Purpose: Assess if simulation-based online education improves performance of cardiologists (C), diabetologists/endocrinologists (D/E) and primary care physicians (PCP) in managing patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk with chronic kidney disease (CKD).

Methods: Two patient cases were presented in an immersive, virtual patient simulation (VPS) platform designed to replicate the real-life decision-making process allowing learners to order lab tests, assess patients, make diagnoses, and prescribe treatments. Tailored clinical guidance (CG) was provided for each clinical decision (CD) so learners could modify their CDs and indicate their rationale. Physicians who fully completed each case were evaluated. Each learner’s pre-/post CDs were analyzed using a paired t-test. The activity posted on 1/31/2019; data were collected through 10/1/2019.

Results: Upon completion of this educational activity C (n=296/154, cases 1 and 2), D/E (236/128) and PCP (228/157) demonstrated improved performance in making appropriate, evidence-based CDs (all p<0.05) with respect to • Ordering a suitable diagnostic workup to establish elevated reno-vascular risks resulting in a significantly higher proportion of correct diagnoses of CKD and hypertension • Tailoring a comprehensive risk management plan including increased patient education, weight management, foot examination and SGLT2 inhibitor or GLP-1 receptor agonist Rx. Predominant reasons for selecting an SGLT2i • Proven CV risk reduction • Recommended by guidelines. Main reasons for not choosing an SGLT2i • Economic considerations • Unfamiliarity with use.

Conclusion: Immersive VPS-based education improves evidence-based CDs related to the crucial aspects of managing T2D in patients at high CV risk with CKD. Collection of learners’ decision-making rationale data provides insight into the decision-making process of physicians in actual clinical practice.


J. Trier: Consultant; Self; WebMD LLC. D. Gunesekera: None.


Boehringer Ingelheim Global; Eli Lilly Global

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