This study was conducted to determine if online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention that engages clinicians in a practical learning experience could improve performance of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) in the management of T2D and sleep problems. The CME VPS intervention comprised one patient presenting at 2 different points. The VPS platform allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Learners’ choices were analyzed using a sophisticated decision engine. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision. Learners were given the opportunity to modify their decisions after receiving CG. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. Through November 2017, significant improvements were documented among participating learners after clinical guidance (D/Es n=19; PCPs n=391):

  • Diagnosis of uncontrolled T2D: 40% absolute improvement among PCPs (3% pre-CG vs. 43% post-CG; P<.001) and 26% improvement among D/Es (0% pre-CG vs. 26% post-CG; P=.004)

  • Diagnosis of insomnia: 31% absolute improvement among PCPs (28% pre-CG vs. 58% post-CG; P<.001) and 537 improvement among D/Es (11% pre-CG vs. 47% post-CG; P=.003)

  • Insomnia treatment: 56% absolute improvement among PCPs (10% pre-CG vs. 66% post-CG; P<.001) and 42% improvement among D/Es (11% pre-CG vs. 53% post-CG; P<.001)

  • Intensification of T2D treatment: 36% absolute improvement among PCPs (28% pre-CG vs. 64% post-CG; P<.001) and 35% improvement among D/Es (29% pre-CG vs. 65% post-CG; P=.013)

This study demonstrates that VPS that immerses and engages the clinical learners in an authentic and practical learning experience can improve evidence-based clinical decisions related to the management of T2D.


A. Larkin: None. K.L. Hanley: None. M. Warters: None. G.S. Littman: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at