title: Differences in level of confidence in diabetes care between different groups of trainees: the TOPDOC diabetes study.
abstract: BACKGROUND
  There is an increasing prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care. The aim of this further evaluation of the TOPDOC Diabetes Study data was to identify if there was any variation in confidence in managing diabetes depending on the geographical location of trainees and career aspirations.
  
  
  METHODS
  An online national survey using a pre-validated questionnaire was administered to trainee doctors. A 4-point confidence rating scale was used to rate confidence in managing aspects of diabetes care and a 6-point scale used to quantify how often trainees would contribute to the management of patients with diabetes. Responses were grouped depending on which UK country trainees were based and their intended career choice.
  
  
  RESULTS
  Trainees in Northern Ireland reported being less confident in IGT diagnosis, use of IV insulin and peri-operative management and were less likely to adjust oral treatment, contact specialist, educate lifestyle, and optimise treatment. Trainees in Scotland were less likely to contact a specialist, but more likely to educate on lifestyle, change insulin, and offer follow-up advice. In Northern Ireland, Undergraduate (UG) and Postgraduate (PG) training in diagnosis was felt less adequate, PG training in emergencies less adequate, and reporting of need for further training higher. Trainees in Wales felt UG training to be inadequate. In Scotland more trainees felt UG training in diagnosis and optimising treatment was inadequate. Physicians were more likely to report confidence in managing patients with diabetes and to engage in different aspects of diabetes care. Aspiring physicians were less likely to feel the need for more training in diabetes care; however a clear majority still felt they needed more training in all aspects of care.
  
  
  CONCLUSIONS
  Doctors in training have poor confidence levels dealing with diabetes related care issues. Although there is variability between different groups of trainees according to geographical location and career aspirations, this is a UK wide issue. There should be a UK wide standardised approach to improving training for junior doctors in diabetes care with local training guided by specific needs.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Jyothis T
authors.initials: JT
authors.lastname: George
authors.forename: David
authors.initials: D
authors.lastname: Warriner
authors.forename: David J
authors.initials: DJ
authors.lastname: McGrane
authors.forename: Kavithia S
authors.initials: KS
authors.lastname: Rozario
authors.forename: Hermione C
authors.initials: HC
authors.lastname: Price
authors.forename: Emma G
authors.initials: EG
authors.lastname: Wilmot
authors.forename: Partha
authors.initials: P
authors.lastname: Kar
authors.forename: Irene M
authors.initials: IM
authors.lastname: Stratton
authors.forename: Edward B
authors.initials: EB
authors.lastname: Jude
authors.affiliation: Glasgow Royal Infirmary, Glasgow G4 0SF, UK. gerard.mckay@gla.ac.uk.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: McKay
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D003625:Data Collection; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D004501:Education, Medical / Q000379:methods / Q000592:standards*; D006801:Humans; D020380:Needs Assessment; D010820:Physicians / Q000523:psychology / Q000592:standards; D011795:Surveys and Questionnaires; D006113:United Kingdom