentations in primary healthcare, he added.

The researchers randomized 135 primary-care physicians (including 52 residents) in southern Brazil to receive education about insulin therapy from the the game (70 physicians) or from traditional instruction (65 physicians).

The physicians replied to a questionnaire to assess their baseline knowledge, skills, attitudes, and satisfaction.

Those who were randomized to the "game group" played the InsuOnLine game, which included patient-case scenarios, on their computers, at their own speed. The physicians in the control group attended 3 to 4 hours of traditional lectures with clinical-case discussions. The content of the game and the lectures was similar and based on guideline recommendations for insulin therapy.

The primary outcome was insulin-prescribing skills and knowledge, as measured by a questionnaire. Secondary outcomes were beliefs about insulin and satisfaction with the activities.

The physicians included 70 men (52%) and 65 women (48%), with a mean age of 38.

The mean insulin-therapy-knowledge score (% of right answers) improved from 52% at baseline to 85% after the traditional education (P < .001), and to 92% after the game-based education (P < .001). The mean improved score was higher in the group that received game-based education than in the group that received traditional education (P = .001).

Participants in both groups had more accurate beliefs about insulin following their education.

All participants in both groups said that the activity increased their knowledge of type 2 diabetes and would have an impact on their practice. The game and the traditional education dispelled some misconception about insulin therapy — for example, that it is better to delay insulin initiation until it is absolutely essential.

Almost all the participants (96%) found that the game was fun. Most participants considered the game to be more effective than attending a lecture to learn about insulin therapy.

"Our results show that a well-designed digital game is very effective for medical education on insulin," Dr Diehl and colleagues summarize. "Due to its flexibility of use and easy dissemination, InsuOnLine has a great potential to improve primary-care-physician skills for treating diabetes and to ameliorate the care given to diabetic patients worldwide," they conclude.

Dr Diehl is on the speaker's bureau of AstraZeneca and Bristol-Myers Squibb and is co-owner of the InsuOnLine game. Disclosures for the coauthors are listed in the abstract.

American Diabetes Association 2015 Scientific Sessions; June 5, 2015: Boston, Massachusetts. Abstract 746-P

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