Diabetes Education Not "A One-Shot Deal"

Former medical students Leslie Johnson (left) and Mary Busowski (center) learn about blood glucose monitoring from diabetes educator Elizabeth Todd Heckel (right).

Dr. Sharm Steadman cannot emphasize the point enough: A diagnosis of diabetes is a life-changing pronouncement for patients, who must learn a new and lifelong regimen of self-care and regular medical attention. “My goal is getting the students to realize that it’s not a one-shot deal, that all the information given at the time of the initial diagnosis is seldom heard or retained,” said the pharmacist and professor in the Department of Family and Preventive Medicine.

A component of their eight-week Family Medicine clerkship, third-year medical students attend a three-hour experiential workshop on diabetes management. The interactive seminar is taught by a multidisciplinary team including a family physician, clinical pharmacist, registered dietitian, nurse practitioner, and certified diabetes educator. Students are introduced to the value of a team approach to treatment. “The physician can come up with a medical plan, but the management of diabetes requires ongoing education and participation and buy-in from the patient. The physician doesn’t have the time or expertise to do it all with the patient,” said Dr. Steadman.

By taking diabetes care out of the textbook and literally into their own hands, students gain insight into what it’s like to live with diabetes on a daily basis. Through four hands-on learning stations they learn about nutrition, foot care, blood glucose monitoring, and insulin administration. Reluctance to perform finger sticks on themselves is not uncommon among the medical students. “It is very much an eye-opener, particularly when we talk about how frequently patients have to check their blood sugar,” said Dr. Steadman. She added, “We want the students to understand how important it is that patients do monitoring. Otherwise we are really guessing on how to put patients’ therapy together.”

As at each of the other stations, instruction about foot care is accompanied by an immediate practical application. Socks and shoes are removed as the students practice doing monofilament tests on each other to assess for neuropathy. “We reinforce that a foot exam should be part of every single visit when treating a patient with diabetes,” Dr. Steadman said. During the course of the three hours, students are also educated on the economics of diabetes care. “They have no concept of how much the test strips and insulin cost, and are always shocked by that,” said Dr. Steadman.

Over the last three years since the workshop has been introduced, student feedback has been overwhelmingly positive and they appreciate the opportunity to take an active role in the learning process. “They gain a greater awareness of all the different pieces that need to fall into place for patients with diabetes to reach their control goals,” said Dr. Steadman. “The medical students also gain a better understanding of how patients feel when they have been told they have diabetes,” she said.

Reprinted from Connections newsletter, September 2003

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