Educational effectiveness of a personal digital assistant-based geriatric assessment tool.

BACKGROUND: Although personal digital assistant use among residents is common, few outcomes-based studies have examined the impact of this technology on medical education. AIMS: We evaluated the educational effectiveness of a personal digital assistant-based geriatric assessment tool. METHODS: Internal medicine residents were enrolled as subjects. Personal digital assistant users were randomly assigned to receive or not receive a geriatric assessment tool for use on their device. Outcome measures included pretest/posttest performance and tabulation of geriatric functional issues on hospital dismissal summaries. RESULTS: Seventy-two residents participated. Of these, 38 (53%) reported personal digital assistant use. Twenty were assigned to receive the geriatric assessment tool. Average change between pretest and posttest scores was highest for the group using the geriatric assessment tool on a personal digital assistant (2.8, P=0.01). This group also had the highest average posttest score and the highest average number of geriatric functional issues identified on dismissal summaries, but neither value was significantly different from respective averages for the other study groups. CONCLUSIONS: Residents who used a personal digital assistant-based geriatric assessment tool demonstrated greater improvement in geriatric knowledge than peers who did not use this resource. Curricula adapted to this technology may prove useful in medical education.

Management of inpatient hyperglycemia: assessing perceptions and barriers to care among resident physicians.

OBJECTIVE: To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. METHODS: As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients. RESULTS: Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern. CONCLUSION: Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.