title: A learner-centered diabetes management curriculum: reducing resident errors on an inpatient diabetes pathway.
abstract: OBJECTIVE
  Diabetes errors, particularly insulin administration errors, can lead to complications and death in the pediatric inpatient setting. Despite a lecture-format curriculum on diabetes management at our children's hospital, resident diabetes-related errors persisted. We hypothesized that a multifaceted, learner-centered diabetes curriculum would help reduce pathway errors.
  
  
  METHODS
  The 8-week curricular intervention consisted of 1) an online tutorial addressing residents' baseline diabetes management knowledge, 2) an interactive diabetes pathway discussion, 3) a learner-initiated diabetes question and answer session, and 4) a case presentation featuring embedded pathway errors for residents to recognize, resolve, and prevent. Errors in the 9 months before the intervention, as identified through an incident reporting system, were compared with those in the 10 months afterward, with errors classified as relating to insulin, communication, intravenous fluids, nutrition, and discharge delay.
  
  
  RESULTS
  Before the curricular intervention, resident errors occurred in 28 patients (19.4% of 144 diabetes admissions) over 9 months. After the intervention, resident errors occurred in 11 patients (6.6% of 166 diabetes admissions) over 10 months, representing a statistically significant (P = 0.0007) decrease in patients with errors from before intervention to after intervention. Throughout the study, the errors were distributed into the categories as follows: insulin, 43.8%; communication, 39.6%; intravenous fluids, 14.6%; nutrition, 0%; and discharge delay, 2.1%.
  
  
  CONCLUSIONS
  An interactive learner-centered diabetes curriculum for pediatric residents can be effective in reducing inpatient diabetes errors in a tertiary children's hospital. This educational model promoting proactive learning has implications for decreasing errors across other medical disciplines.
authors.affiliation: Department of Medical Education, Children’s National Medical Center, Washington DC, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Desalvo
authors.forename: Larrie W
authors.initials: LW
authors.lastname: Greenberg
authors.forename: Celia L
authors.initials: CL
authors.lastname: Henderson
authors.forename: Fran R
authors.initials: FR
authors.lastname: Cogen
mesh_terms: D003479:Curriculum; D003920:Diabetes Mellitus; D006801:Humans; D007297:Inpatients; D007396:Internship and Residency; D019300:Medical Errors / Q000517:prevention & control; D010372:Pediatrics / Q000193:education